Citing the example of a patient who was denied proper pain management because, as a smoker, his doctor deemed him “more likely to become addicted,” Dr Chochinov questions the logic of recognising the right to end one’s life, ahead of the right to seek out appropriate care to ensure that the end of one’s life is of the highest quality possible.
He says: “Despite the impressive strides that palliative care has taken in areas such as pain and symptom management, and sensitivities to the psychosocial, existential and spiritual challenges facing dying patients and their families, at their time of licensure, physicians have been taught less about pain management than those graduating from veterinary medicine. Most MDs have knowledge deficiencies that can significantly impair their ability to manage cancer pain.”
In addition, according to Dr Chochinov, inadequate training of doctors in end of life conversations, mean that goals of care are often left unclear, to the detriment of the patient and the family.
“In light of the court decision, these issues have never been more important, nor the need to resolve them more pressing,” says Dr Chochinov. In the year-long period that the court has given the Canadian Parliament to review and rewrite the criminal code, the responsibility of ending patients’ lives lies with doctors, many of whom do not have the education or experience to provide proper palliative care to these patients.
The court ruling has been defended on the grounds of providing patients with more choice but, asks Dr Chochinov, “by adding doctor assisted suicide into the mix, what options will dying patients in Canada actually have? For 70 to 80 per cent of Canadians, palliative care is not available and hence, not a real choice.”
In the future, he says, the choices may be between “settling for sub-optimal care, dislocating from friends and family to seek out better care elsewhere or considering medically hastened death.”
He concludes by noting: “We are about to become a country that extends patients the right to a hastened death but no legislative guarantees or assurances that they will be well cared for until they die… Federal and provincial governments will need to make large investments in hospice and palliative care in order to offer patients and families choices that are equitable, compassionate and real.
“The time for physicians to learn how to look after their patients until the very end, is now.”
Read the full article on The Province website.