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Ricky Gervais as he hosts the 77th Golden Globe Awards in Beverly Hills, Calif., Jan. 5, 2020.


Letters to the Editor should be exclusive to The Globe and Mail. Include your name, address and daytime phone number. Try to keep letters to fewer than 150 words. Letters may be edited for length and clarity. To submit a letter by e-mail, click here:

Warning shots

Re Iran Fires Missiles Targeting U.S. Troops At Two Military Bases In Iraq (Jan 8): The Iranian attacks might be called shots across the bow. It seems no one was killed, but the message was clear: North Atlantic Treaty Organization troops, including Canadian troops, should leave Iraq. Fighting Iran and Iraqi Shiite militia is not their mission, and they would be ill-prepared to defend against this new threat.

The assassination of foreign officials should be punished. If this is not done, President Donald Trump, and his successors, may take a different lesson from what has transpired: That it can be done again with impunity.

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The U.S. Senate seems prepared to let Mr. Trump get away with murder, but Iran is not, regardless of the price it may pay. As citizens of the world, we should all hope the White House learns the right lesson.

Peter Love Toronto

If the world has learned anything about the United States since the 2016 election, it’s that the U.S. constitutional infrastructure seems to have become obsolete.

While the U.S. Constitution is full of lofty aspirations conceived to ensure accountability, it seems that all a president has to do is tell Congress to go jump in the Potomac, and they dutifully totter down to the water’s edge while the attorney-general holds their towels.

That Donald Trump seems to have blithely assassinated a high-ranking foreign official, which by all international standards constitutes an act of war, suggests that he would feel no compunction about hitting the red button, if he happened to feel like it.

Michael Fox Stratford, Ont.

Iran better be careful: Donald Trump has proven himself to be a master of quid pro quo.

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Bill Bousada Carleton Place, Ont.

MAID in hospice

Re Hospice’s Refusal Of Assisted Death Divides City (Jan. 4): The question of providing medical assistance in dying in hospices is charged. That is because palliative care embodies a philosophy, not only a set of services. Dying persons and their families come to hospices to end the journey in its own time. They share space and intimacy with others in a similar continuum.

A few dear friends have chosen MAID at home or in a hospital setting, thereby respecting other fellow companions’ aspirations to a different kind of passing in hospice.

Marie Ranger Gatineau, Que.

Re Although It’s Legal, Assisted Dying Must Still Involve Ethical Consideration (Jan. 6): Contributor Tom Koch seems to oversimplify the saviour effect of palliative care.

When an older person suffers an irreversible decline, the kindest thing they could wish for is a timely, painless, dignified passing. There are no medals for pointless, spirit-destroying suffering that seems to only dishonour the good life they have led as a competent adult.

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It should be a caring, compassionate, comfortable death that ends a finished life “ethically.”

Jill Kannegiesser Toronto

Perhaps it should be acknowledged that medical assistance in dying and palliative care are both part of end-of-life care.

Palliative and end-of-life care used to mean the same thing, and still does for many. However, palliative care is now often provided at earlier stages in a disease’s trajectory. Palliative-care physicians such as myself are comfortable prescribing life-prolonging antibiotics, IV fluids and blood transfusions in the appropriate setting.

Hospices, on the other hand, are a setting where life prolongation is generally not offered. Many patients who are found eligible for MAID continue to be supported by their palliative-care team until they die of natural causes or access MAID at home. But sometimes, the needs of patients seeking MAID require a transfer to hospice. Is it ethical for these vulnerable patients to be forced out of hospice for MAID? Or denied hospice altogether simply because they have requested MAID?

I do believe conscience rights apply to all and must be protected. However, they should apply to individuals, not institutions. There are conscientious objecting staff in many different settings where MAID is provided. Why is hospice different?

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For myself, my conscience demands that I relieve suffering by all legal means, according to the wishes of my patient.

Jyothi Jayaraman MD, Vancouver

I have personally witnessed friends die from both assisted dying and palliative intervention. The assisted death took about five minutes and was truly dignified. The palliative death took five days, during which my friend was not fed nor hydrated and given large doses of pain medication. The end result: Both friends were assisted in dying.

We should all have a choice. All institutions receiving public funding should have to provide both options to patients who meet the criteria.

Derryck Smith MD, Vancouver

How easily we forget that palliative care is a relatively recent medical discipline.

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The hospice movement in North America began in the late 1970s in response to paternalism. At that time, patients with terminal illnesses were frequently not informed of the nature and progress of their condition. The expectation was for patients to accept the doctor’s treatment without question and “fight to the end" – many of them spent their final days in hospital being administered futile treatment.

What was revolutionary about the hospice movement was the idea of patient autonomy. The individual was placed at the centre of the decision-making process. Their feelings and values were heard and they were able to decide how to spend their final days. Unfortunately, the Canadian Hospice Palliative Care Association and the Canadian Association of Palliative Care Physicians seem to have forgotten their roots and fallen back into the paternalistic trap when it comes to medical assistance in dying.

To say MAID is, as contributor Tom Koch describes their position, a “violation of hospice and palliative medical goals of care,” questions whose goals of care. It should not be about hospice organizations – it must continue to be about patients and about choice. The alienation of those considering MAID threatens to deprive them of the very care they need by palliative-care practitioners, some of the most caring and competent doctors in our health-care system.

Over the past half-century, the hospice movement’s patient-centred focus has quietly changed the way medicine is practiced across all disciplines. Forgetting this threatens to return us to the dark ages of medical paternalism.

James Cox MD, Victoria

Class act

Re Hey Hollywood: You’re Wrong And Ricky Gervais Is Right (Jan. 7): Columnist John Doyle commends Ricky Gervais’s Golden Globes speech, in which he openly berated his audience, because it expressed the “guy-at-home’s” dislike of preachy celebrities. Be that as it may, some of us “guys-at-home” also value decorum and the art of treating people you don’t like with restraint and tact. Insults and verbal abuse are not the same thing as satire.

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Glenn Parsons Guelph, Ont.

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