I am a retired physician in Vancouver (cardiology), and having worked here for just under 50 years—in hospital as well as a clinic—I have had to think about the end-of-life problem all too often. I am glad to see discussions on this thorny issue are finally beginning.
Without an accepted policy being in place, one encounters situations in hospitals where a patient with end-stage chronic disease is repeatedly admitted to the ICU with the same problem and at some point requests that this be the final time. Often that patient is then given a dose of sedation that is perhaps too large for his or her weight. But this is not a solution. It is time we discuss this issue and develop a directive (with an option for palliative care—where beds are available). Seeing what Dr Lowe and many other people have had to go through, it is time to tackle and solve this difficult problem (to the best of our abilities in 2014).
And I believe the problem should be discussed with a broader group, not only with people who have an incurable disease or are in constant severe pain, which, despite pain clinics, is not always relieved. There are times when people are left to face a life that is not acceptable to them, and whether a person has the right, and help, to decide his or her fate should be decided and that decision should become accepted practice.
Many doctors agree with these ideas in theory but nevertheless are not prepared to help a person to end his or her life—it goes against what we have been taught and practised for so many years.
This discussion has been started in the April and May issues of the BC Medical Journal and that is an important first step. I think all physicians should take a few minutes to start a conversation with their patients regarding their wishes, encourage them to discuss this with their families, and follow up. I was encouraged to see Dr Cunningham’s President’s Comment on this subject, “The necessary discussion that’s often hard to have” [BCMJ 2014;56:168]; we need to make it a general discussion for all doctors and as many people as possible. The time of treating people without their knowledge and wishes has passed.
—C. Eve Rotem, MD
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