My most recent visit with my father was a shock. His condition had deteriorated significantly since the last time I'd seen him, just a few months earlier.
When I walked into his room at the nursing home where he now lives, he offered only the slightest acknowledgment of my presence; a short smile, an arched eyebrow. But he couldn't even raise his bowed head. He seemed to have shrunk in the time since our last get-together. At 87, he can't hear, or walk on his own. Only occasionally can one of my saintly sisters coax a mumbled word or two from him.
The last visit left me profoundly distressed. I realized that my time with my father was coming to an end. I wondered about the quality of his life and what this always wise, witty man who abhorred self pity would say about it himself if he had the voice.
My father came to mind this week while reading about the right-to-die hearings taking place in Quebec. As baby boomers begin assuming their next-up positions in the end-of-life queue, there will likely be more discussion about this controversial and sensitive subject. Right now, of course, euthanasia and assisted suicide are illegal in Canada. The Quebec inquiry is unlikely to change that, but it could prompt a national discussion that needs to take place.
The U.S. state of Washington recently joined Oregon as the only jurisdictions to allow euthanasia and assisted suicide. It remains a deeply divisive issue in the United States, and an easy one to create fear around. This was never more evident than when Sarah Palin and others suggested that President Barack Obama's health-reform measures would create "death panels" that would "pull the plug on Grandma."
Despite some of the hysteria, there does seem to be momentum building in the U.S. behind efforts to have doctors talk about end-of-life options with terminally ill people. New York recently joined California and a handful of other states that have passed laws giving doctors the authority to have discussions with people about alternatives to the often harsh and pointless treatment they are receiving to prolong their lives.
There is nothing simple about this debate. Those against euthanasia or assisted suicide say it is a slippery slope that could ultimately undermine society's fundamental value of respect for life itself. They also say it encourages people to give up hope when they could live for months or years longer.
The most basic case for euthanasia is that individuals should have the right to choose the manner, time and place of their death. Especially if they are in any kind of pain. Modern medicine has complicated matters further. There is seldom nothing a doctor can do for a dying patient. But many admit privately they prescribe treatments they know are unlikely to improve the patient's bleak future or prolong their life.
In a brilliant article in The New Yorker, Atul Gawande, a surgeon who often deals with terminally ill patients, wrote that that the entire U.S. medical system is built around the idea of extending life, or attempting to, in the faint hope there might be an unexplained miracle that allows a patient a few more years on Earth. It has turned many hospitals into "warehouses for the dying," with people drugged to oblivion.
"We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win," he said.
Dr. Gawande makes a convincing argument for palliative care, which focuses on managing a patient's symptoms and improving the quality of a patient's life while they are alive. This, in contrast to continual aggressive treatment, such as chemotherapy, that may, in fact, shorten a person's life, not extend it. A major new study on palliative care determined that it went a long way to reducing a patient's suffering in their last year of life and allowed patients who took advantage of it to live longer than those that received hard-hitting medicines.
Palliative care could potentially save a health-care system billions of dollars. In the U.S., a quarter of all Medicare spending goes toward 5 per cent of patients in the last year of their lives. Money for care that is of little or no use.
Right now, I couldn't imagine my father enduring chemotherapy to extend his life. He wouldn't survive it. Nor could I imagine giving him medicine to end his life. Making sure he's as comfortable as possible until it's time to go seems like a just and reasonable accommodation and perhaps the best for which we can hope.