Canadians may be fiercely divided when it comes to physician-assisted suicide and euthanasia, but not on their desire for as painless an exit as possible. As the population greys, the gaps in the health system’s ability to deliver high-quality end-of-life care are growing more acute and more alarming.
The main fears most people have as they age focus on dying in pain, dying alone and being a burden, says Dr. Louis Hugo Francescutti, head of the Canadian Medical Association. There’s a “crying need for palliative care” that can ease these anxieties for many of the 250,000 Canadians who die every year, the CMA found after holding town hall meetings across the country on end-of-life issues. Yet barely 30 per cent of people have ready access to good care. The CMA heard “horror stories” about some who don’t.
As the Star’s Tonda MacCharles reports, at a time when the debate over euthanasia is blotting out the sun, the CMA has made a useful contribution by stepping up pressure on Ottawa and the provinces to develop a coherent national strategy to ensure that the terminally ill and dying get the best possible care.
When their time comes, people should be able to die with dignity in their family’s arms or in a caring hospice, fully medicated against psychological anguish and physical pain.
This reminder by Canada’s physicians that compassion must be a priority is a welcome one, and politically well-timed.
Just last month the House of Commons mustered a rare show of cross-party approval for a motion by New Democrat MP Charlie Angus that made the same case. The motion voiced Parliament’s support for ensuring that “all Canadians have access to high quality, home-based and hospice palliative end-of-life care,” better support for overburdened caregivers, and encouragement to discuss and plan their end-of-life care.
This is an area where Prime Minister Stephen Harper’s government could be showing more initiative. Given that the Conservatives have zero taste for legalizing physician-assisted suicide, they ought to have an interest in blunting demands for the service by helping the provinces to provide the best possible end-of-life alternatives.
Granted, health budgets are strapped. Canada already spends more than $200 billion a year on health care, roughly $6,000 per person. And there are unmet needs. But good palliative care can be a money saver. A patient who dies in hospital in an acute treatment bed costs the system twice as much. What’s needed are front-end investments to provide more home care for the terminally ill, more hospice beds and more appropriate hospital care. The need is especially acute outside major cities.
The CMA also urges Canadians to discuss end-of-life wishes with their family and to prepare directives in advance for care. That eases the pressure later on.
However Ottawa and the provinces react to this effort to nudge the issue higher up the political agenda, at root Canadians want more control over their final days and hours. And that means the debate over physician-assisted suicide and euthanasia isn’t going away.
The Harper government is reluctant to change a law that was designed to protect everyone in society, including the most vulnerable. Yet the status quo is under fire on every side.
A majority of Canadians now favour assisted suicide, surveys suggest. The Supreme Court is scheduled to hear a key case in October involving the ban on physician-assisted suicide. And Quebec has just passed a law that allows “medical aid in dying.”
Political pressure, jurisprudence and the prospect of legal anarchy may all conspire to force reluctant Ottawa lawmakers to address the issue sooner rather than later, if only to determine whether the law needs to be adapted to changing times and needs.
But come what may, Canada can do better by its aging population by delivering more accessible, higher quality end-of-life care. On that, there’s no dispute.