ETHICS MADE REAL

Gordon Self

August 29, 2011

In my ethics classes I often tell "the grizzly bear story," illustrating how our outlook on life can change when confronted by new information or experiences.

A hospital social worker once went hiking in the mountains with her son and sister. The son was a park ranger and knew all the backcountry trails. They decided to tackle a grueling hike but, despite being physically fit, the sisters huffed and puffed trying to keep up with the younger son.

BARELY KEEP UP

Their fatigue soon gave way to complaints, half joking about wishing they were dead rather than endure another moment on the trail. They failed to notice their trusty guide had disappeared from the path ahead of them.

They rounded the corner only to be stopped short by the son who commanded in a hushed but authoritative voice, "Be very, very still." He pointed to a grizzly bear on the ledge only several feet above them. Fortunately for the sisters (and probably the bear), they were too out of breath to scream, backing up slowly to allow the bear to move on.

Reflecting on her experience afterward, the social worker admitted how quickly her attitude on life changed. Mere moments before she jokingly longed for death, but when confronted by her mortality in the presence of a 300-kilogram bear, she realized just how much she wanted to live.

She had a renewed appreciation for the decisions her patients make despite an uncertain or poor prognosis, given the sheer strength of their will to live. Conversely, she was reminded to explore carefully with patients when they see no hope in living and are tempted to give up. Perspective, evidently, is everything.

The context in which we make decisions is equally important. Clinicians have to take heed to ensure patient decisions to forgo treatment are not masked by an underlying depression. Overwhelming grief, the fear of pain, or the loss of control may be distorting a person's outlook that can change with the benefit of counselling, proper medical management . . . and time.

While few of us will ever confront a grizzly bear on a trail, we will walk down a path in life that will bring us face to face with our mortality. We also may be privileged to accompany someone on their end-of-life journey. The context in which we face this journey will look differently to different people.

REALITY HITS

No one can know for certain how they will confront their own mortality, and we can appreciate why some people, finding no hope, or no one to help them endure their suffering, may seek to end their lives at the moment of their choosing. Even those with family and friends around them may desire suicide to spare burdening their loved ones.

In recent weeks we have heard more calls for establishing assisted suicide as a legal right in this country. If successful, the legal challenge in British Columbia will have implications for the future of our country. This case will no doubt garner national media attention, as we hear the impassioned pleas of those stricken with or caring for persons with ALS and other debilitating terminal illnesses.

This, however, is not the only perspective we need to consider. Later this fall, the parliamentary committee on palliative and compassionate care will table its report, based on the presentations by hundreds of delegates who presented before the non-partisan committee last year. Covenant Health and the Catholic Health Alliance of Canada were among those who gave testimony about the need for quality palliative care in this country.

PALLIATIVE CHOICE

We need to discern all the voices in this debate. As the public debate intensifies, we need to listen to the experience of the thousands of Canadians who benefit from quality hospice and palliative care. We also need to hear from the compassionate men and women who accompany people at the end of life, meeting their physical, emotional and spiritual needs without abandoning them.

The voice of the majority of Canadians must be heard and advocacy shifted to increasing palliative services, not legalizing approaches that risk undermining our compassionate society.

We can only imagine how we respond at the end of life. But we can be certain how to respond today to ensure all Canadians, especially the most vulnerable, are provided with the palliative services, legislative protections and authentic compassion to bear one another's suffering - as a true welcome presence on our path.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at mes@covenanthealth.ca.)