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Deacon-structing end of life issues: Palliative Care

April 17, 2016
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Last week I wrote about the law as it stands in Canada and what the changes to allow for physician assisted dying may be. Since then, the Government has tabled a bill which is now going through the proper channels on its way to approval before June 7th, 2016.
You can read the proposed bill: Bill C-14 - First Reading, April 14, 2016
Also - read the statement from Toronto's Cardinal Collins.
You can also watch all the Every Life Matters webcasts that we just finished doing in Edmonton with Archbishop Richard Smith. The series featured several wonderful speakers, including a lawyer, doctors, parents and people living with disabilities.
When we were working on Turning the Tide, almost 10 years ago now, one of the learning points for me was about palliative care. I kept hearing that what we needed was not assisted dying, but better palliative care. In fact, Turning the Tide features one of Canada’s palliative care pioneers, Jean Echlin.
But most people probably don’t know what palliative care is and many, who have heard about palliative care, are afraid of it because they think it’s for people who are dying.
One of the speakers for the Every Life Matters series was was Dr. Anna Voeuk. She is a palliative care physician. At the second session she said that we shouldn’t be asking “what’s wrong with euthanasia and assisted suicide?” as much as we should be asking, “what’s right about palliative care?” That’s what I’d like to do today.
First, some terminology and a reminder of the definitions:
Euthanasia is the intentional termination of a life of a person, by another person, in order to relieve suffering (with or without that person’s consent).
Voluntary euthanasia is euthanasia performed in accordance with the wishes of a competent individual, whether those wishes have been made known personally or through a valid, written advance directive.
Physician-assisted suicide (PAS) is intentionally killing oneself with the assistance of a medical practitioner or a person acting under the direction of a medical practitioner who provides the knowledge, means or both.
Physician Assisted Dying/Death (PAD) encompasses physician-assisted suicide and voluntary euthanasia that is performed by a medical practitioner or a person acting under the direction of a medical practitioner.
Physician Assisted Dying is also referred to as “Medical Aid in Dying” (MAD) or Medical Assistance in Dying (“MAID”).
Dr. Voeuk prefers to call it Physician Hastened Death (PHD) because the intention of these acts is to bring about death sooner than it would occur through natural causes. This is done by the administration of a lethal dose of a drug.
None of these practices, PAD, MAD, MAID or PHD are part of Palliative Care as palliative care allows for people to be comfortable as they approach death naturally.
Last week I mentioned the Carter v. Canada case. In Section I (1) of the ruling it says that a person facing the prospect of a life of unbearable, irremediable suffering “has two options: she can take her own life prematurely, often by violent or dangerous means, or she can suffer until she dies from natural causes. The choice is cruel.”
Dr. Voeuk says that there are other options. She would say and the Church would agree (and so would a Parliamentary Committee on Palliative Care) that what we need is not medically assisted dying. What we need is better care. We need better mental health resources. We need better spiritual care. We need better social supports and we need better palliative care.
According to Wikipedia, palliative care is a multidisciplinary approach to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis.
Better yet, according to the World Health Organization, Palliative Care is:
An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Palliative Care affirms life and regards dying as a normal process. It intends neither to hasten nor postpone death.
Palliative care is not:
• Hastening or prolonging death
• Focused solely on end-of-life care
• Failure/abandonment (“nothing more we can do”)
Some of you may have heard of Dame Cicely Saunders. She is known as the mother of the Modern Hospice Movement. Her approach was revolutionary because she had a total pain approach; it was holistic and team-centered.
The Canadian Society of Palliative Care Physicians has the following key messages:
1. Patients with life limiting conditions, and their families, have a right to high quality palliative care that includes impeccable pain and symptom management.
2. Palliative care does not include physician hastened death
3. Palliative care does not hasten or prolong death
4. Palliative care strives to reduce suffering, not end life
(NOTE: The word "palliative" in medicine refers to relieving pain or alleviating a problem without dealing with the underlying cause. Good end-of-life care is palliative because it doesn't seek to cure the person.)
At the end of life people may have to deal with many symptoms, conditions or concerns. These may be physical, such as pain, nausea/vomiting, diarrhea/constipation, fatigue, drowsiness, lack of appetite, breathlessness or insomnia.
They could be psychosocial such as pain, anxiety, depression, finances, family issues, fear becoming a “burden” or loss of dignity, to name a few.
They could also be existential. Some of these could be pain (distress/suffering), fear of loss of control, questions about meaning of life/death, spiritual/religious questions.
Good palliative care seeks to address all of these. That’s why you don’t just need one palliative care doctor, but rather all your doctors should have a palliative approach. This includes all of your professional healthcare team: Physicians, Nurses, Social Worker, Chaplain/Pastoral Care, Physiotherapist, Occupational Therapist, Clinical Psychologist, Psychiatrist, Clinical Pharmacist, Respiratory Therapist, Dietician/Nutritionist, Music and, Art Therapist, Recreational Therapist, chaplains and volunteers. I would say that this also includes your family members, friends and loved ones.
At the end of the last Every Life Matters sessions, Disability Rights Advocate, Mark Pickup said that if he ever gets to the point where he is so low that he is asking for death he needs his support group, his family, his community, to tell him that he is loved and valued; that his life still has purpose and meaning. He needs them to hold him and care for him and to validate him as a person. He does not need them to kill him. What he means is that he needs good palliative care.
I would add that this approach to dealing with pain is not to be reserved only to end-of-life care. We need to support all people who suffer pain whether it is physical, emotional, psychological or social.
Another of our Every Life Matters speakers was pain management specialist, Dr. Robert Hauptman. Dr. Hauptman said that in this day and age, most pain can be managed. In fact he added that in 30 years of practice, he has never seen anyone die in intolerable pain. If your pain cannot be managed what you need is another doctor, not assisted death.
One common confusion that people have with palliative care revolves around issues of withholding or withdrawal of life-prolonging treatment. Let me be clear: Palliative Care is not considered physician hastened death. And so, refusing treatment and allowing life to take its course is not assisted dying or euthanasia. Good palliative care would not simply leave that patient to be after they’ve refused treatment. That patient would still be cared for in a palliative way; which may not involve life-prolonging treatment.
Regarding someone who is on life-support; a respirator or ventilator without which that person cannot survive (normally referred to as extra-ordinary care): In essence that person is already dead. Removing the life-prolonging treatment does not kill them, because without the machine, they are not alive. [This is different than removing a feeding tube, for example from someone who is breathing on his/her own and whose heart is beating on its own. Removing this "basic care" would be starving that patient to death. That is euthanasia.]
Another question we had was regarding the refusal of resuscitation or CPR. Again, if someone needs resuscitating or CPR, they are already dead. Not “treating” them is not euthanasia.
The Catholic Church supports the palliative approach which does not hasten death through artificial means; rather, it allows for life to take its natural course and for death to occur naturally. Of course, we always seek to make the person comfortable and at peace.
When people ask for death and they say things like, “I want to end it all” what they mean is that they want the suffering and the pain to end. That is why we need to try to get at the root of the suffering and help them manage their pain. Good palliative care does this.
But good palliative care is not available everywhere in Canada. In fact, the Parliamentary Report mentioned above says that only about 30% of Canadians have access to good palliative care. Shouldn’t we be talking about improving palliative care instead of legalizing physician assisted dying?
"You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but to live until you die.”
--- Dame Cicely Saunders
As we move towards this new Canada, I invite you to watch the Every Life Matters series, presented by Archbishop Richard Smith of the Archdiocese of Edmonton. You can watch all the webcasts at www.caedm.ca and also, starting on April 23 on Salt + Light TV. You may also be interested in watching a series of interviews I did for Catholic Focus on End–of-Life Issues, which will air in May. More details on all these broadcasts as we approach those dates.
And, I can’t leave without inviting you to watch our award-winning documentary, Turning the Tide, which deals with Euthanasia and Assisted Suicide in Canada and with its study guide, is perfect for classroom or a parish study.
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Photo credit: CNS photo/Rick Musacchio, Tennessee Register.
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PedroHeadShot
Every week, Deacon Pedro takes a particular topic apart, not so much to explore or explain the subject to its fullness, but rather to provide insights that will deepen our understanding of the subject. And don’t worry, at the end of the day he always puts the pieces back together. There are no limits to deaconstructing: Write to him and ask any questions about the faith or Church teaching:pedro@saltandlighttv.org
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