As head of the University of British Columbia Division of Palliative Care and being active in a number of national palliative-care organizations, I am familiar with many palliative-care physicians’ attitudes and beliefs around this difficult issue and would like to clarify our position.
Palliative-care physicians are at the forefront of managing patients with significant symptoms that affect their quality of life. We see firsthand how serious illnesses can lead to intense suffering for both the patient and their loved ones; in fact, we devote our working lives to relieving that suffering.
We also see patients in whom the suffering is emotional or existential rather than physical, and use teams of skilled professionals from all disciplines to try to address all aspects of suffering. We are well aware that for some patients, it is not possible to relieve suffering entirely, especially when it is related to functional loss or to existential concerns, rather than pain or other physical symptoms.
Though every physician might have his or her own personal feelings about whether they would be willing to provide hastening of death or not, Canada’s palliative-care physicians recognize that this choice is about to become legally respected, and the majority are supportive of eligible patients having access to it. Some have publicly advocated for this right.
The stance of palliative-care physicians toward physician-hastened death is not that of opposition, but about how we can best implement access to it in parallel with universal access to high-quality palliative care. Those patients whose suffering can be relieved by good palliative care should not instead ask a physician to hasten their death while being unaware of potentially effective treatments or supports.
Some believe that palliative care leads to an earlier demise than would otherwise be the case, despite clear evidence of the reverse being true. There are still many people who are strangers to the practice of modern palliative care and believe it is only appropriate when truly at the end of life, with only days or weeks to live. A large proportion of B.C. residents die from chronic progressive illnesses without any contact with a palliative-care service at all.