How do you want your life to end?
It’s a weighty question, but one that we all should answer sooner rather than later. That was the primary take-away message from a panel discussion on end-of-life care at the Yukon Arts Centre on Wednesday night.
Hosted by Maclean’s magazine Ottawa bureau chief John Geddes, the panel included Dr. Jeff Blackmer, the Canadian Medical Association’s director of medical ethics, as well as Yukon’s Dr. Danusia Kanaschowski, a palliative care physician and Wenda Bradly, a family caregiver.
The discussion ranged widely between people’s thoughts on palliative care up to the ethics of doctor-assisted suicide and euthanasia.
The panel began by explaining the difference between taking someone off life support, doctor-assisted suicide and euthanasia. Many people, Dr. Blackmer said, eventually make the decision to go off life support.
Regardless of what you call it, it’s a difficult topic to talk about, he said.
“If you ever hear a politician talking about this, they will say that it’s really important and we need to have that discussion … and so we’ve been waiting, and waiting, and they don’t do anything about it because the next election cycle comes along, or whatever,” Blackmer said.
“The CMA finally got fed up with waiting. We said, clearly the politicians aren’t going to do this so we need to take the lead … that’s why we’re out here,” he said. The information gathered from this and four more talks across the country will help guide the CMA in creating its own end-of-life policies for its doctors.
“Death is the only disease that we know for sure will affect all of us and we’re not funding it properly. If we all knew we were going to get diabetes, there would be a run on insulin,” he said.
While discussing euthanasia elicited the most emotional responses, the conversation also focused heavily on the need to adjust the way our society sees death.
One woman suggested including end-of-life experts as staples of the medical system.
“We have health-care specialists. Maybe we also need death-care specialists,” she said.
Dr. Kanaschowski explained that the Yukon already has legislation covering how patients can express their end-of-life wishes.
“We have the legislation, we have the papers,” she said. What is needed is a better understanding of how to use it, and a willingness for families to have the difficult discussions before it’s too late.
Patients need to fill out their advanced-care directives, which tell doctors how they want to be treated if they’re unable to communicate, and discuss those wishes with their families, Kanaschowski said.
One woman raised the concern that filling out the paperwork might mean that she’s eventually pressured into accepting palliative care over acute treatment.
“At the end, I want to fight to live. I’m afraid of signing those papers,” she said.
But highlighting the diverse views, another speaker said putting his end-of-life wishes down on paper was a “liberating experience.”
The audience was full of registered nurses, many of whom offered their thoughts and support for better palliative care, but hardly any doctors spoke from the crowd.
And the common message from the territory’s nurses? The Yukon needs a dedicated facility for palliative care because the hospital isn’t suited for it.
“The maternity ward rooms can accommodate an entire family, because it’s a family event,” but the hospital’s palliative care rooms don’t, said one nurse.
City councillor Dave Stockdale knows exactly what he wants at the end of his life.
“I’d like to be pain free. Secondly, I’d like a TV in my room, and access to cable and movie channels, especially sports,” he said, earning a round of laughter from the crowd.
On a more serious note, however, Stockdale spoke about how important it is to have social supports as well as medical ones for people who are reaching the end of the line.
“I’d really like someone to talk to. I just came out of a rehabilitation centre, and one of the highlights of that centre was, when we weren’t all fed in our rooms, we all had a room where we could go to eat together. It was a social occasion,” he said.
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