Mark Miller, C.Ss.R. Ph.D.
Early in June of this year the Special Senate Committee issued its long-awaited report on euthanasia and assisted suicide. When the Report was issued there were a flurry of responses in the media—and then quiet! As often seems to happen with government reports, the sound and fury was in the process, with only a passing tribute to the results.
However, proponents of assisted suicide and even euthanasia continue their work of making one or both of these socially acceptable. Consequently, it is important to continue to educate the general public about the moral options and alternatives to killing people. A careful reading of the Senate Report reveals, I believe, several broad foundations from which to build a caring society rather than a killing one.
The strongest recommendation of the Report rightly aimed at furthering the availability of palliative care for all Canadians. Palliative care, or care appropriate to the circumstances of the dying, often finds itself pushed off into a peripheral corner of our health care system, despite the heroic efforts of many who work in palliative care. Huge resources are devoted to curing illness and researching new cures. The reality of death and the processes of dying, however, continue to be an inconvenience to the profound conviction of the power of modern medicine to cure and restore.
But where the health care system neglects the dying precisely because they cannot be ‘cured,’ then the system has become distorted and the dying—who are still very much living!—do not have access to proper and appropriate care. In particular in pain is not being adequately controlled, or if depression and discouragement take over because counseling and human contact are absent, then some people will take matters into their own hands and decide that death is better than life. Even more tragically, others will die in needless pain, isolation and anguish.
Still, palliative care (or hospice care) is not well known in all of Canada—nor always available. One physician reported to the Senate Committee that palliative care is really only available to about 5% of the Canadian population! Hence the task of ensuring good care for the dying remaining a daunting one for the Canadian health care system.
On the Prairies palliative care has been slowly growing in availability, through the efforts of many professional caregivers, numerous local volunteers, and often with the support of Catholic health institutions. Palliative care units are active in each major city. And, gradually, the concept of palliative care has been spreading into the rural areas where doctors and nurses, working with local volunteers, have built networks of good palliative care opportunities. In some rural centres, the local hospital, nursing home or health centre has at least one room which is available for a person who is dying and in need of medical attention. Place is generally kept for family to remain with the patient as well.
Even more intriguing is the effort both in rural and urban settings, to assist people to spend their last days or months at home. Doctors and nurses are available to ensure proper pain control. Social workers and pastoral care workers assist in dealing with living conditions, or facing emotional, spiritual, or psychological difficulties. Numerous volunteers help on many levels: organizational, offering respite care, sitting with the dying, and supporting families. Stories abound of the beauty of dying in the painful midst of losing a loved one, because care, love, sharing, reconciliation and time for one another are key to the palliative care process.
Nonetheless, across Canada palliative care has a long way to go before it is fully accepted by government planners. An example of how government decisions at the top can affect the reality of good palliative care, consider the following contrast. In Saskatchewan, the health care system recognizes the integral place of palliative care in proper health care both at the hospital and at home. Drug costs are covered by the insurance plan wherever palliative care is needed. In Alberta, however, only those drugs used while in the hospital are covered. Palliative care at home (with some exceptions) becomes more costly to the patient and family. Ironically, while the comfort level of the dying is often much higher at home (with proper palliative care), some families may demand a hospital palliative care bed simply because of the cost—and then the whole system must pay the much higher cost of a hospital stay!
If the recommendations of the Senate Committee regarding palliative care are not to be lost, it is important that this already-proven aspect of health care be given proper support by our governments and those responsible for health care. The dying deserve no less than this care if they are to die with the dignity that every human person deserves. Let us not allow our governments to neglect this issue. (And, finally, do you know whether palliative care is available in your health district? Maybe it is time to ask some questions, before improper care for the dying makes it an issue.)