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Friday, October 8, 2010

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.***


  1. Hi, I'm not quite sure what point is being made by this post. Perhaps the author could clarify. Do you agree with the ranking given by the Economist research data? What problems do you see in the Canadian situation? How does this fit in with (say) Dying with Dignity's goal to see the law regarding assisted dying changed?

  2. Hi Greywizard,

    Thanks for your comment as well.

    I am sure Dr. Thomson can elaborate on some of these points as well, should he see them, but I think we can also add some insight:

    I think the point of this post is, at some level, is another aspect of end-of-life care – pain management – and some of the factors associated with that.

    I’m not sure the post has anything to do with physician-assisted dying (PAD) at all – and I’m not sure it ever intended to. The original post had to do with overall end-of-life care, and you had made a great point in the comments section about PAD and its lack of reflection in the Quality of Death Index. But I’m not sure Dr. Thomson had intended to write about PAD in his piece.

    And I think this brings up a great point. As an organization, Dying With Dignity Canada aims to improve the quality of dying for all Canadians. That includes lobbying for better end-of-life choice, including PAD, if that is what the patient seeks. But it also includes lobbying for improved hospice and palliative care, helping to open the lines of communication between individuals and their families and medical professionals, and educating them on the rights they currently have in Canada. Not to mention education on the importance of advance care planning, choosing a Power of Attorney for Personal Care, the right to refuse treatment ... the list goes on.

    If I am correct in believing Dr. Thomson is talking about pain management here, then we see great relevance to our mission to improve the quality of the end-of-life care Canadians are receiving.

    Thanks again for posting.

    -DWD Canada

  3. Hello again - sorry for the delay.

    Probably like other people interested in end-of-life issues (not many I guess), I scrounge around wherever possible to glean whatever is available. This time the kickoff was Andre Picard's article which led to the paper from the EIU.

    Picard warned us: "Britain is the best place in the world to die" - an invitation perhaps to snide commentary. Sounds a bit like the golf expression "The Open" rather than the "The British Open". (But we all have to live together). It was interesting to see that the world problems are also our problems.

    Canada is somewhere close to the top of the list and that is fine with me. The important thing is that we have a new forum of international discussion, whomsoever the sponsors and main movers are. And now we have a DWD website to hammer out the details.

    As for the Canadian situation, Picard also leads us to the Canadian Hospice Care Association which attempts to inform about Victoria, Edmonton, and Niagara West and New Brunswick. Further details available from the CHPCA Policy Brief -Quality End-of-Life Care? It Depends on Where you Live .... and Where you Die.

    John Thomson