Easing our last days
The new president of the Canadian Medical Association says doctors and the public are willing to explore euthanasia, SHARON KIRKEY writes.
The incoming president of the CMA says doctors and the public are more willing to explore euthanasia.
The incoming president of the Canadian Medical Association says the time may have come for the powerful doctors’ group to revisit its stance on euthanasia.
Dr. Louis Hugo Francescutti says more doctors appear ready to have the same frank conversation many Canadians are being forced to have, as baby boomers watch their parents’ end-of-life struggles, and consider their own future.
The organization officially opposes euthanasia and doctorassisted suicide in a policy that has not been updated since 2007.
But every policy is a snapshot of the thinking of the time, says Francescutti, the Edmonton emergency physician who assumes the helm of the CMA next week at the group’s annual general council meeting in Calgary.
“What I’m sensing is that the thinking is evolving quite rapidly around this issue right now, and it may change,” he said.
Some surveys suggest that euthanasia is already being practised. For example, morphine can be administered in ever-increasing amounts to control terminal pain. Morphine depresses breathing at high doses.
“More (doctors) want to have the discussion,” Francescutti told Postmedia News. “And as more people start having the discussion, they start comparing what’s happening right now, either in their own practice or within their institutions.
“They’re starting to find that a lot of what people are discussing may be going on officially or unofficially, and they’re getting this sense of relief that finally things are out in the open and we can talk about them in a way that we can learn from each other and see what other countries have done as well.”
Euthanasia and doctor-assisted dying are among the most emotionally charged and polarizing issues today. But the issue is taking on new urgency as boomers confront their own mortality, Francescutti said. His own mother died only weeks ago at the age of 84. She died at the West Island Palliative Care Residence in Kirkland, Que., a palliative care centre “of the highest calibre I have ever seen,” Francescutti said.
“If I’m going to pass away, that’s the way, other than dying in my sleep of a heart attack, that’s the way that I would like to go — being surrounded by compassionate people who understand the issues, and who really care for each individual that comes through the system.”
But, “having gone through this, all of a sudden it’s not just the discussion, but it’s the reality of most of us that have aging parents. And as we age ourselves, we’re starting
DR. DERRYCK SMITH
Past president, B.C. Medical Assoc.
to realize half our life is over,” he said.
“It’s the full spectrum of end-oflife care — it’s not just physician-assisted euthanasia,” he stressed. He said the more urgent issue is to improve the health of all Canadians “so that we can die healthier.”
But, “I think what we’re seeing is that society is saying, ‘Enough of us are going through this and we want to have a frank discussion.’ The Canadian Medical Association is not shying away from this issue,” he said.
‘Are we going to allow patients the privilege of deciding when they want to die, if they want to die and how they’re going to die, particularly if they’re faced with a terminal illness?’
“But at the end of the day, society is going to lead the way. It’s not going to be physicians.”
The doctors’ annual meeting, which has been dubbed the “parliament of Canadian medicine,” will hear from an expert panel Monday that was struck to explore a full spectrum of end-of-life issues, including palliative care and “advance directives” or living wills, as well as euthanasia and assisted suicide.
Any resolutions passed by the general council will be referred to the board of directors. “Maybe we need a one- or two-day think tank,” Francescutti said. “Maybe we need a cross-country town hall meeting on end-of-life issues, which I suspect would be very well received by the public.
“And then after an enormous amount of discussion we can come up with a new consensus document that may be the same, maybe it will change. But I think the driver is that boomers are reaching the stage where their parents are ill and dying. They’re questioning a lot of what they see and they’re not quite satisfied with it.”
Some observers say that the group is likely to be strongly divided, and that the CMA rarely takes a leadership role on issues as controversial as doctor-hastened death.
The issue is as divisive as abortion was decades ago, said Dr. Derryck Smith, a Vancouver psychiatrist and past president of the BC Medical Association.
“If you look at the debate around abortion, the medical organizations were the last people to come on board and come out with policies on this,” said Smith, clinical professor emeritus in the University of British Columbia’s department of psychiatry and a member of the physicians’ advisory committee for Dying With Dignity.
“The one area in which we seem to have sacrificed patients’ autonomy is when it comes to issues of dying,” he said. He pointed to the case of Margot Bentley, an 82-yearold B.C. woman with advanced Alzheimer’s disease who is being spoon-fed in a nursing home, unable to talk or move, despite a living will clearly directing that she be allowed to die should she ever reach such a state.
“Are we going to allow patients the privilege of deciding when they want to die, if they want to die and how they’re going to die, particularly if they’re faced with a terminal illness from which they’re going to be suffering and there is no chance of recovery?” Smith said.
Canada’s criminal code currently outlaws euthanasia and doctor-assisted suicide, decreeing it a criminal offence punishable by up to 14 years in prison.
Quebec has become the first province to move to challenge the federal law against what some have called “therapeutic homicide.”
The Parti Québécois government has introduced legislation that would allow doctors to administer lethal medications to dying patients experiencing unbearable physical or psychological suffering.
“Quebec has been obviously leading the country,” Francescutti said. “But other people are now starting to say, ‘ Do we want governments to get involved? Is this something that society can direct physicians towards?’”
But he stressed that end-of-life issues extend far beyond doctorassisted dying. Too often discussions around what medical interventions people would or would not want at the end of life don’t occur until people are near death, he said, “which, in my experience, is the worst time to start talking about these things.”
Palliative, hospice and supportive care to help keep dying patients at home are “grossly, grossly underfunded” in Canada, he said. More also needs to be done to help keep people as healthy as possible “until the very last day.”
“You want someone born absolutely healthy. They remain healthy their entire lives. And then they drop dead. You don’t want people to go through what a lot of people are going through now with these chronic diseases.”
His goals as president include raising awareness around the social inequities that lead to poor health and premature death. Studies show that a minimum guaranteed income “is probably the greatest thing you can to do to improve the health of an individual,” he said. “We need to start talking about the inequities that exist our system.”
Born to parents who immigrated to Canada from northern Italy in the 1950s, Francescutti is a celebrated teacher and doctor who has devoted his career to public safety and injury prevention. He developed an award-winning multimedia injury-prevention program for teens called Heroes; he studied under world leaders in injury prevention at Johns Hopkins University in Baltimore and founded a University of Alberta studentled organization that is pushing for a total cellphone ban behind the wheel.
“Louis is a guy who is super energetic, super enthusiastic and who pours his heart into everything he does,” says outgoing CMA president Dr. Anna Reid. “He’s very passionate about a strong, universal health care system. He’s strong about the need for us to all love our job … and work hard to make our system work better.”
“I think he’ll capture the attention of many Canadians.”