What is a good death?

By Gordon Self, Covenant Health Vice-President, Mission, Ethics and Spirituality

We only die once. In humility, answering what is a good death is part anticipatory—what I hope it will be for me. But it is also informed by my experience with many personal family losses, including the death of my granddaughter. I have also reflected on my clinical experience with the many people I was privileged to be with as their loved ones drew their last breaths in Intensive Care units, Emergency departments, Palliative Care units, Medicine and Long-Term Care settings, and yes, in Labour and Delivery units, too. I have worked over 35 years in Catholic health care in Canada and the United States and can confidently say a good death is not only possible, but it is something we strive to provide to all we serve at the end of life.

There is no mistaking that death brings pain and suffering. There may always be some degree of suffering; it is part of the human experience and it cannot be medicalized away. To know I am dying means letting go of family, friends, meaningful work, and that is sad. Family bereavement is also a process that takes time to unfold, and other than complex grief that requires skilled medical help, for the most part people work through the process with time. Do not ever underestimate the power of holding a person’s hand and other simple gestures of presence, born out of our collective experience of having suffered ourselves. Suffering, therefore, can be addressed by caring and empathy.

As far as pain and symptom needs, that is typically managed through appropriate medications and other comfort measures. We do this very well, too, despite the misconception that people are left to writhe in agony in hospitals. If you visit any of our palliative units you will note the calm and peaceful atmosphere as families keep vigil during those final hours. Sometimes crying is heard, but also laughter. Maybe piano music, too. But you will not hear people writhing in pain and agony. This is the story that the wider public deserves to know.

Elena Clark kisses her first grandson, Nicholas, who is being cradled by her daughter Jackie Clark. For Jackie, being able to visit her mother on the palliative unit 24/7 is a blessing for her and her siblings.

Some argue that physician-assisted death is part of palliative care, separated only by degree, which Covenant Health and the larger palliative care community completely refute. The traditional three goals of medicine remind us to cure sometimes, manage disease and symptoms often, care always. Our ongoing duty to care requires us to respond to the suffering and lamentation associated with letting go, the need for closure, the administration of rituals and prayer, and emotional and spiritual presence. We do this by staying engaged with the person who is dying, and helping them to live their dying well. Palliative care seeks to end the suffering, not the life of the sufferer.

Elena says she is at peace with the decision to move into palliative care. It allows her to focus on spending time with her children.

Reflecting on my personal and clinical experience, I can confidently claim we provide excellent palliative, hospice and end-of-life care without intentionally ending the life of the sufferer, nor needlessly prolonging death. It is an injustice that the current disproportionate focus on physician-assisted death fails to give balanced attention to what the literature actually reports. For example, studies show that in places where physician-assisted death is provided by law, few people ever avail themselves of it. Some people desiring physician-assisted death die without ever filling their prescription for lethal medications, or, if the script is filled, the lethal drugs are never taken. If there were the same proportionate attention and advocacy for palliative care as we are now witnessing for physician-assisted death, we would have a better chance of ensuring consistent and equitable access for all Canadians to benefit. Yes, we only die once. But we can anticipate our mortality and learn from the silent majority who model through their dying experience that a “good death” through excellent palliative care is very much a reality. This is consistently demonstrated by the high satisfaction rates among patients and families who have benefited from this wonderful resource.

In the spirit of transparency and humility, we seek to deepen public awareness and understanding of all that we already have in place to support people at the most vulnerable moments of their lives. There is much work we can all do to lessen public confusion, anxiety and fear, in which the palliative care community and Catholic health care are willing to help. 

Therefore, Covenant Health and our palliative care physicians propose inviting meaningful conversation with media and elected officials to help educate the public that a good death is not only possible, but happens every day in our facilities. And that we have a proud team of clinicians who dedicate their professional lives to ensure that it is a continued reality. As we each anticipate our own mortality, this will give us all hope of what is truly possible, and something worth fighting for and telling the world about.

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