Dr. Sydney G. Grant

I was asked to speak this evening for 15 min. and in that space of time I hope to impart to you all the basic elements of Palliative Care, how it is different from care directed towards cure and how it is the same. And I hope to outline how anything else; i.e., euthanasia, mercy killing and now “physician assisted death”, as it is now called is not only second best but is also morally wrong and is dishonest.

Palliative Care is care directed towards making the patient’s life as complete as possible at the end of life when there is no longer hope for cure. Patients have as their main concerns at this time of life, the fear of abandonment, the fear of pain or discomfort and the fear of a loss of dignity. It is a philosophy and a system of care that affirms life when a person with irreversible illness is approaching death. There is a shift of treatment goals from cure and prolongation to the control of suffering. Both the patient and the family are the unit of concern. This time of life can be one of great personal reflection, restitution, perhaps repentance. Old hurts and broken relationships are allowed to be healed and restored. The patient is treated wholistically by a trained team of professional care-givers and volunteers during their last days. The care is as problem-solving, committed and concerned as it would be for any other patients – those who are to be cured. Families are able to attend and care for their loved one and are allowed to resolve old hurts.

Before all of the a/m can be attained however, the patient needs to have physical symptoms treated. Nausea, pain, s.o.b and constipation are the 4 main symptoms about which we are concerned. The medical staff on a palliative care service work intensively in trying to bring comfort to the patient while the Social Worker, the OT, the PT, the Pastoral Care person, the dietitian and others also meet the patients at their point of need. Fears are lessened; no longer is abandonment a concern; expectations of a cure and a longer life are replaced by a sense of hope based on reality. And if there is a belief in a loving God and a belief that His promises are true, there can be an expectation of a journey from this life to another – far more glorious – and so wonderful that words are unable to express.

We are fortunate in this city and in the other three larger cities in this province in that we do have a palliative care service at our local hospitals and that we do have, in effect a home-care program that is second to none in Canada in the EMP. This is not so in the rest of Canada. And in this province, although EMP is available to allow patients to stay at home in their last days, there are only a few fledgling hospital-based palliative care services available in the rural parts. Part of the reason for this is the slow response on the part of our Medical schools and nursing schools to educate trainees in the elements of palliative care. And part of it is due to the lack of interest of our politicians in encouraging and assisting with the establishment of palliative care services in our smaller communities.

Some sad facts:

Between 5% - 15% of Canadians have access to palliative care services.

Canadians living in remote and rural areas or those living with disabilities have severely limited access to palliative care service.

Although most Canadians want to die at home, 75% of deaths today will take place in hospitals or long-term care facilities.

As a result of health-care restructuring across Canada, the number of institutionally based palliative care beds has been cut and care has devolved to community based agencies – yet the government funding of community-based palliative care has not increased proportionately.

It is estimated that 54 hours per week would be needed to take care of a dying loved one at home. The toll on family care-givers to do this is great. Some can do it without help; most cannot. In this province, the greatest need that we have for this to happen more often, is enough home-makers – which means adequate pay to increase their numbers.

Canada’s population is aging. Of the 248,000 Canadians who die each year, it is estimated that more than 160,000 of these require access to hospice palliative care services. Stats Canada projects that the rate of deaths in Canada will increase by 33% by 2020 to more than 330,000 deaths per year. And so we have problem. There is much advocacy work ongoing by the CHPCA to correct these deficiencies and in time some of the gaps may be filled. However, in the meantime, we have the looming prospect of a private member’s bill requesting the legalization of euthanasia being introduced in the House again – by a member of the Bloc. She introduced it before the last election but the election call cancelled any action that could be taken. Although this government will surely not advocate for euthanasia, or “Physician Assisted Death”, the possibility of a private member’s bill being introduced is very real.

And the times, they are changing. What was one time considered unethical and immoral is now being considered neither in many parts of the world. We have palliative care in this country as the answer to those with such agendas. However, we do not have enough of it. Senator Sharon Carstairs, the one champion that we did have in government who worked so hard to promote palliative care in the past three years has said, “Canada is not ready for a debate on assisted suicide or euthanasia.” She stated also, “Unless every single Canadian can be guaranteed quality end of life care in which they have a legitimate choice to make, then I would suggest that we cannot start that other debate. We aren’t there yet. We are a long way from being there”.

Those who would advocate for “physician assisted death” are on a completely different wave-length than the rest of us. These are the people who consider “individual rights” trumping “societal and community rights”. They happen to be the same folks who think that the individual rights of a woman supercedes those of her unborn child. The devastation left by their machinations does not seem to trouble them. The psychological and potential physical damage done to such women and the fact of society’s loss of adequate future population is of little concern to them. For them, the easy and convenient path out of anguish and trial, if one chooses, is quite acceptable, in spite of what it does to the moral fabric of society in general. And so they can see no problem with advocacy for euthanasia for those who are approaching death – in spite of the great good that can come about in traveling the God-given road that some of us are meant to travel in our last days. The reason that we have palliative care is to give patients comfort from physical symptoms so that they can deal with other issues – so important . Our palliative care units are designed to be interdisciplinary so that the psychological, relational, and spiritual aspects of our patient’s lives can be attended to and the time left can be spent in relating and loving and forgiving, and in making restitution – and in praying – and maybe in self-examination. To do all of this in folks who lack energy takes help from many others. To do all of this in folks who are in pain is impossible. And so we who do such work find that for those who avail themselves, the rewards are immeasurable - for the patient – for the family – and amazingly for those of us who care for them. As with the early Hospice keepers of medieval times, to serve the dieing is to be rewarded with so much personal and spiritual growth – with so much fulfillment.

Proponents of “choice” in dying exploit and foster fear of pain in order to further their drive to legalize physician assisted death. But we are not awaiting some scientific breakthrough with which to conquer pain. It is available now –and it is available without intolerable sedation and with few side-effects. It is a truism that those who are suffering medical depression are the ones most likely to ask for euthanasia. They are in the minority. And when treated competently and with proper anti-depressant medication, the desire to suicide leaves. Very few of our patients ask for help in dieing.

Care and treatment are not cheap. Caring for the elderly with dementia or other limiting diseases is expensive. And with the ever decreasing population of our countries, partially because of smaller families and other influences including abortion, the number of elderly who will need care will be ever increasing into the future. And the number of the economically productive young who would contribute to their care directly or indirectly will be ever decreasing. The utilitarian pressures on our policy makers to consider involuntary euthanasia for these who cannot speak for themselves, will increase. There will become a “duty to die” – sounds like extremism doesn’t it – but so did warnings about euthanasia in the mid “80’s when we were dealing with the abortion issue. Already, those who are disabled and who may be seen as a burden on the state, are feeling the pressures from the euthanasia lobby. The experiences of Holland and of Switzerland and of Oregon tell us that a move towards this easy acceptance of willful disobedience to God’s plan for our lives will have ramifications into the future that cannot be imagined. Already, many die in Holland every year without their consent. And again in Holland consideration of euthanasia in dieing infants and children is being entertained at this point. And the agenda of the liberal humanists and secularists continues to make front page news. Not only would they have you believe that trees and selected species and the environment are worthy of interest and activism but they would have you believe, strange as it may seem, that our unwanted unborn and our dieing are unworthy of the same. And the confusion among the laity concerning these issues continues on unabated. And with apathy and ignorance of the issues – and without a strong sense of morality and ethics based on knowledge of a loving and all-knowing God – there is a public who will make decisions based on those ideals which get the most exposure.

I appeal to you here tonight to try to turn the tide on all of this. It is important to speak out – not only for those small ones who cannot speak for themselves before birth, but for those many others with life to be lived out to the end who, because of a lack of energy caused by terminal illness, and those without full intellectual or physical capacity, cannot speak for themselves. Get informed and get involved in speaking out for them. Do not let the other side win this one. Speak up for those on the other end of life and for those without the ability – and truth be told, for us, because many of us will be there someday too. Tell them what is available now – and what can be made even more available for those not so fortunate in this province and this country. Thank you.