Sarah Chauvin is a PGY2 Family Medicine resident at McMaster University.
Palliative care empowers and comforts individuals with life-limiting illnesses. It may be sought at any point and serves as an adjunct to other treatments provided it falls within someone’s goals of care. It is not just trendy terminology or a “feel-good” concept; it is the cornerstone of a good death.
So why, then, after weeks of advocacy, was it denied from my grandmother. Denial? Arrogance? The belief that despite multi-system organ failure at the age of 88 years old we might still be able to “fix” her? So that rather than allowing her to control her environment and provide us with the opportunity to say goodbye, she passed away alone, minutes after being offered a colonoscopy. In fact, minutes after refusing further intervention stating, “I want to go home”. Perhaps an option she never knew existed to her until that moment. ...continue reading
Cory Peel is a GP-Anesthesiologist who locums throughout British Columbia, Alberta and the Yukon
A couple of months ago I read Mike Hager’s article in the Globe and Mail about Dr. Reggler’s tribulations at St. Joseph’s Hospital in Comox, BC, and I was overcome by a realization that, despite having been a practicing Family Physician for 7 years, I had culpably little understanding of the prejudicial impact of faith-based hospitals in determining patient access to care.
The article detailed the refusal of the “Catholic hospital” in Comox to provide medical aid in dying to its patients despite having a staff physician willing and able to do so, thereby forcing them to be transferred elsewhere. That such a policy could exist stunned me. It is the work of “the bishop [a.k.a. the Diocese of Victoria] and the hospital board,” with the board’s CEO maintaining that “minimizing patient discomfort and pain is always the highest priority,” which seems to me to fly in the face of logic.
It is not, however, an isolated example. Canada contains many hospitals whose delivery of healthcare to its patients is directed by Church doctrine. ...continue reading
David Falk is a palliative care physician working in Calgary, Alberta
Recently the president of one of the Quebec medical federations published a request to the public to give the medical profession some time to accept physician assisted death (or medical assistance in dying - MAiD) “because they do not like change.” I agree and disagree with him about this. Yes, physicians are slow to change without measured assurance that the change would be beneficial to their patients, but, when it comes to the matters of the heart, these changes may not be beneficial nor become mainstream. Suppression of visceral responses does lessen with repeat exposure, just as shoplifting becomes less traumatic the more often you do it, but whether continued suppression of the heart language is good is questionable. ...continue reading
Jonathan Breslin, PhD, is an Ethicist at the Southlake Regional Health Centre and Mackenzie Health in Ontario
Following the recent passage of Canadian legislation governing assistance in dying many might ask whether the law should be amended in the future to allow for request for medical assistance in dying in advance of becoming mentally incapable of doing so. This question is most relevant to people diagnosed with conditions like Alzheimer dementia (AD). The federal government made a commitment to study advance requests prior to passing Bill C-14. There are a host of problems with advance requests for medical assistance in dying that warrant deep and thorough reflection.
At first glance the idea of allowing advance requests for medical assistance in dying seems intuitive. ...continue reading
Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy
When Canada’s Supreme Court struck down the law prohibiting the provision of assistance to someone committing suicide in February last year, I wrote a column welcoming this ruling. That led to an invitation to address the Annual Conference of the BC Palliative Care and Hospice Association in May 2015 on the topic of ‘healthy death’.
More recently, I have collaborated with Dr. Douglas McGregor, Medical Director of the Victoria Hospice, in conversations with hospice staff and volunteers from Victoria and across Vancouver Island. Our topic was physician-assisted death (PAD) and the dilemmas this poses for the people who work in hospice and palliative care.
I am very clear that a ‘healthy death’ is one that enables someone to have control over their way of death. ...continue reading
This story is about my family’s experience with PAD (Physician Assisted Dying). Our hope is that it will be of some help to others following, or contemplating following, the same path.
In the fall of 2015 my brother, Curt, age 62, was diagnosed with incurable prostate cancer. He had been overseas for a number of years and by the time he came to us he was skin and bones, couldn’t walk, suffered from hallucinations and vision issues as well as bone and joint pain. The hospital doctors got him stabilized and resolved the hallucination and visions issues but held out no hope for curing the cancer. We were very lucky to secure him a bed at a hospice facility in a state in which PAD is legal. I cannot say enough about how wonderful and supportive they were to Curt and the rest of his family and we all feel a huge debt of gratitude for their efforts. I am not naming this facility or state because, although everything they did was perfectly legal and above board, the staff expressed a desire to fly under the radar regarding their participation in the process. This position reinforces the reality that PAD is still a very controversial endeavor ...continue reading
Diane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open.
In June 1993 I attended my first international research meeting. WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) was having its annual meeting in The Hague and I had gotten funding from my fellowship program to attend.
It was all very exciting for someone new to the research world to see the hustle and bustle, and feel the energy, that accompanies such a large meeting. Even Queen Beatrix attended.
But that’s not what I remember most about the meeting. ...continue reading
Dr. Rene Leiva is an Assistant Professor with the Department of Family Medicine of the University of Ottawa. Part of his work includes in-patient Palliative Care and Care of the Elderly at Bruyere Continuing Care in Ottawa, ON
I read with interest the CMAJ Editor in Chief’s latest editorial about protecting the right of physicians to conscientiously object to being party to physician hastened death. Principled medicine has dealt with suffering since Hippocratic tenets were first formulated about 2400 years ago. It is only in the last fifty years that causing death has been construed as ‘medical treatment’ for suffering, which I firmly believe to be erroneous. I’m disturbed to see that while Quebec is leading the country on euthanasia only a fraction of its population has access to palliative care. Palliative Care has been around for close to forty years, but Quebec's new law on ‘medical aid in dying’ expects to make that option available to 100 per cent of Quebecers in a matter of months. ...continue reading
Shannon Lough is a news journalist for the CMAJ
I found out my grandpa had a stroke on Thursday night. He was doing work in the backyard where he collapsed; my nanny found him 40 minutes later and called an ambulance. Too much time had passed. This was his second stroke, the first occurred 10 years ago just moments before he was due to depart on a cruise ship to Alaska. Emergency crews attended to him right away and his recovery was almost seamless.
This time it was different. My family told me to stay put in Ottawa for the night, but in the morning my brother called and told me I should come right away. It took about four and a half hours to reach the hospital in Mississauga where my grandpa, who I affectionately named Pa as a toddler, lay with tubes and patches attached to his body. When my mum told Pa that I had arrived, he opened his steel blue eyes for a moment with a look mixed with confusion and – I hoped – even acknowledgement. Then his eyes shut, and I never saw them again.
Jamie L. Rothenburger is a veterinarian and researcher in the Department of Pathobiology at the Ontario Veterinary College in Guelph, Ontario
Editor’s note: This article was originally published on February 26, 2015, in The Western Producer.
The recent Supreme Court of Canada ruling on assisted death has opened the door for legislation and sparked dialogue about what assisted dying should look like in this country. As we grapple with these difficult questions surrounding assisted death, it may be pertinent to consult those in our society with considerable experience: veterinarians are frequently asked to euthanize their patients. ...continue reading