End of Life

"Physicians are taught from the beginning to diagnose and treat, to diagnose and cure, to diagnose and make better, or at least control."
"The fact that you're dealing with death means that somehow you can't make the patient better, you can't control. And some people are fundamentally afraid of that."
Dr. Angela Genge, director, ALS clinic, Montreal Neurological Hospital

"We can do amazing things, and we've been surprised. We've had people walk out of here that we would never have thought would."
"But it creates this expectation that we are miracle workers. And when we can't perform miracles, it's tough."
Derek Strachan, spiritual care professional, Toronto General Hospital

"You cannot see these deaths and not be moved [resulting from aggressive end-of-life treatment, forestalling death temporarily]. They are just so unnecessary. We had every opportunity to intervene and provide these patients with better end-of-life care, and prepare their families for what was inevitable."
Dr. James Downar, critical- and palliative-care physician, University Health Network, Toronto

Dr. James Downar, a critical care and palliative care physician at Toronto General Hospital, poses for a photograph in the ICU.  Photograph by: Matthew Sherwood for Postmedia

"In a black and white world, it's easy to say you don't want those things [aggressive interventions, being kept alive with the use of machines]. But in Pat's case, nothing was black and white. It was all grey. Each morning the doctors would start their rounds with, "Today is day number 'fill in the blank'. This is Pat."
"Any death in the hospital is going to be bad, and she suffered a little at the end. There were so many doctors involved I could see that it would be easy for someone to think, well, someone else must have discussed this [end-of-life patient wishes] with the family So nobody ended up talking about it."
Ken Hillcoff, Markham Ontario

"Often I have a very long and established relationship with these patients. I will look them in the eye and tell them that, unfortunately, there isn't any other treatment I can offer, and that we're in trouble. Real trouble."
"Oftentimes patients are already there, and we're the ones struggling to catch up. I think it's just an incredibly difficult thing [doctor-patient end-of-life discussion] to do."
Dr. Heather Ross, heart transplant specialist

MP Steven Fletcher, who lives in a wheelchair after a car accident left him a quadriplegic, is leading the charge for assisted dying legislation.  Ottawa Citizen

A quadriplegic Member of Parliament in the Government of Canada is supporting two private member's bills in support of legislation that would make it legal in Canada to assist the terminally ill to put a stop to their suffering. The Supreme Court of Canada is close to ruling on the constitutional right to assisted suicide. The Province of Quebec has taken the initiative among Canadian provinces, preparing to grant terminally ill, competent adults whose suffering is "unbearable" the right to request assistance in terminating their lives.

In October of 2014 the latest poll on the subject found that three in four Canadians supported the concept of doctor-assisted suicide brought into law. Of people surveyed in the online poll 84% said they agreed that "a doctor should be able to help someone end their life if the person is a competent adult who is terminally ill, suffering unbearably and repeatedly asks for assistance to die." More men agreed with the statement than women.

Support for assisted suicide was lowest in Saskatchewan, Manitoba, Newfoundland and Labrador, New Brunswick and Prince Edward Island. From among those who support the right to die, 88% claimed it for patients with a "terminal illness that results in unbearable suffer", the number dropping to 86% favouring the right for patients with a "serious incurable illness or condition, with an advanced state of weakened capacity that is permanent, incurable, and results in unbearable suffering."

The debate is a lively one, with those opposed warning that should such a law come into effect, it would result in a slippery slope where that right would be given to those who are depressed, to young people dissatisfied with their lives, even to children. But the movement seems unstoppable now, and the right to euthanasia may soon become law in the land. The governing Conservatives for the most part, are resistant but the opposition parties are open to such a law.

Last August the new president of the Canadian Medical Association, Dr. Chris Simpson, stated an open position on euthanasia. Palliative care should remain a priority, said Dr. Simpson, chief of cardiology at Queen's University in Kingston, Ontario. But in the instances of deep suffering, that even the most ideal end-of-life care will not alleviate such as with Lou Gehrig's disease and some cancers, "Those are some examples of things where, we would all agree if we were in that situation we would be looking for potentially other solutions."


Another solution would have been just the right ticket for Mr. Hillcoff's wife Pat. Who at age 57 was diagnosed with pulmonary fibrosis, requiring a double lung transplant to save her life. After the eight-hour operation she spent the following half year in intensive care, her immune system fighting the new implanted organs. Infections abounded, requiring that her chest be kept open for four months to treat the infected chest wound.

She did eventually rally, and then her kidneys shut down after which four afternoons weekly she had to go on dialysis. She spent 300 days in intensive care. She was eventually discharged, lived for another two years on dialysis administered at home until she was diagnosed with breast cancer and was informed that in her condition she would not survive surgery. Radiation was offered. She developed an overwhelming infection, spending her final six weeks of life in hospital, dying before her husband reached her side.

Statistics inform that though most people think of dying at home, amidst loved ones, the reality is that 70% of Canadians die in a hospital, with ten to fifteen percent admitted to an intensive care unit. With no written statements regarding life-prolonging treatments and fewer than half of people designating a substitute decision-maker should they become incapacitated, the situation becomes one where neither the patient, the family nor the medical staff have clear ideas of how to proceed.

In Canada today, a gentle exit to life resulting from quality end-of-life care is a "crapshoot" according to Harvey Max Chochinov, professor of psychiatry at the University of Manitoba. "Is it any wonder that people are so afraid [of death]?"