Why we should fund palliative care

Key is being able to die with dignity, writes Tyler Dawson.

Getting sick and dying is awful. Most of us try not to think about it, but there it is.

There’s a decent chance you and I are going to die unpleasantly, whether prematurely or at a ripe old age.

There just aren’t that many good ways to go. But there are two ways to sidestep, to some extent, this problem: palliative care and assisted suicide. The latter seems to get all the attention.

On Friday afternoon, the Supreme Court of Canada, which ruled last year that criminal prohibitions on assisted suicide are unconstitutional, said the government gets four more months (not the six they’d asked for) to come up with new laws on assisted dying.

There are a few good reasons to object to assisted suicide: mainly that it conscripts someone else into your death, and that maybe life really is sacred and we shouldn’t be ending it whenever we feel like it. Fair enough. These questions, while dismissed by proponents of assisted suicide, lead to other, maybe even more important questions about how people die without being helped along.

As assisted dying is meant to allow a dignified end on one’s own terms, palliative care eases end-of-life suffering.

Assisted dying is gutsy; it’s got to be a tough choice to make a final call that you’re ready to go.

There’s a degree of lionization here, a cultural admiration for knowing when it’s time and doing it on your own terms. But there’s a twist.

Do you think you’ll be able to do it when the time comes?

Yes doc, pass me one last cocktail to put me out of my misery.

Or, despite your suffering, do you think you’ll want to hang on for as long as physically possible? You risk not having that perfect goodbye, but by not choosing assisted suicide and instead opting for palliative care, you get to spend a little more time alive, and in less pain.

Surely, there are Canadians who will choose assisted suicide, but there are others who won’t — either because they don’t want to die yet, or because they have a philosophical objection to it.

There are no doubt other reasons as well. (I for one would opt for whatever option didn’t involve needles.)

There’s value in squeezing out the last droplets of life and trying to spend its final moments in as much comfort as possible. While we laud those who choose assisted suicide as brave, it’s hardly cowardly to instead choose hospice care. Nobody wants to die unpleasantly, so we need to be thinking more keenly about how everyone dies, not just those who will choose assisted dying.

In short, those people who choose to stick it out until the end deserve quality care, too.

Earlier this week, the Canadian Cancer Society released a report calling for reform on end of life care, pointing out major discrepancies between provinces, a lack of standard guidelines across the country and little training for doctors in palliative care.

Jane Philpott, the health minister, has said only 15 per cent of Canadians have access to high-quality palliative care.

That is, to say the least, awful. To put it another way, that’s 85 per cent of Canadians who could die without care meant to lessen suffering.

The federal government, for its part, plans to spend $3 billion on home care over the next few years, which would also fund some palliative care.

This is an undeniably good thing, not only because much of the burden of caring for terminally ill people falls to family members. Although palliative care is going to become a more acute problem, given the aging population, the Canadian Cancer Society points out that terminally ill children also deserve access. Care at home is key. More hospice beds are key. These are expensive propositions, requiring staff and equipment.

If the point of assisted suicide is to die with dignity, people ought to get to die as they see fit, even if it doesn’t mean hastening the end.

With the country finally having a discussion about death and dignity, this is a pretty good time to get moving on palliative care reform. It’s unpleasant.

But so too is dying. We should be fighting to make it less so.