bulletCanada must help dying to go with dignity
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bulletCanada must help dying to go with dignity

Doctor says euthanasia cannot be morally addressed until help is available to all ~ Canada must dramatically improve its palliative care system for dying patients if it is to succeed as this country's alternative to euthanasia and assisted suicide ...

Canada must help dying to go with dignity By Mark Kennedy Southam News

OTTAWA - Canada must dramatically improve its palliative care system for dying patients if it is to succeed as this country's alternative to euthanasia and assisted suicide, says a report by a leading member of the medical profession. The article, published in this month's journal of the Royal College of Physicians and Surgeons of Canada, is written by Dr. Balfour Mount, the 61-year-old Montreal physician who has been dubbed the "father of palliative care" in Canada. Dr. Mount's article also closely examines Holland's plan to decriminalize euthanasia and assisted suicide by establishing a framework of rules that must be followed by doctors. He concludes the plan's supposed safeguards to prevent abuse aren't as solid as many might believe.

"The Dutch choice of implementing euthanasia before palliative care was pragmatic and perhaps born out of cultural and historic factors," Dr. Mount writes. He notes the Netherlands -- where euthanasia has been practiced illegally for years -- is also improving its palliative care system to minimize patients' pain and provide dignified end-of-life treatment. That means dying patients will be able to choose between euthanasia and palliative care.

"In Canada, however, where palliative care is available to five per cent of the dying, we have chosen neither. On the one hand, our courts voted against euthanasia by the narrowest of margins, while on the other hand, our governments have failed to give adequate support to palliative care."

Unless the problem is remedied by governments the "appeal of EAS (euthanasia and assisted suicide) as a compassionate alternative to overcrowded clinical services, inadequate fiscal resources, and increasing family caregiver burden is unlikely to lesson," concludes Dr. Mount.

He warns people should think twice before concluding that Holland has designed the perfect system for euthanasia. Last November, the lower house of the Dutch Parliament passed a bill that set various criteria, but Dr. Mount identifies many potential loopholes, such as:- The criteria stipulate a patient's request for euthanasia must be "voluntary and well considered." However, studies show Dutch doctors already end their patients' lives without request in anywhere from 15% to 40% of cases. As well, half of all doctors in the country considered it appropriate to suggest euthanasia to their patients -- a fact which Dr. Mount says is troubling as patients might feel "obligated" to opt for assisted suicide to save the health system money;

- Patients must be in "unremitting and unbearable" pain. Dr. Mount writes the level of suffering is linked to the quality of palliative care which offers pain relief. Palliative care in the Netherlands has lagged behind that of other countries. In Holland, he writes "the cart continues to go before the horse, in that EAS have been adopted as a solution before ensuring optimal integrated whole-person care;"

- A doctor must get a second professional opinion before conducting euthanasia. Dr. Mount argues there are few doctors in the Netherlands qualified to assess whether a patient's request is voluntary and whether their pain is unbearable and hopeless.Ultimately, he suggests, the focus should be on offering Canadian patients a chance to die pain-free "before assuming that there is a need to follow Holland's course.

"Canada must no longer sit on the fence. We need decision-makers who recognize the unnecessary suffering experienced by dying Canadians, and political leaders who refuse to hide behind federal-provincial jurisdictional squabbling." In an interview, Dr. Mount said Canadians have strongly held views on either side of the emotionally-charged euthanasia debate.

"The one thing we can all agree on is that if we can treat pain, nausea and vomiting, anxiety, isolation, and marginalization, we have a moral responsibility to do it. We can't possibly morally address the need for euthanasia until we've made palliative care available to people."

Dr. Mount's complaint reflects years of frustration from the health profession, medical ethicists and patients over the unwillingness of governments to assign a high priority to palliative care. In 1995, a Senate committee issued a report urging federal and provincial governments to jointly develop national guidelines and standards for palliative treatment, improve palliative training of health-care professionals and expand research into improved pain control techniques. The committee said euthanasia should remain a criminal offence, but called on the federal government to amend the Criminal Code to clarify when it is legally acceptable to use pain-control medicines that may shorten life and when it's permissible to withhold or withdraw life-sustaining treatment.

Last year, another Senate committee held a five-year review of the upper chamber's earlier report. It found governments had virtually ignored all earlier recommendations. The committee, chaired by Sharon Carstairs, a Liberal Senator, urged governments last June to develop a five-year "national strategy" for palliative care. In January, Ms. Carstairs became government leader in the Senate and Jean Chrétien, the Prime Minster, announced last week she will assume "special responsibility" for palliative care. Ms. Carstairs has long been an ardent advocate for the cause and Mr. Chrétien said she will assist Health Minister Allan Rock on the issue. In an interview, Ms. Carstairs said she agrees with Dr. Mount's conclusions. "If we do not have quality palliative care in this country, people will be forced to make choices that don't involve palliative care." She said she'd prefer if Canada can "bypass" the debate over euthanasia by ensuring doctors are trained in pain relief.

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Conference Report go to:
Innovations in Hospice and Palliative Care
The 2nd Joint Clinical Conference and Exposition on Hospice and Palliative Care
March 23-26, 2001 Orlando, Florida
David Introcaso, PhD [Medscape Primary Care, 2001. © 2001 Medscape, Inc.]


The 2nd Joint Clinical Conference and Exposition on Hospice and Palliative Care, "Palliation and Passion in End of Life," was held in Orlando, Florida, March 23-26, 2001. The conference was jointly sponsored by the American Academy of Hospice and Palliative Medicine (AAHPM), the National Hospice and Palliative Care Organization (NHPCO),and the Hospice and Palliative Nurses Association (HPNA).

Nine pre-conference sessions focused on advanced pain management; social work practice in palliative care; innovative solutions for end-of-life care; medical director training; nursing practice review; pediatric palliative care; and skill building for volunteer managers. Seventy concurrent sessions covering psychosocial concerns and bereavement; physical and spiritual issues; and system and clinical innovations were presented during the conference. To obtain complete documentation of all the sessions presented, please contact the National Hospice and Palliative Care Organization at 703-837-1500, or visit the NHPCO Web site at (Sessions will be posted on the NHPCO
Web site after May 1, 2001.)