Departing Life

"I can simply say it isn't the intention of our government to propose this type of change to the law. I think it's important to resist the idea of giving the power to kill. I understand the reasons some might want to propose this. If there is a proposal like this in the House of Commons -- a moral question -- I would always allow my members a free vote."
Prime Minister Stephen Harper

"I don't know what I would do. I would probably feel that it would be part of my responsibility to be with the patient. But would I want to do it?"
"We have the tools that we need. We would sedate [the patient] if she was having trouble swallowing, if she was having trouble breathing -- if she had so much existential distress that she didn't want to live anymore. We have that relationship: I know what she wants."
"I know that many of my colleagues would feel that they can't do this."
"I understand that when I meet somebody they're not going to be my friend forever, that our time is going to be limited. But I enter a contract with them: 'I will help you through the dying process."
Dr. Manuel Borod, director, McGill University director of division of supportive and palliative care programs Montreal General Hospital

Dr. Manuel Borod, Director of the Division of Supportive and Palliative Care Programs at the McGill University Health Centre (MUHC) at the Montreal General Hospital in Montreal, on Wednesday November 13, 2013.

The Quebec government is preparing to pass Bill 52. This bill represents "An act respecting end-of-life care", permitting "medical aid in dying" for patients meeting these criteria:

• that they be of full (legal) age and capable of giving consent;
• that they suffer from an incurable serious illness;
• that they suffer from an advanced state of "irreversible decline in capability", and
• that they suffer from constant and unbearable physical or psychological pain "which cannot be relieved in a manner the person deems tolerable.

Section 14 of the Criminal Code of Canada states: "no person is entitled to consent to have death inflicted on him". A doctor who provides a patient on request with a lethal injection would be criminally liable as the code's section 14 deems it an offence to counsel, aid or abet anyone to commit suicide; punishable on conviction by up to 14 years' imprisonment.

Bill 52 evades breaking the law under the federal Criminal Code by declaring "medical aid in dying" - euthanasia is to be deemed by definition a medical act and as such an act directly under provincial jurisdiction. That would be one hurdle; the second is the reluctance of many doctors to be involved with euthanasia. A 2013 survey by Leger Marketing for the Quebec Medical Association found 66% in support of the concept of "medical aid in dying as appropriate end-of-life care".

Of the French- and English-speaking doctors, some 1,201 in number who responded to the survey, 41% said they would agree to aid a patient on request to achieve a quick death with eligibility criteria met. The remainder of respondents were divided on the issue: 30% would refuse, 30% were uncertain how they might respond. Dr. Borod, one of Canada's top ranking palliative care physicians is concerned that legalizing euthanasia might result in patients being helped to premature death; doctors' ability to predict survival times far from perfect.

He has had quite a bit of personal experience in his specialty of palliative care provision. He has helped two to three thousand people transit their final life journey to death. But he is well enough aware that for every request for a "hastened" death, there are at least one hundred people who prefer their life be prolonged even after medical science holds out no hope for continued survival. He has his own very intimate experience, when his mother was admitted to Montreal General where Dr. Borod practises.

She was 82, in respiratory distress following a failed heart surgery. She had been connected to a machine that fed air and oxygen to her longs. She would never again be capable of breathing on her own. "We finally all agree that she's not going to survive so we withdraw the oxygen. Three months later, my dad says to me, 'I think we killed mum when we stopped her oxygen.' I told him, 'mom was dying, we didn't want to prolong her dying', that she never would have recovered, and that in no way did we kill here. What we did was withdraw treatment."

"I do this [work with the dying and their families] and I still missed the boat a bit in trying to get him to understand what we were doing. None of this is perfect, for anybody. We don't want to suffer, or our family to suffer. We're hopeful that we'll go peacefully, but why is euthanasia the answer? I can't say that I would never -- under any circumstances -- consider hastening death. That is too extreme. But, I just don't see the need for it."

When he was himself under great stress after the profound effort he is called upon to render calm, empathetic professionalism to ease end-of-life transitions for those awaiting death his "soul dog", Roxie would climb up on the bed in their home to lie quietly beside him and rest her head on his chest. That, said Dr. Borod, "felt like a healing". After Roxie died Dr. Borod and his wife brought another golden retriever into their home and their lives.

Now, Diane Borod, Dr. Manuel Borod's wife, brings Gracie with her to the hospital once a week to visit with the palliative patients. To offer them the healing effects of an affectionate and sweet-tempered animal somehow seeming to understand the need to give her emotional attachment of tenuously-sweet relief, to them.

"I feel very strongly about not forcing treatment, about letting people die and not getting in the way. But we don't have to kill them", said Dr. Borod.