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Palliative care is not always the final answer
by Tom Harpur
Toronto Author / Broadcaster
In her fine book, A Gentle Death, Marilynne Seguin, R.N., talks about some doctors who seem to believe that the initials M.D. after their name stand for "Medical Deity." She is not more anti-doctor than you or I. She is simply drawing attention to the fact that some doctors like to project an aura of infallibility.
They like control. They don't like anyone, least of all a layman, suggesting that they can't control all pain or that they may not always be acting in the best interests of dying patients. I have heard from a number of physicians of this mould lately in response to columns in which I argued for a change in the criminal code to permit doctor-assisted dying under certain stringent conditions. Their differing opinions have been welcome. But, I must say the tone has often been both defensive and offensive. The most arrogant of all seem to come from the school of thought that believes the best in palliative care would render the entire debate over euthanasia and assisted death unncecessary. If you're looking for a simple answer to the ethical dilemnas surrounding dying, they've got it. Palliative care means doing everything possible to look after the dying patient's quality of life, physically, spiritually and mentally until the end is reached. Efforts to cure are stopped and, accepting that death is inevitable, the focus is to make dying a comfortable and meaninful experience. I'm strongly in favour of the aims and the philosophy of the palliative care movement, for those who desire it and for those to whom it is available. I have great admiration for both professionals and volunteers who engage in this kind of work. But, it's far from being the panacea its enthusiastic supporters maintain. This is a most crucial point. Many doctors and nurses give good palliative care without advertising it. But, palliative care, like every other aspect of medicine, has become a speciality. It's extremely costly. Consequently, it is estimated that only about five per cent of patients who need it in Canada right now can get it - even in major centres. There's absolutely no use in telling people to ignore the issue of assisted dying because nobody would ever ask for it if they had good palliative care when the latter option simply isn't there for most! Furthermore, there are still palliative care experts who are very puritanical when it comes to using the amount or kinds of drugs needed to relieve chronic pain. Their idea of what level of pain the dying patient could or should stand may not be acceptable to the patient himself. Anyway, dying in a hospice or palliative care ward, possibly drugged out of one's mind for days, weeks, or months, is not everyone's concept of a good death.
While on this topic, I was unable to accept an invitation to appear as a witness before the Special Senate Committee on Euthanasia and Assisted Dying in Ottawa recently and so sent a written brief. Here are some of the key points made in it:
* It is frequently argued by religious opponents of any change in this direction (to permit freedom of choice to people suffering from an irreversible, terminal illness) that we must preserve the sanctity of human life at all costs. I am convinced that true observance of the sanctity of human, personal life - as opposed to simple biological life - is most truly preserved when the deepest wishes of the dying person are acknowledged and honoured. Nobody should have to suffer and die according to the religious or philosophical beliefs of others, however well-meaning. The Judeo-Christian tradition gives evidence of the utmost regard for the sacredness of the individual and for his or her autonomy.
* Some religious thinkers put great store by the supposedly purifying effects of suffering. But, the mental and physical anguish of those who want to die but cannot is the very opposite of this. It's a form of cruelty to make people accept other people's assessment of how much suffering they should endure and whether or not it is ultimately "good" for them.
* One often hears the cry ... that doctors must not "play God." But, modern medicine "plays God" every moment of every day with ever intervention conceivable. We are already playing God; the question is will we be compassionate, respectful of the individual kind of God or an authoritarian "we know better than you" kind of deity. My reading of the Bible is that God's intention is that we should be "fellow-workers" with him in an adult partnership. That makes taking full responsibility for our actions and technologies and not backing off at the end to leave the terminally ill patient stuck there, helpless to act, impotent.
* Any change in the law must, however, be accompanied by the strictest possible safeguards to prevent its abuse. Any such decision on the part of a patient must be informed, competent, wholly voluntary and subject to review by responsible family members and at least one other physician.
Hunger striker says CMA stand dangerous
by St. Thomas Times-Journal Staff
A local hunger-striker who launched a petition in favour of doctor-assisted suicide says the Canadian Medical Association's stand against it could make things worse for sick people.
"It's stupid for the medical association to vote this way because people will start doing it (without a doctor)," Rhonda Clarke said.
Mrs. Clarke, who works at a downtown chip wagon, said she has been asked three times by people who want her to assist a sick person to die, but she was refused.
She said her petition asks the government to change the law so terminally ill people have the option of a doctor's assistance to end their life. She said doctors should assist with a request for death because untrained people may botch the procedure and leave the sick person worse off.
Tuesday was the 27th day of Mrs. Clarke's hunger strike to publicize her attempt to get 50,000 signatures on her petition.
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