Health and Welfare Canada defined
palliative care as: A program of active compassionate care primarily
directed towards improving the quality of life for the dying.
Health and
Welfare Canada, Palliative Care Services Guidelines,
Ottawa, 1989, Cat. No. H3932
Dame Cicely Saunders, who in the late 1960s pioneered
palliative care units, or hospices for the terminally ill in the United
Kingdom, speaks of it as, "ELC - efficient loving care." Her philosophy and
methods of care for dying patients have spread to all parts of the world.
Comfort and Dignity: Care of the
Terminally Ill in Ontario, Ontario Advisory Council on
Senior Citizens; Position Paper, June 1991
Palliative care began in Canada in 1975, when units were
opened at the St. Boniface Hospital in Winnipeg and at the Royal Victoria
Hospital in Montréal. One of the first leaders of the hospice was Dr.
Balfour Mount, of the Royal Victoria Hospital. He described the philosophy
of the movement as follows: "Several features characterize hospice care as
being distinct from traditional health care programmes. There is a concern
for the family and other loved ones as well as the patient. The fears and
doubts of all involved, the strain on relationships and financial resources,
the need for spiritual care, are all considered in addition to the more
traditional issues relating to the disease itself. There is also a
relaxation of institutional regulations concerning visitors, food, pets, and
other details of daily life. When the length of remaining life is
recognized as lying outside the influence of further treatment, the focus is
not on curing or prolonging life but on its quality each day; not on death,
but on life and on living in the moment!"
Balfour M. Mount, M.D., "Palliative
Care of the Dying," Care for the Dying and Bereaved,
ed. Ian Gentles (Toronto: Anglican Book Centre, 1982), pp.
7, 18.
Palliative care units have been established in many hospitals across Canada. Many daycare and outpatient support services have also become available for those who are able to spend their last days away from a hospital. The goal of those involved in offering palliative care is to relieve pain and thus to reduce the great fear of pain that is sometimes associated with dying. It is this fear which drives people to accept euthanasia as the only available option.
Dr. Larry Librach of the Mount Sinai Hospital palliative
care team, formulates the essence of palliative care in this way:
"Palliative are is committed to healing, and that is something different
from curing. Healing is to make a person whole, to relieve suffering and to
give the individual a sense of who he or she is as a person. Palliative
care is person-centred, not disease-centred."
"Comfort and Dignity: Care of the
Terminally Ill in Ontario," Ontario Advisory Council on
Senior Citizens, Position Paper, June 1991, p.4.
Dr. John Scott is the Director of the Regional Palliative
Care Service in Ottawa, and Head of the Palliative Medicine Program at the
University of Ottawa. He describes present day palliative care service as:
"...a philosophy and a system of care that affirms life when a person with
irreversible disease is approaching death...Palliative Care involves a shift
of treatment goals from cure and prolongation to the control of suffering.
This shift will often be reflected in the cessation of some therapies and
the initiation of new symptom directed therapies. However, Palliative Care
is not passive euthanasia. At the heart of Palliative Care is the
affirmation of life, not the choosing of death."
John Scott, M.D., Submission to the
legislative committee on Bill C203,
November 19, 1991, p.1.
In the concluding portion of his submission to the legislative committee on Bill C203, Dr. Scott said: "As we watch suffering, we too share in the lament. When death approaches, we cry out and at times even cry out for death, but we must reject the temptation to kill. Hear the cry of life at the heart of the lament. Neither physician nor legislator must presumptuously respond to the lament by silencing the one who issues the cry."
The provision of palliative care services is one means of stopping the call for legalized euthanasia. At the same time, efforts must be made by governments, and by health care workers, to inform and to educate the public about the necessity of promoting the hospice philosophy of dying. Good palliative care, in all its facets, is the alternative to euthanasia.
PAIN CONTROL
The New York State Task Force on Life and the Law emphasized the need for palliative care and pain management in its May 1994 report on euthanasia and assisted suicide. The Task Force concluded and commented as follows: "Physicians, nurses, and patients must be aware that psychological and physical dependence on pain medication are distinct phenomena. Contrary to a widely shared misunderstanding, psychological dependence on pain medication rarely occurs in terminally ill patients. While physical dependence is more common, proper adjustment of medication can minimize negative effects."
The provision of appropriate pain relief rarely poses a serious risk of respiratory depression. Moreover, the provision of pain medication is ethically and professionally acceptable even when such treatment may hasten the patient's death, if the medication is intended to alleviate pain and severe discomfort, not to cause death, and is provided in accord with accepted medical practice.
The education of health care professionals about pain relief and palliative care must be improved. Training in pain relief and palliative care should be included in the curriculum of nursing schools, medical schools, residencies and continuing education for health care professionals. Hospitals and other health care institutions should explore ways to promote effective pain relief and palliative care, and to remove existing barriers to such care.
Public education is crucial to enhance pain relief
practices. Like many health care professionals, patients and families often
have an exaggerated sense of the risks of pain medication, and are reluctant
to seek treatment for pain. Nurses and physicians should create an
atmosphere that will encourage patients to seek relief from pain.
Strategies for pain relief should also maximize patients' sense of control.
Executive Summary, When Death is
Sought: Assisted Suicide and Euthanasia in the
Medical Context, The New York Task Force on Life and the
Law, May, 1994.
Supporting References
We have daily contact with some of the most vulnerable
people in society at the hardest times of their lives and we know that many
of the problems that they suffer, they suffer as a result of poor resourcing.
If euthanasia were an alternative then the imperative to provide the
resources for these people, whether it is in the education of doctors in
pain control or provision of decent facilities for elderly people with
physical illness, would be cut at a stroke.
Royal College of Nurses, testimony to
the Select Committee on Medical Ethics,
quoted in the Report of the Select Committee on Medical
Ethics, House of Lords,
Great Britain, Session 199394, January 31, 1994, p.26.
Canadians must not believe the lie that they are faced
with a choice between a quick good death and a slow painful death.
Palliative care has demonstrated to the world that the pain and other
symptoms of advanced disease can be relieved. The methods to relieve
suffering are available now.
John M. Scott, M.D., "Cancer Pain: a
Monograph on the Management of Cancer Pain,"
Health and Welfare Canada, Ottawa, 1984 (Cat. No. H4225).
We have to make it possible for people to die well in our
hospitals. We must examine the components of a good death: having the
opportunity to be with family, to make peace, to be free of pain, perhaps
even to be released from the confines of a traditional hospital room and
routine...this has been happening for some time in palliative care, a
specialty in health care that attends exclusively to the dying.
Bridget Campion, "Taking the Final
Steps to a 'Good Death,'"
The Globe and Mail, Nov. 19, 1993.
It is not immoral to relieve the pain of the terminally
ill even if the methods used unintentionally hasten death. Deliberately
causing death, on the other hand, is gravely wrong and can never be
tolerated in a civilized society.
Vancouver Archbishop Adam Exner, News
Release, "Response to the Attorney General's
Policy Guidelines on Active Euthanasia and Assisted
Suicide," November 4, 1993.