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Euthanasia or pain control — that is the question

October, 2010

This fall, about the time the provincial hearings on euthanasia began, I spoke with a retired neurosurgeon. I told him that 71 per cent of Quebecers supported euthanasia.

He scoffed at this revelation and insisted that most of the people in the survey didn’t know what they were talking about because their understanding of the concept of euthanasia was so confused. He said that the only way to clear up this confusion is to have crystal clear distinctions and definitions on the subject.

As a result of that conversation, I have worked out a little schema on the meaning of euthanasia. The first broad distinction is between active and passive euthanasia. Passive refers to the omission of any extraordinary means to keep the seriously ill patient alive, for example, not using heroic measures to resuscitate the person.

Many of us have left instructions to this effect in a living will. It would not, however, be appropriate to discontinue natural food or water. Neither would be considered an extraordinary means to prolong life.

I would divide active euthanasia into two categories. The first refers to the terminally ill patient arranging his or her own death. For instance, the person mixes a lethal dose of sleeping pills into a deadly cocktail and takes this potion.

The second (usually called physician-assisted suicide) occurs when the doctor inserts a drug into the patient’s body with the intention of procuring death (ostensibly because of intractable pain). It would not, however, be euthanasia were a doctor to inject accidentally a lethal dose of morphine into a patient when the doctor’s intention was to control pain, not to cause death.

There are a great many arguments for and against the practise of euthanasia. Those who oppose euthanasia argue that it constitutes a “slippery slope” leading inevitably to deaths that are neither wanted nor authorized. Evidence from Holland and Oregon, where euthanasia is legal, suggests that a worrisome number of killings are indiscriminate, wanted by neither patients nor their families.

One major reason for these unwanted deaths lies in the nature of our health system. A disproportionate amount of limited health resources are spent in the last days or weeks of a sick person’s life. Furthermore, hospital staff are often desperate to free up beds occupied by the terminally ill for younger people who still have their lives before them.

Those in favour of active euthanasia often argue that it is going on willy-nilly in Canadian hospitals. Much better, they say, to have it legalized so that euthanasia can be transparent and surrounded by safeguards.

Perhaps the most popular argument for active euthanasia is the fear most of us have of relentless pain during the dying days of our lives. It is this aspect of the euthanasia debate that I should like now to focus on.

Many years ago, I interviewed Dr. Balfour Mount, considered the founder of palliative care in Canada, on the pros and cons of euthanasia. Mount said 95 per cent of pain could be controlled by the medical team. That leaves only five per cent to cope with, perhaps even less now that pain management has vastly improved.

I would argue that most people, when they think of dying, also think of the ravages of uncontrollable pain and its assault on our desire to die with dignity. The real problem is the woefully inadequate facilities for dealing with pain. I assume that the best way of dealing with severe pain is in some level of palliative care. Yet, according to a recent article in the Globe and Mail, fewer than one in three Canadians have access to specialized hospice and end-of-life care.

According to the newly created Quality of Death Index, Canada ranks ninth among 40 countries in our provision of end-of-life care. (Britain is the best place to die.) It’s true we are renowned for our technical abilities – using medication and other such techniques as music therapy to lessen pain and suffering.

There are four principal reasons for Canada’s mediocre showing on end-of-life care, the Globe article says: It is poorly co-ordinated; it is expensive (many services and drugs needed at the end of life are not covered by medicare); patient-centered care is lacking (meaning the wishes of patients are not respected enough) and there is a shortage of policy leadership.

In Canada, about 240,000 people die each year. That will increase to 300,000 by 2021 and to 432,000 by 2041. The vast majority of Canadians die in old age. Two-thirds die of chronic illnesses such as cancer, cardiovascular disease, lung disease and illness associated with dementia.

Pain control is the most important issue for most dying patients. It is urgent that Canada develop a larger palliative-care network.

Patients should be able to expect, as an integral part of their health care, effective pain management, emotional and spiritual support, and comfort and care from compassionate and skilled people committed to honouring their dignity.

This scenario has been eloquently summed up by Dame Cecily Saunders, who spear-headed the modern palliative care movement: “We will do all we can not only to help you die peacefully, but also to live until you die.”

A letter of thanks I was touched by Mr. Neil McKenty’s last article. His words were heartwarming because I have been devastated by the ugly, unkind, vilifying comments on my president (I have dual citizenship). The man has passed more legislation for the needy than any other president. — Geraldine Doucet



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