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Technology plays a role in keeping patients alive in the Critical Care Unit at Sunnybrook Hospital. (Moe Doiron/The Globe and Mail)

Moe Doiron/Moe Doiron/The Globe and Mail

This is part of the Globe's in-depth series on the agonizing decisions surrounding end-of-life care in the 21st century. For the complete series, click here



One of the most pressing issues in Canadian health care is a taboo subject: end-of-life costs.

Technology lets us live longer, but sometimes it also prolongs death. How much medical treatment is too much at the end of a life? Where should we draw the line? These vexing questions require leadership on many levels – especially because of the aging demographic.

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Today, The Globe and Mail begins an exploration of these issues. A reporter and photographer were granted special access to the critical-care unit of Sunnybrook Health Sciences Centre in Toronto. Over four months, they followed four families who were facing end-of-life dilemmas.

Death can look very different when it seems to be imminent. Patients change their minds. And when they have not expressed their wishes about end-of-life care, either on paper or orally, they place a terrible burden on their loved ones.

Some choose the most drastic measures, by default. That can perversely result in doctors providing treatments that do no good and can even do harm.

As the law now stands, doctors cannot unilaterally withdraw treatment that they believe gives no benefit. That's not necessarily a bad thing, but giving patients the power to insist on medically useless treatments makes no sense.

The average daily cost for an intensive-care-unit bed in Canada is $2,908 – more than $1-million a year – and there are 3,505 of them across the country. Though 69 per cent of Canadians die in hospital, some of them in intensive care, a survey has found that a majority would prefer to die at home.

Canadians need face up to their future deaths. They should take responsibility to articulate what treatments they would want – or not want – by talking with their next of kin or by filling out advance directives.

Doctors working in intensive care should communicate to families the realistic prospects for a patient's recovery – not later than three days after admission.

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Provincial governments, for their part, could reimburse health-care providers for holding end-of-life discussions with patients and their families.

The end of life is not a topic that attracts political support. Nor does it make for pleasant dinner conversation. But by continuing to avoid the subject, Canadians not only endanger themselves but also their health-care system, too.

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