Helping journalists, producers and conference planners find the female guests, speakers and expert sources they need.

Limited options turn loving relatives into end-of-life advocates

The Ottawa Citizen by Debby Hanscom 10 September 2012

Let’s say someone you love, for whom you would do anything in your power, is terminally ill. Their diagnosis is clear and irreversible: they’re going to die. Soon, but — in light of the dependency and pain their illness delivers — not soon enough to avoid tremendous suffering. What can you do to help them?

In Canada, at the moment, not much.

But the experience of trying is likely to turn you into an advocate for medically assisted death. It did for me.

In February 2000, my mother, Betty Hanscom, was diagnosed with an inoperable brain tumour.

She was 82 and had been afflicted with Parkinson’s Disease, which she bore with great courage, for 20 years. A hard-working mother of five, she prized honesty and self-reliance. But the brain tumour was a game stopper and she knew it.

Unwilling to endure the suffering she faced, and in the absence of a law permitting her to get a prescription that would help her to end her life quickly, she made the tough decision to refuse food and water. It took 10 days for her organs to slowly shut down before relief finally came. Helplessly witnessing the process from her bedside, I vowed to work to create choice for myself and for others to prevent such needless suffering.

My mother’s end came in Arizona, which, like Canada, has no dying with dignity legislation. But had she lived in Oregon, her options would have been different. In 1997, Oregon passed an act to allow terminally ill residents to obtain prescriptions from their doctors for self-administered, lethal doses of medication that would permit them to decide the time and place of their death. The act lays out clear and stringent compliance guidelines, requiring that all prescriptions be documented and an annual public report issued.

At the time, those who opposed the legislation warned that vulnerable people would be put at risk and their lives devalued. The annual reports published under the law prove otherwise.

In 2009, for example, physicians wrote 95 prescriptions at patients’ request. Of these, 53 took the medications, and the vast majority of them were between 55 and 84 years of age, well-educated, and suffering from cancer.

Their most frequently cited end-of-life concerns were loss of autonomy, loss of dignity and decreasing ability to enjoy life.

Clearly, the law is being used as intended, by those living and suffering with terminal disease but capable of exercising decisions in their own best interest.

Furthermore, last year the Royal Society of Canada conducted a scientifically rigorous review of medically assisted death in a host of permissive jurisdictions — including not just Oregon and its neighbouring state of Washington, but also the Netherlands, Belgium and Switzerland. It concluded that there is no evidence to support the concern that a legal regime with safeguards puts vulnerable people at risk.

These conclusions were reinforced by both a report tabled by the Dying With Dignity Select Committee of the Quebec National Assembly last March, and by a decision in June by the Supreme Court of B.C.

In the latter, Justice Lynn Smith found that current Canadian law and medical ethics already allow several end-of-life practices. In Canada, taking one’s own life is not prohibited. Patients can require their doctors to withhold or withdraw life-sustaining treatment, and to request pain control medication in dosages that actually accelerate death. Given this background, Smith ruled that preventing physicians from responding to a patient’s desire to die is arbitrary; it unfairly discriminates against people who wish to end their lives but can’t do so without assistance due to their illness.

These are all encouraging developments when you consider that Canadians die principally from old age and progressive ill health. And although most of us desire to do so at home, the nature of chronic disease and aging results in almost 70 per cent of us dying in hospital settings.

More troubling is the fact that even though 95 per cent of Canadians nearing death would benefit from palliative care, less than a third of us are able to access to it. Since the number of seniors in Canada is expected to double over the next two decades, without some significant change in the near future, these figures are likely to worsen.

So it’s not surprising that a public-opinion poll conducted this summer by Angus Reid shows that 80 per cent of Canadians support allowing a doctor to assist a fully informed competent and terminally ill adult to end his or her life.

That strong majority must now make its views known and press for change. By doing so, we will not only honour the memory of brave people like my mother, but also promote the kind of choices we’d like to have, when our own time comes.

Debby Hanscom is a lawyer and past board member of Dying With Dignity.