ETHICS MADE REAL

Gordon Self

October 28, 2013

Dr. Donald Low's posthumous plea for assisted suicide posted last month on YouTube, widely reported in the news, along with Quebec's proposed law has generated renewed debate regarding the legalization of "medical aid in dying."

It was also a focus of conversation at the recent provincial health ministers meeting in Toronto. It would appear public opinion on the subject remains divided.

The question is, for what members of the public and on whose behalf do advocates speak? Of course, every heartfelt plea of a dying person must be heard and responded to with utmost compassion and respect.

As Low challenged in his video statement, "There's a lot of opposition to (assisted suicide); there's a lot of clinicians in opposition to dying with dignity. I wish they could live in my body for 24 hours and I think they would change that opinion."

I believe Low is right that we must first walk in the shoes of those who request assistance in hastening their death. It is easy to pass sweeping judgment without understanding another person's lived experience. Until I am on my deathbed, my comments cannot ever carry the same influence and credibility as those spoken by a person facing their mortality.

Walk in a dying person's shoes during their final journey before casting judgements.

Walk in a dying person's shoes during their final journey before casting judgements.

But many other voices equally demand our attention. Other pleas spoken from the precipice between life and death could arguably garner the same YouTube and broad media exposure as this man's heartfelt testimony.

Every day on our palliative and hospice units across Covenant Health, people die with dignity, without ever being abandoned or feeling they pose a burden, nor ever requesting a clinician to hasten their death.

The literature indicates that the majority of patients and their families are satisfied with their care and that unresolved symptoms at the end of life are statistically low.

While some may entertain a desire to choose the time and means of their own death, we know preferences for treatment change over time and are directly proportional to patients' knowledge and experience. What I thought I wanted may look different from what I actually need at the end of life.

I ask those who have visited our tertiary palliative care unit at the Grey Nuns Community Hospital in Edmonton to recall your own experience. I also extend this question to patients who are on the community palliative program and who have been previously admitted to the unit for pain and symptom control.

Palliative care is not a panacea for death. Death will come for all of us, but quality palliative care that embraces care for the whole person - body, mind and spirit - can make a positive difference in how we make this journey with meaning and hope.

OTHER VOICES

We need to hear the other posthumous pleas so all may benefit from the same dignified end-of-life care as those who receive quality palliative care. Their voice also needs to be heard.

A few years ago we held a news conference at the unit in conjunction with the release of the Parliamentary Committee Report on Palliative and Compassionate Care, to which Covenant Health contributed.

During the news conference I was tempted to tell reporters to train their ears towards the patient care rooms and hallways. If they had, they would not have heard sounds of anguish or moans or abject suffering. Instead, they would have heard laughter, serene conversation, perhaps a bird chirping in its cage or someone playing a piano.

MANY SOUNDS

Volunteers would be asking people if they would like tea, clinicians would be on the phone consulting other specialists to manage their patient's care. Yes, they may have heard crying as a family gathered in vigil around the bedside, but there would also be the staff chaplain's or faith community leader's consoling voice in prayer.

Patients, those nearing the end of life, would still be very much living - going for walks in the hallway, or out on a pass to attend a family event. Yes, if you listened carefully, you would indeed hear the simple crying out that is part of being human. A cry to be recognized, to be seen, to be loved. A cry for dignity.

There are many ways in which we accompany people at the end of life that affirm a person's intrinsic and incalculable dignity without ever resorting to hastened death.

Assisted suicide and euthanasia are unnecessary and an affront to the need for a compassionate society to enshrine death with dignity for all by ensuring comprehensive palliative and end of life care.

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