No matter what the Supreme Court of Canada decides in Friday's expected ruling on physician-assisted death, one thing won't change: We need better palliative care for the dying and their grieving families. An Angus Reid poll published early this year said 80 per cent of Canadians approve of assisted suicide, a number that was higher among respondents who had watched a loved one die within the previous three years. Experience shapes our attitudes, and few human events are more intimate than death – for those at the bedside and for those who can only imagine themselves there.
I was more than halfway across the country in 2001 when my father-in-law died of pancreatic cancer in Victoria, at the age of 94. What still astounds me is that he died peacefully at home in the care of his 90-year-old wife, a woman of great intellect and curiosity but lacking in any medical training. That's because they were supported by a stalwart family friend who happens to be a British-trained nurse, and they were in the care of Victoria Hospice. I say "they" because the hospice works on an interdisciplinary and holistic model that combines the training and skills of doctors, nurses and counsellors in caring for the patient and the family.
"We didn't invent the model," says social worker Wendy Wainwright, director of clinical services, "but we have lived it." The earliest palliative-care programs in Canada were started in the mid-1970s by doctors – David Skelton at St. Boniface Hospital in Winnipeg and Balfour Mount at the Royal Victoria Hospital in Montreal – who had a direct connection with Dame Cicely Saunders, the founder of St. Christopher's Hospice in London.
Victoria was different. It began in the late 1970s as a grassroots movement initiated by passionate volunteers, distressed by the end-of-life suffering they had witnessed. Granted provincial funding for a pilot project in 1980, they envisaged an interdisciplinary model connecting the hospital and the community.
Along with medical care to relieve symptoms, addressing psychological and social problems has always been a core part of visioning, strategic planning and budgeting, says Wainwright, a forthright woman with a hearty laugh. "Everything we do, we try to do in a holistic way and that is really different from most places." There is a palliative response team – a nurse and a counsellor – who make house calls, as poignantly described by former hospice counsellor Eve Joseph in her recent book, In the Slender Margin, and an equivalent team that operates in the hospice unit located in what once was a maternity ward in the Royal Jubilee Hospital.
Last year, Victoria Hospice had 900 deaths, of which 35 per cent happened at home, another 43 per cent in the palliative-care unit and the remainder on medical wards or in long-term residences. Comparisons are tricky, but for the overall Canadian population, close to 70 per cent of deaths each year occur in hospital.
Social worker Michelle Dale has worked as a counsellor in the hospice unit for a decade. She talks about death and dying with patients and their families and tries to "create the space" in which they can talk to each other. "If we have done it well, the family doesn't remember us, they remember themselves as being loving and giving and capable," she says. "By taking some of the load off families, they are able to be more present."
Better palliative care will not eliminate the desire or need for assisted suicide and euthanasia. Baby boomers, who grew up in the age of autonomy, want choices in dying as in every other aspect of their lives.
What palliative care does offer them, especially Victoria's psychosocial model, is a means to find solace for the spirit as well as relief for physical symptoms. That wasn't enough for Sue Rodriguez, a Victoria Hospice patient suffering from ALS who led the first challenge at the Supreme Court against the Criminal Code prohibition against assisted suicide back in 1993. It might not be what you want, but it will give all of us more options and our loved ones more comfort.