Marianne Dees is a family physician and academic researcher at Radboud University Medical Centre in the Netherlands
Let's take a look at appropriate end of life care.
The case of Mr. Jones
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 Professor of 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