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death & dying
As a qualified trust and estate practitioner, I often receive an increased number of calls in January from people who are either updating their wills as part of their New Year's plans, or unfortunately, experienced the loss of a friend or family member.
In any assisted-dying regime, a competent patient is free to change their mind or express their ambivalence by withdrawing a request or postponing an assisted death. To permit an assisted death to proceed on the basis of an advance directive effectively denies this protection to persons who are no longer capable of making or expressing health-care decisions.
With the advent of physician-hastened death, there has never been a more pressing moment in history demanding we get our approach to human suffering and palliative care right. Fewer than two per cent of patients will likely choose to have their lives ended; most will want to live out the length of their days in care and comfort. That should not be asking too much. One thing is for certain: the dying are too ill to speak, and the dead will never complain.
Despite recent headlines, Canadian rates of suicide and attempted suicide have remained largely unchanged over the last several decades. What has changed is that we've seen increasing rates of suicide in the Canadian military recently, after stable rates for decades. The problem of suicide is not limited to the military in Canada; indigenous populations, especially in northern remote communities, have high rates of suicide. We need a unified approach across provincial and federal sectors to reduce suicides in the military, among veterans and civilians.
Using non-beneficial medications or failing to offer comfort medications to chronically ill patients is potentially harmful, time-consuming and simply bad medical care. Unnecessary or unwarranted medical interventions, including medications, are also costly to the healthcare system. It's time to embrace new ways of thinking.
For 70 to 80 per cent of Canadians, palliative care is not available and hence, not a real choice. A dear friend of mine recently died of brain cancer. She spent her final months in hospice, where she received exquisite end-of-life care. How might this kind of scenario play itself out in the many Canadian settings that do not have adequate palliative care?
The need for people also to make advance directives (often called living wills) and to discuss them with family is greater than ever as medical technology advances, but there is a serious legal problem. You may have an advance directive signed in perfect health clearly stating your wishes, but if and when you become incompetent, current law in some provinces permits your next of kin or power of attorney to ignore it. Surely new legislation must recognize and prevent this potential abuse that most people would find offensive and unacceptable.
The act of dying ultimately becomes "a 24-hour-a-day process" and patients usually need increasing levels of care as they draw closer to the end. Ideally, a multi-disciplinary team of doctors, nurses, personal-care workers and others should be involved in your care. Here is what you need to know.
If you are an animal lover and heading into your senior years chances are you have said goodbye to more than a few pet companions. One dog died in my arms from cancer, another from old age, one was killed by another dog and one died while I was on vacation. My grief for each one was no less than the grief I've felt for the passing of a beloved human.