ETHICS MADE REAL

Gordon Self

March 25, 2013

One of my former English literature professors used to say that you can tell a society's hangups by its swear words. If this is true, I leave it to the readers' imagination to consider where our own societal discomforts may lie.

But I think euphemisms of speech can also reveal a lack of comfort about certain realities.

Consider death. Just think about the many ways we talk around death without actually naming it. "He's gone," seems a clear enough statement. But do we mean the person went for a walk, took a trip or died? How long you might expect to wait for their return will depend on your interpretation.

Euphemisms that try to soften the reality of death for age-appropriate and other pastoral or contextual reasons are one thing, but persistently denying death altogether is another.

It would seem today we continue to deny the inescapable reality of our own mortality. I pause here to ask the reader if you have a personal directive to help guide family or other substitute decision-makers to make health care decisions on your behalf if you are no longer capable of doing so.

In fact, when was the last time you talked with others about your wishes, needs and values at the end of life? Yet, as important as this is, few risk such candid conversations.

RELUCTANT SILENCE

It is quite common for expectant parents to articulate their birth plans; identifying who they wish to be with them in the case room, discussing pain management options, clarifying who will cut the cord, and so forth. Yet, as a society we are less comfortable and proactive in speaking up about how our values can be best respected at the other edge of life.

Why would we not be as straightforward about expressing our views concerning the benefits and burdens of life-prolonging treatments if faced with a terminal illness? Or naming what is important as far as rituals and sacraments and other needs to help bring closure to our life?

Advance care discussions about our pain management needs are equally as important in preparing for a "good death" as those discussions we have about transitional labour.

It for this reason that Covenant Health's Palliative Care Institute has identified the need for public education as one of its strategic goals. One such public education initiative is the promotion of advance care planning.

It is fitting this year that the National Advance Care Planning Day falls on April 16, not long after many readers will have taken part in Holy Week liturgies. Recalling the suffering, death and resurrection of Christ certainly invites an honest reflection about our mortality.

The Speak Up campaign is an opportunity to begin or continue conversations with your loved ones about your needs, wishes and values for care at the end of life. I invite readers to go to the website to review the practical resources for initiating such conversations and documenting your wishes. (See: www.advancecareplanning.ca/about-advance-care-planning/what-is-national-advance-care-planning-day.aspx)

This can be a good opportunity to promote in parish bulletins or even to host drop-in education sessions. I urge clergy to encourage parishioners to give this due consideration. It is an investment of time that may help your caregivers later to best respect your wishes, insofar as the options you identify are clinically and ethically appropriate.

Given the unknown set of circumstances and unique trajectory of our disease pathology or just plain aging may take, it is more useful to articulate broadly what is important or valuable to you, than to state, for example, "I want everything done."

Canadians should be proud of the quality palliative and hospice care resources we have in this country, notably the clinical expertise and academic research of Covenant Health's own Palliative Care Institute.

FEAR OF DEATH

Still, our reluctance to talk about death and dying, to confront our mortality, to accept inherent limits as stewards of our lives (not creators or masters) no doubt continues to fuel public interest in assisted suicide and euthanasia. Arguably, such interest is rooted in a fear of death and need for some sense of control when all seems like it is slipping beyond us.

However, speaking up and having candid conversations about our needs, wishes and values with responsible advance care planning will best counter the potential legalization of such dubious practices. As Christ witnessed, we need to move beyond denial and euphemisms, and embrace confidently the realities of our lives, including death.

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