White Coat, Black Art

Make Both Palliative Care & Assisted Suicide Priorities

Next month, the Supreme Court of Canada will hear arguments on whether terminally ill Canadians have the right to assisted suicide. A 2013 Forum Research poll found sixty-five percent of Canadians support doctor-assisted death. But earlier this month, federal Health Minister Rona Ambrose told CBC News that better access to palliative or end of life care should take priority over assisted suicide.  I disagree....
  Next month, the  Supreme Court of Canada will hear arguments on whether terminally ill Canadians have the right to assisted suicide. A  2013 Forum Research poll found sixty-five percent of Canadians support doctor-assisted death. But earlier this month, federal Health Minister Rona Ambrose told  CBC News that better access to palliative or end of life care should take priority over assisted suicide.  I disagree.
  Let me start by saying while there are some pockets of Canada where palliative care is excellent, the overall lack of palliative care across the country is a huge problem.  Earlier this year, the Canadian Medical Association said seventy percent of Canadians are at some point likely to need  palliative care or symptom management at or near the end of life.  In his  Inaugural Address as CMA president in August 2014, Dr. Chris Simpson said just sixteen percent of Canadians who die this year will have access to palliative care.  An aging population means that in the years to come, even more Canadians will need end of life care.  Unless we improve access, we might end up with an even smaller percentage of Canadians who get palliative care when they need it.

  There have been recent calls for a pan-Canadian national strategy on palliative care.  Dr. Chris Simpson said the CMA is calling for a national senior health care strategy - for which palliative or end of life care would be expected to play a major part.  In her exclusive interview with the CBC's Susan Lunn, federal Health Minister Rona Ambrose said Canada has to do better when caring for people who are dying. Ambrose said she wants to make that a priority.

  Citing personal experience with family members, the minister said in Canada, "we still don't have the best elderly care and palliative care yet."  That call has not yet turned into new funding.  We've heard this before.  In 2010, a  report by then Senator Sharon Carstairs made 17 recommendations for the federal government and the provinces and territories to ensure quality palliative care for those who will need it.  So far, that hasn't happened. 

  That the health minister is calling for better access to palliative care before talking about assisted suicide and euthanasia is worth discussing. First, you can't argue that better palliative care is a priority.  Second, the statistics support putting palliative ahead of assisted suicide.  Far more Canadians will need palliative care than doctor-assisted death. 

  But there may be political reasons for saying what she said. The federal government is not a strong supporter of assisted suicide.  Putting palliative care ahead on the priority list means years of delay until assisted suicide gets to the top of the agenda. 

  Not every member of the federal government sees things that way.  In March 2014, Conservative MP Steven Fletcher introduced  two private members bills - one of which sets up the conditions for assisted suicide.  It's unlikely the bills would make it to the floor of the House of Commons, which is why he has introduced the bills in the Senate in the hopes they can be passed there and sent back to the House with a better chance of success. 

  So, what is the connection between access to palliative care and assisted suicide?  Palliative care doctors and other supporters argue that a lack of services is one of the key reasons why two thirds of Canadians support assisted suicide. They believe Canadians want assisted suicide because they fear dying with unrelieved pain.  By that argument, fix the gaps in palliative care services in Canada and support for assisted suicide will go down.  While that is undoubtedly part of the reason why support for assisted suicide is that high, it's not the only reason. 

  A smaller number of Canadians have Huntington's, ALS or Lou Gehrig's disease and severe MS. They aren't in pain. They wish to die before they become a burden on others and before they need to be on a ventilator.  People like  Nagui Morcos, who I spoke with on White Coat, Black Art. He was steadfast in his desire to take his own life, which he did in 2012.

  I'm glad for the calls for more palliative care but let's hold the applause until see we see it.  And let's be clear about one thing.  Boosting palliative care will not in my opinion lower support for assisted suicide.  And even if it did, there is no way the provinces will be able to improve services fast enough to change the minds of people who support doctor-assisted death.  That plus the fact that several states in the US and now the province of Quebec have passed laws allowing assisted suicide make it even harder to stop

  Instead of palliative care or assisted suicide, why not have both?

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