By Letter to the Editor on March 22, 2019.
Re: Assisted dying changes unlikely before elections, tough news for dementia sufferers, March 8, 2019.
Euthanasia advocates often state that without MAiD, “we will never be able to have a good death.” This statement is frequently used as an argument that the current safeguards must be loosened so others can have “a good death.” This argument was recently put forward in the Medicine Hat News as a reason to allow advanced directives for euthanasia – specifying in one’s advanced care plan (similar to living will but for health care decisions) that they would like to be made dead at a certain point after they lose capacity to properly understand or make that decision. The Canadian Council of Academies studied the question of advanced directives in depth over the past 2.5 years and released their 244-page report last December. While there have been several high profile cases in the media pushing for advance directives, the CCA report enumerated multiple problems with that practice. My point here is not to argue advanced directives, but to explore a “good death.”
Is it really true that one can only have a good death if they have euthanasia (euphemised as MAiD)? Certainly one has control of the time and manner of death, and for some that is a critical comfort. Yet, studies have consistently shown assisted suicide or euthanasia are sought usually to help alleviate future unrealized fears – fear of suffering, fear of loss of control, fear of being a burden, fear of loss of dignity. The hope and care we offer to people with these fears should not be with a needle and syringe. It should be the hope that comes with human touch, spiritual and mental health care for existential concerns, and helping find meaning and purpose in the time remaining.
What is a good death? And does only MAiD provide it? Does that mean that everyone had a bad death prior to June 17, 2016 (the day Bill C14 was signed into law decriminalizing physician-assisted suicide and euthanasia)? Or that everyone that dies without MAiD now has a bad death? Have we been dying badly since time immemorial? Certainly people are fearful of what end of life, and particularly dementia, may bring. It has much stigma attached to it. Yet as a physician working in long term care centre where 90 per cent of residents have dementia, I have seen virtually everyone live out their lives naturally with dignity and peace. Very few pass away in pain. Family and friends have time to visit, and there is no rushed timeline.
None of the residents have ever brought up euthanasia – it’s only a few family members that ask, since it’s now legal and it’s hard to watch a loved one’s mind slow down and falter. Far from allowing a good death, MAiD for advance directives would put many at risk of premature and wrongful death. Some of these family members would push for euthanasia out of a false sense of compassion, to help ease their own suffering of watching the decline, but not their loved one’s suffering since they aren’t in distress. Alternatively, if one were to simply utter during their healthy years, “I wouldn’t want to live with dementia,” but then develop dementia later on, they are at serious risk of being taken at their previous word and given euthanasia. Indeed, this is already happening in the Netherlands, where a case report describes doctors going so far as holding a woman with dementia down to give her the fatal needle while she was kicking and screaming she wanted to live. That is not a good death.
A good death does not come from MAiD. It comes from a life well-lived, from beginning to end, and rising to the challenges that present themselves between those two goal posts. Yes, some endings are harder, more symptomatic, and I can understand the desire to skip the horrible parts. But how we face or endure those horrible parts is what truly defines us, not only as individual patients, but as communities who care and greater society at large.
Dr. Luke Savage
Three Hills, Alta.
(The writer is a rural family physician and board member of Canadian Physicians for Life.)