The Commons: Death Is Natural
The Commons: Death Is Natural

The Commons: Death Is Natural

A culture of life cares for the dying.
Appears in Fall 2015 Issue: Health Beyond The Hospital
September 1 st 2015

For the first 149 years of Canada's existence, life was believed to possess an inherent dignity, and it deserved the fullest protection of the law. However, in February 2015, the Supreme Court's decision in the Carter vs. Canada case essentially struck down the provisions prohibiting assisted suicide. Although the ruling won't take full effect till 2016, choice now trumps life as Canada's political preference of, well, choice. By this time next year, Parliament must codify the principle that the choice to take one's own life is a greater good than life itself.

Politics still has work to do, naturally, in defining how broadly or narrowly the terms of that choice will be. Still, the Supreme Court has spoken, and a fundamental shift has taken place. Death is now seen as something we can—and should—control. Given that 2015 is an election year in Canada, any solution will be presented as a compromising middle ground; though it's hard to imagine there won't be alienation on either side of the unbridgeable divide between the choice for life and the choice for death.

Palliative care, unfortunately, is often the tug-of-love orphan in the life-versus-choice argument.

The paradox is that we all share in the commonality of death. While we squander days and months and years arguing over the timing and manner of death's inevitable arrival, we should be spending our energies preparing for, and ultimately accepting, the finitude of life on earth.

Despite death's inevitability, it's a curious fact that only 5 percent of Canadians have had an end-of-life conversation with their doctor. Maybe that's, at least in part, why 70 percent of seniors don't wish to have life-preserving treatments, yet 54 percent will be admitted to an intensive care unit at some point. It may also be key to the Canadian Medical Association's reminders that only 16 percent of Canadians have access to best-practice medical care.

Palliative care, unfortunately, is often the tug-of-love orphan in the life-versus-choice argument. Both sides claim to want more of it. Both use its recognized benefits to pursue very different rhetorical outcomes. Could a source of this discrepancy be the very hypermedicalized approach to dealing with end-of-life issues? I'm starting to think so.

Indeed, I'm becoming increasingly convinced that in addition to palliative care, the gamut of enmeshed family, community, and spiritual supports necessary for best-practice end-of-life care are being ignored, to the detriment of all Canadians. It's not an abstract or philosophical concern. Death not only claims us all but also touches those we love and know. That, surely, should make it a fit subject for public policy discussion well beyond the moment and the means.

At the time of the Supreme Court's decision, employment insurance benefits provided only six weeks of compassionate-care support for terminally ill family member with six months or fewer to live.

Six weeks.

Pause for a moment and think about that. You just got word that your spouse has six months to live, and as a gesture of compassion society offers you six weeks of support. So, do you take it now while you come to grips with the prognosis? During the six months when care needs will spike? At the end so you have time together? Since the decision, six weeks has been expanded to six months, which is a good start to promoting a more healthy culture of life in the face of death.

Interestingly, in 2011 an all-party Commons committee tried to start more of these discussions, publishing a 180-page report called Not to Be Forgotten: Care for Vulnerable Canadians. It is filled with practical recommendations for acting on palliative care, elder abuse, suicide prevention, and effective ways to lessen the need for assisted suicide. Sadly, like so much fine work done in Parliament, it was largely filed and forgotten.

Perhaps instead of filling the remaining months with more heat than light over life and choice, Parliament's report could act as a conversation-starter for those debating issues surrounding community care, hospice, palliative care, and bereavement support groups, as well as those in doctor's offices, where seniors and vulnerable Canadians are known to go. We will have a historic political debate over wide versus narrow lawmaking, but we can— and should—also have a mature conversation about becoming a country that prepares itself well for the end that awaits us all.

Ray Pennings
 
Ray Pennings

Ray Pennings co-founded Cardus in 2000 and currently serves as Executive Vice President, working out of the Ottawa office. Ray has a vast amount of experience in Canadian industrial relations and has been involved in public policy discussions and as a political activist at all levels of government. Ray is a respected voice in Canadian politics, contributing as a commentator, pundit and critic in many of Canada’s leading news outlets and as an advisor and strategist on political campaign teams.

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