In an era of assisted death, we need to strengthen palliative care

Terminally-ill patients must know there are more options, Dylan McGuinty writes

The new reality in which we are living reminds me of the following tale.

There once was a frail elderly man who lived with his son, daughter-in-law and four-yearold grandson.

One day, the son became impatient with his elderly father, because, in his old age, he caused a mess at every meal. So every night, the son made his father sit alone in a room with a wooden bowl to eat by himself, so that the rest of the family would not be bothered.

One day, the son came home from the fields to find his fouryear-old son sitting on the kitchen floor playing with scraps of wood.

“What are you doing?” asked the father, sweetly.

Just as sweetly, the boy replied, “I am making a wooden bowl that you can use when I grow up.”

This powerful story makes me think of how we are treating elders and vulnerable people who are dying today. In particular, it makes me think of the woeful lack of palliative care in Canada.

According to the Canadian Hospice Palliative Care Association, 70 to 84 per cent of Canadians die without access to or do not receive palliative care and end-of-life care services.

Based on recent news reports, there is a strong, arguable case that, only two years after federal assisted-dying legislation was passed, the lack of palliative care is influencing people to choose assisted death when they would have chosen palliative care had it been available.

If we allow the most vulnerable among us to choose assisted death because they lack palliative care, what kind of society will we have built?

What kind of people will our children say we were?

Of those who have already died by assisted death, did they opt for assisted death to relieve them of the shame they felt at seeing themselves as a burden to others (i.e., “shame relief ”)?

This information should be publicly available; otherwise, how will we ever know if the absence of palliative care was an overriding and undue influence?

We need to give people the option of strong palliative care so that they can choose to live until their last dying breath, instead of taking their last dying breath while living. Caregivers are access to life. If we provide access to death, the least we can do is to provide access to life through adequate end-of-life care.

Palliative care sees a natural death as a beautiful moment on the journey of one’s life, as a time to say farewell; as a journey toward the sublimation of the body into the rest of creation, and the advancement of the spirit toward the higher powers that we often feel throughout our lives.

It treats life as a journey that we co-pilot with those greater forces. It recognizes our smallness in the face of an awe-inspiring God, who alone decides our final destination and when the flight takes off.

But assisted death appears to have become the more attractive option for many who are weak, marginalized, desperate, dying, lonesome, frail, elderly, and who may not be able to boldly demand the palliative-care option, but who may nevertheless prefer the journey that palliative care offers.

Who will protect these against an inauthentic and unduly influenced wish for assisted death, once the die is cast?

In the final analysis, assisted death without palliative care risks undercutting efforts to fund more and better palliative care at home and in our health-care institutions. That is because a consensus is at risk of emerging that palliative care is redundant, for so many are opting for assisted death in the absence of palliative care.

I do not want to be the boy carving a wooden bowl for my father. And I do not want my son to carve a wooden bowl for me.

Nor do I want society to carve wooden bowls for its elders and vulnerable in their time of greatest need.