Killing must not be part of palliative care

Thursday, March 28th, 2019

Physician-assisted death includes both physician-assisted suicide and voluntary euthanasia.

The court and society have thrust assisted-death squarely into the laps of physicians and we are now left grappling with what this will look like.

My perspective as a palliative care physician on living and dying has been shaped by the thousands of patients and families I have had the privilege of walking alongside as they face suffering in the context of a life-threatening illness.

It is from this vantage point that I can say with resounding confidence that physician-assisted death is not palliative care and should have no home within a palliative care service.

And I am not alone in this perspective.

In a recent poll by the Canadian Society of Palliative Care Physicians, 74 per cent of members felt that euthanasia and physician-assisted suicide should not be provided by palliative care services or palliative care physicians.

The World Health Organization’s definition of palliative care states:

“Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

Palliative care also “… affirms life and regards dying as a normal process; and intends neither to hasten or postpone death.”

By definition, palliative care does not hasten death, and while dying is a normal life process, killing is not. Let’s not kid ourselves or cloak reality with soft words — physician-assisted death is killing.

Dying is hard work for everyone involved: the patient, family and care providers.

It is innately an existential matter and asks us what life is all about.

Dying is a normal process and final growth stage of life.

Like birth, it is an important developmental stage in the lives of humans, but unlike birth, one that we seldom talk about as a society.

As a palliative care physician, I do not hasten death, but approach dying as a normal and important stage of life. Killing is not and must not be part of palliative care.

Those of us privileged to work with and journey alongside the dying and their families will tell you that dying can be transformative — relationships can be healed and past hurts reconciled.

Requests for hastened death are predominately related to existential suffering and do not correlate with physical symptoms such as pain. These existential concerns are typically due to loss of control, loss of hope, loss of meaning in one’s life, or a sense of burden to others.

Thanks to the great work of Canadian palliative care physicians such as Balfour Mount and Harvey Chochinov, we have developed holistic dignity-conserving palliative care interventions that aim to restore purpose, meaning and hope in the face of loss that accompanies a life-threatening illness.

These therapies help a person focus on living while dying.

The foundations of our work in palliative care are trust and relationship.

Trust between patient and physician, family and care providers and between members of the health-care team. Is trust really engendered when we reach out with one hand inviting patients to engage in the hard and intense work of addressing their suffering, while in the other hand, we hold the needle to end their lives?

Suffering is not limited only to the individual.

Individuals are inevitably part of a community – family, friends and care providers, to name a few.

Individual choices affect us all. Continue reading

Leonie Herx is the Head of the Division of Palliative Medicine and Associate Professor in the Department of Medicine, Queen’s University. She holds the W. Ford Connell Chair in Palliative Medicine.