The National Post has recently run a number of columns on palliative care that are worth a read. I have had an interest in this area for many years, and worked on the board of the Maycourt Hospice (then called The Hospice of All Saints) when I lived in Ottawa. At that time, the hospice movement was relatively new in Canada and the hospice provided much needed services in the community, offering relief to home-based caregivers of dying persons through trained volunteers as well as a day hospice program where people in their last days could spend a day at the hospice, relaxing, having a meal, making use of an accessible tub and chatting with others facing the same issues. Since then, the Hospice has expanded to in-patient services where beds are available for those who are unable to spend their last days at home.
Jonathan Kay has written about these issues, beginning with a piece describing the conflict between the training of many physicians “who take “heroic” measures to provide dying, elderly patients with a few extra days in intensive care.” This was followed by an article describing the point of view of physicians who often feel pressured by families to continue invasive treatment, particularly when they are ethically required to describe alternate scenarios for a patient’s last days.
In today’s Post, Tom Blackwell writes of the lack of physician training in how to talk with patients about dying. He interviewed Dr. Larry Librach, a palliative care physician who “has developed a unique program to teach health professionals how to deal with assisted-death requests in a country where saying ‘Yes’ could lead to murder charges — and a flat ‘No’ might cut short an important conversation.” Librach says that understanding why a patient wants to die can lead to discussions that can ultimately provide direction to families and physicians.
As the population ages, these are important issues to understand and to discuss with those who may be responsible for your end-of-life care. In particular, we need designate who should speak for us at the end (typically through a Power of Attorney for Personal Care) as well as detailed instructions for the measures we want to be taken should we find ourselves in protracted final days (advance care plan – pdf).
I’ve had a Power of Attorney for both Financial and Personal Care for many years, but have never completed an Advance Care Plan. I’ll be doing that today. If you’re not convinced that you need one, please read some of Kay and Blackwoods articles. More information on Powers of Attorney is available here.