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 →
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 →
Prof Harvey MaxChochinov, OC OM MD PhD FRCP(C), is Canada Research Chair in Palliative Care; Director, Manitoba Palliative Care Research Unit; Chair, Canadian Virtual Hospice; and Distinguished Professor in the Department of Psychiatry, University of Manitoba
Prof Balfour M. Mount, OC QC MD FRCP(C), is Eric M. Flanders Professor Emeritus of Palliative Medicine, McGill University
On October 15th, the Supreme Court of Canada will hear an appeal by the BC Civil Liberties Association that could grant terminally ill Canadians the right to assisted suicide. Given that impending ruling, the recent passing of Bill 52 in Quebec (legalizing euthanasia or what is euphemistically being called Medical Aid in Dying [MAD]) and rumblings from parliament of yet another private members bill on assisted suicide, Canada is clearly at a crossroads on this issue. The Court faces a daunting task. Where rhetoric ends, the war of what the data say begins; with each side invoking elements of empirical evidence that happen to support their particular argument. Add fear of death, dread of the process of dying—and our societal aversion to discuss these issues—and one begins to appreciate what the court is up against.
First and foremost, the Court must consider how people in this country die and whether their decision will move us toward improving care for the terminally ill. Dying in Canada can be a scary prospect. According to a parliamentary report from 2000, the vast majority of Canadians of all ages do not have access to comprehensive, quality palliative care. ...continue reading →
For most Canadians, the October 14 arguments at the Supreme Court in Ottawa will be about medical “aid in dying,” what the Dutch bluntly but accurately call physician assisted or directed termination. But what is really at stake in Carter et al. versus Attorney General et al is Canadian law itself, the meaning of its guarantees, promises, and injunctions. In effect, lawyers for and against “aid in dying” are asking the Supreme Court’s justices to interpret two sections of the Canadian Charter of Rights and Freedoms.
The result will define not simply issues of “assisted dying” but the future of Canadian law and society for years to come. ...continue reading →