Blog Submission from a Member

We welcome any members to write in and share your story or opinion with us. One member wrote the following piece, sparked by an earlier blog post "We've Still Got a Lot of Work to Do..." 

REVIEW OF "THE QUALITY OF DEATH" -  Economist Intelligence Unit

Commissioned by the LIEN FOUNDATION,  2010

By: John A. Thomson   MD  DPH

It was pleasing to note that the discussion of these subjects has reached an impressive level on a global basis - a discussion long overdue. The principal Canadian expert consultant was Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association.

I have become accustomed to reading medical scientific papers, and the methodology employed in this EIU paper may not meet usual rigorous scientific standards in all respects, but given the limitations of sources available the results are still quite impressive. It is hoped that in Canada a more detailed presentation may eventually become available to guide those in need of help and those engaged in planning, investigations in a milieu where essential details for sources are forthcoming.

The vexing Hippocratic Oath so often quoted in the popular press is as usual not specifically identified, but no doubt its reference in the paper is to some more recent revision of the original oath. (Wikipedia explains).

There seemed to be a considerable bias in this paper in favour of government involvement in distributing services, but in Canada we find that comprehensive national medical care has obviously serious shortcomings and apparently will soon run out of funds. I agree with a later comment in the paper that the movement for hospice and palliative care needs to stay close to government essentially to change legislation or the administration of it to favour improved relief for problems of pain. At least we should be able to return to the patterns of patient care which existed prior to “The War on Drugs“.

The opioids question is attacked on page 28 quite well. In Canada deficiencies in this respect are almost as severe as in less fortunate countries. Some of my own experiences and those of friends with younger physicians indicate a considerable physician ignorance about opioids. To correct it we need to look carefully at universities to discover why this phase of teaching has become so reduced. Some debates become quite irascible, where one side may accuse others of being “junkies”, or the opposite side may consider their opponents as “sadistic monsters”. There are numerous references to various opioids in this paper, but it needs to be understood that some medical conditions are beyond the reach of opioids and require other techniques.

On page 13 for example, the fact that “in Canada hospitalisation is 100% funded by the state” is presented as if it would be an advantage rather than have the usual retardant effects we so frequently see. So that if we are looking for niche types of problems and solutions, I would expect answers to arise from the private sector first, then eventually be developed by the government when political decisions direct action.

In scientific medical papers it is now quite refreshing to note the addition of ethical considerations such as liens with or support by pharmaceutical firms or tendencies of some physicians to create iatrogenic diseases - quite blunt approaches to these issues compared to the past. More discussion about these patterns may have been perhaps added to the cultural issues section (2) or the economics of health care (3) insofar as the general health care industry is concerned - an expansion perhaps of Dr. Kevorkian’s original complaints about what is “good for business” or “bad for business”. 

*** Note: The opinions and views above are those of the author, and do not necessarily reflect the opinion, stance or mission of Dying With Dignity Canada, it's staff or volunteers.***