In 2014, death came out of the closet.
The end-of-life conversation, which for so long was conducted in apprehensive, hushed tones, finally worked its way into the mainstream media, various legislatures and all the way up to the Supreme Court of Canada.
One of the most poignant contributions to the debate came from Gillian Bennett, an 83-year-old woman in the early stages of dementia who posted a farewell letter on her blog Dead At Noon before lying down on the beach near her home on Bowen Island, B.C., and taking a fatal dose of barbiturates.
Kim Teske, suffering from the degenerative Huntington's disease, chose a different tack, starving herself to death to protest the absurdity of Canadian laws that don't allow for assisted death. Her choice was documented in a powerful story by Sandra Martin in The Globe and Mail.
Margot Bentley, a former nurse with dementia, thought she had done everything right by stating in her will she wanted to refuse all treatment, but she is being force-fed because the courts ruled that is not a medical intervention. The family's appeal will be heard by the B.C. Court of Appeal in February.
Last week, Hamilton journalist Eric McGuinness, an outspoken right-to-die activist who suffered from terminal cancer, travelled to Zurich to end his life legally there. In an earlier essay, Mr. McGuinness said: "I want to die as easily and humanely as a loved family pet."
What all these cris de coeur have in common is a demand to have one's wishes heard at the end of life, something that is currently denied by Canadian law, which makes "assisted suicide" a crime.
As Ms. Teske said: "It's ridiculous to have a law so you can't die."
Under the Criminal Code, helping someone to die, no matter how compassionate the gesture, is a crime. But that provision is being challenged as unconstitutional and the Supreme Court will soon release its ruling in the case of Lee Carter and Gloria Taylor, two women with degenerative diseases who sought a hastened death.
Also in coming months, Quebec's Bill 52, which allows people to request assisted death from a physician if a number of strict criteria are met, will also take effect.
There is no question the public is well ahead of lawmakers in their views of assisted death, with polls showing overwhelming support for it.
But this doesn't mean Canadians will be opting for assisted death in large numbers. On the contrary – the experience of jurisdictions with right-to-die legislation shows that it remains a marginal choice. That's the key: The debate is really about choice.
The vast majority of people now die of chronic illnesses, in a fairly predictable manner. Patients with terminal illnesses know they're going to die, at least in the abstract. What they want is a more honest conversation about how their pain and suffering (and that of their loved ones) can be minimized.
Physicians, more than anyone else, recognize the limitations of medicine. This point was made eloquently by U.S. doctor Ken Murray, who wrote an essay titled How Doctors Die. The central message was that physicians reject a lot of "life-prolonging" interventions in their final days, opting instead for pain control and maximizing quality of life.
These approaches are slowly – and hopefully surely – being introduced into practice. "Do not resuscitate" orders are now being described more accurately as "Allow natural death" orders. And patients are now being given much more honest information about the benefits (or lack of benefits) of performing cardiopulmonary resuscitation on terminally ill patients.
One of the greatest benefits to come from all these high-profile stories and legal cases is that they have drawn attention to the lamentable state of palliative care in Canada. One of the most important and largely overlooked aspects of Quebec's end-of-life legislation is that it guarantees every patient access to palliative care. That in itself is a monumental change in a country where somewhere between 16 and 30 per cent of patients currently have appropriate end-of-life care.
Palliative care and assisted death are not at odds with each other. They are, or at least should be, choices that people have when they discuss how and when they are going to die.
But the real paradigm shift that needs to occur is a recognition that death is not a failure. Dying without dignity – that is the failure.
Editor's note: The plaintiffs in the Supreme Court case aiming to strike down the Criminal Code provision making assisted suicide a crime are Lee Carter and Gloria Taylor. An earlier version of this column gave an incorrect name.
André Picard