Dr. David Amies: No tug of war between palliative care and assisted dying

In his latest post for Dying With Dignity Canada’s blog, Dr. David Amies responds to an offensive, incendiary column written by National Post columnist Barbara Kay, in which she insults supporters of assisted dying and the thoughtful, compassionate clinicians who provide it. He also reiterates an important point that is at the heart of our work: palliative care and assisted dying are two essential options for Canadians at end of life, and the availability of one option doesn’t eliminate the need for the other. Ultimately, it’s up to each individual to decide which interventions are best for them when the time comes.

In a piece published in the National Post on March 27, columnist Barbara Kay writes that lobby groups, like Dying With Dignity Canada, are not doing enough to improve palliative care services across the country. Had she left it at that, her article would have been worthy of debate. But, she then suggests that supporters of medical assistance in dying (MAID) and palliative care professionals are engaged in some sort of ghoulish competition for ‘customers.’ With this offensive rhetoric, Ms. Kay crosses the line that divides the civil from the unacceptable.

• Read DWDC’s response to Barbara Kay’s column

Healthcare professionals, such as nurses and doctors, have patients, not customers. The word ‘patient’ comes from a Latin root meaning one who suffers. Hence, the task of those in healthcare is to relieve suffering. They employ a variety of means to achieve this end. Patients in the grips of end-stage cancer or a grave neurodegenerative disease are beset by unpleasant symptoms that can make their lives intolerable. Often their options are limited. They can choose to continue under the care of their usual healthcare team and hope for as much relief as possible. Or, they can put themselves into the hands of palliative care specialists, of whom there are far too few in Canada. While these specialists are dedicated to easing suffering brought about by terminal illnesses, they acknowledge that they do not have the answer to all the problems faced by those who are imminently dying. The third option is to apply for a medically assisted death, a procedure that is now legal in Canada. Surveys indicate that more than 75 per cent of the Canadian population approves of assisted dying.

It is hardly surprising, though, that many in the medical community are uneasy about acting deliberately to end patients’ lives, believing as they do that the task of the physician is to preserve life and not to take it. Many in the palliative care field incline to this view.

“The patient is in charge”

The remainder of the palliative care professionals and other healthcare professionals consider that, in certain well-defined circumstances, patients whose deaths are reasonably foreseeable, and who are suffering intolerably and beyond the reach of any treatment acceptable to them, should be permitted to seek relief via assisted dying. The medical team will seek to provide relief as best they can while acknowledging that their powers are limited and that one conclusion to the palliative care journey resides in a medically assisted death.

Even physicians uncomfortable with MAID may offer terminal sedation. This procedure involves administering powerful drugs that render the recipient unconscious and allows them to die sooner than perhaps they might otherwise have done but relieved from anguish during their final few days. The intention of these practitioners is to relieve symptoms and not to bring about death — a fine ethical point but a real one.

It has to be emphasized that the patient is in charge during these grave circumstances and makes a free choice about the road to be travelled. The healthcare workers looking after him or her have the task of clearly explaining the situation and outlining in an unbiased manner the available options.

Without a doubt, the primary concern of these workers is the care and treatment of their seriously ill patients. But when Ms. Kay writes that “activists for euthanasia regard activists for palliative care as rivals for the same customers,” this calls into question the integrity of healthcare professionals facing difficult ethical and practical problems. It also exposes Barbara Kay’s writing on this subject as ill-considered, hurtful and unhelpful.

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWDC’s Clinicians Advisory Council.

(Header photo credit: Robert Shields/Brooke Army Medical Center Public Affairs)