Improve palliative care before giving the ‘right to die’

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Pontiac Perspective  Peter J. Gauthier


Pontiac Perspective  Peter J. Gauthier

Our health care system is usually considered to consist of three types of care: acute care, chronic care, and palliative care. Acute care relates to the provision of short-term medical care for serious disease or trauma, chronic care is used to define long-term medical care (usually more than ninety days) for individuals with chronic physical or mental impairment and palliative care aims to improve the quality of life of patients and their families facing life-threatening illness.
There are pressures on all aspects of the Canadian health system, but palliative care could be considered the type of care most in need of improvement; a recent comparison of
palliative care services highlighted that Canada is well behind other countries such as Great Britain, Australia, New Zealand and Denmark in this area, which is especially disturbing as the recognition of the special services needed for palliative care was
pioneered in Canada. Prior to the 1970s, the idea of
palliative care was nonexistent. Starting in 1973,
Dr. Balfour Mount of McGill University conducted a series of studies to determine the needs of
the terminally ill. His goal was to enhance patient quality of life with special attention on the psychosocial, spiritual and existential challenges of advance illness – the “Whole
Person Care” approach. Dr. Mount’s work is the basis of international standards for palliative care.
Unfortunately, governmental cuts to medical care have resulted in a failure to build on this pioneering work in Canada. Now we have legalized doctor-assisted suicide in Quebec and an order from our Supreme Court for the federal government to enact some similar legislation. Without improvements in our palliative care systems, many patients may despair of a meaningful life and elect for this suicide option.
Any enactment and enforcement of “right-to-die” legislation must include provisions for proper and meaningful
palliative care. Proper care should affirm the meaning and significance of human life. There must be a regime that provides relief from pain and offers a support system that helps patients live as actively as possible until death. Supports to help family and loved ones coping with the stresses of caring for the patient are also needed and a full
array of therapies that can
prolong life and minimize pain must be provided.
The American general, Douglas MacArthur, once said that old soldiers do not die, they just fade away. Our present system of
palliative care treats patients with little more than the hope that they will fade away. This is not acceptable in a society
that should cherish each individual, especially those
facing end-of-life situations. Improvements to
palliative care must come before any implementation of right-to-die legislation.