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 →
Interview with Dr. Camilla Zimmermann, head of the palliative care program at UHN in Toronto, associate professor and Rose family Chair in the Department of Medicine at the University of Toronto, as well as senior scientist at Princess Margaret Cancer Centre.
In a research article (open access) she co-authored, Dr. Zimmermann conducted interviews with patients and their caregivers in an effort to understand attitude and perceptions about palliative care. Early palliative care improves quality of life, symptom management and satisfaction with care in patients with advanced cancer. However, stigma associated with the term palliative care may be a barrier to timely referral.
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 →
Professor Scott A Murray is the St Columba’s Hospice Chair of Primary Palliative Care Research Group at The University of Edinburgh in Scotland, UK
We live in exciting times for palliative care in general and for palliative care in primary care and family medicine in particular. The World Health Assembly (WHO's resolution-making body) in May 2014 passed its first ever resolution about palliative care. It called for palliative care to be integrated into health care in all settings, especially in the community, and countries will be answerable to this resolution in May20161.
Sébastien Moine est médecin généraliste en Saint Just en Chaussée, France, et doctorant en santé publique (Université Paris 13) | Sébastien Moine is a GP in Saint Just en Chaussée, France and a PhD candidate in public health (Université Paris 13)
[English version follows below]
« Nous sommes très heureux que vous veniez travailler avec nous ! C’est vrai, nous avons peu de médecins généralistes dans notre hôpital. Il est toujours bon de développer de nouvelles relations. » Je ne sais pas pourquoi, mais je sens qu’elle va rajouter quelque chose. J’acquiesce avec un sourire, sans dire un mot. C’est mon dernier entretien d’embauche avec la directrice adjointe des affaires médicales. ...continue reading →
Anthony J. Caprio, MD, CMD serves as the medical director and an Associate Professor for the Division of Aging, in the Department of Family Medicine for the Carolinas Healthcare System, Charlotte, North Carolina
The release of the IOM report was regarded by many U.S. healthcare professionals as a significant step forward in identifying gaps in the delivery of care for seriously ill and terminally ill patients. Specific recommendations were outlined as a “call to action” to improve end-of-life care. Hospice and palliative care physicians, in particular, rallied behind the report. ...continue reading →
Mr. Jones, aged 88, was referred to the hospital for the fourth time that year with dyspnoea. He was diagnosed with pneumonia. His medical history mentioned myocardial infarction, chronic heart failure, and a pacemaker. Two years earlier he had made a written will with a non-resuscitation and non-intensive care statement. The next day he became progressively dyspnoeic and developed kidney failure. He was transferred to the ICU ...continue reading →
Geoffrey Mitchell is Professorof General Practice and Palliative care at the University of Queensland in Brisbane, Australia
The developed world is experiencing a dramatic shift in its demographics, with rapidly increasing proportions of older people. By 2050, many countries will have over 30% of their citizens aged 60 or over. With this comes a quantum increase in the proportion of people with chronic and complex diseases, and of deaths. Most people who die are old. Most people will die of conditions with a period where death can be anticipated, rather than by a sudden event. Dying over time also brings complex psychosocial and spiritual needs – as Samuel Johnson once said – impending death concentrates the mind wonderfully! ...continue reading →
James Downar is a Critical Care and Palliative Care physician with a Master’s degree in Bioethics. He is an Assistant Professor in the Department of Medicine at the University of Toronto, and co-chair of the Physicians’ Advisory Council for Dying with Dignity Canada, a group that advocates for the legalization of Physician-Assisted Death.
Physician-Assisted Death (PAD) is a controversial subject in Canada, but it shouldn’t be. The latest polls show that Canadians support PAD almost as much as they support sunlight and clean drinking water. PAD is now legal in many jurisdictions, and we have a large body of evidence to address fears about slippery slopes. When PAD was legalized in Europe, it did not become the default option for dying patients; it generally remained stable while Palliative Care grew dramatically. According to the Economist, the 5 countries that have legalized PAD are world leaders in the “Basic end-of-life healthcare environment”, while Canada sits in the middle of the pack. According to the Center to Advance Palliative Care, all three US states that have legalized PAD by statute rank in the top 8 for availability of palliative care services in hospitals. The vulnerable do not appear to be pressured into accepting PAD - on the contrary, the patients who receive PAD appear to be disproportionately wealthy, educated, and well-supported by family members and health insurance. I would almost call them “privileged”, but then I remember that they were suffering enough that they chose to end their lives.
I don’t support death. I enjoy my life, and I work very hard as a Critical Care physician to keep patients alive when I can. But I accept that there are times when I can’t. And there are times when I can keep people alive, but not in a state that they would value. ...continue reading →