There are only two things to be sure of…and this is one of them

11 02 2015

Death and taxes…the two things that we can be sure of. I don’t have much to say about taxes, but I’ve become very conscious of death these past few weeks. I suppose that’s a natural result of crossing the big 7-0 threshold, and because I just had my will redone due to my move to BC, but it’s also because death has been in the news lately. The Supreme Court has ruled that the medical profession can assist in a patient’s death under certain circumstances. While the ruling is fraught with dire possibilities, after thinking about it for a while, on many levels, this decision makes good sense to me and, rather strangely, provides some comfort.

I will, of course, die some day. I’ve had two heart operations and have experienced other health issues so my chances of an earlier than normal death may be heightened. I don’t really fear death but I do resent the thought of not being alive. I love life, even on the days that I’d rather crawl under the covers and disappear for a while. I love being involved in the lives of my friends and family and will hate not knowing how their story evolves. But I will die and the thought that I have some control over the circumstances of my death, should my life be filled with unbearable pain with no possible end to its unremitting horror, then I would want to be able to die peacefully surrounded by my family, and supported by my physician.

At present, of course, a patient or family designate under certain circumstances.can leave orders not to resuscitate a terminally ill loved one while in hospital. I came face to face with this terrible decision when my mother became extremely ill and had several small strokes following a massive stroke and was taken to hospital. I was teaching and was called to the school office by the principal to take a call from the doctor in charge of my mother’s care while in hospital. He introduced himself and then bluntly asked, if your mother has another stroke, do you want us to resuscitate her? I was totally taken aback as I had no idea that this kind of decision would be mine. I told him that I’d never had this discussion with my mother and would have to think about it. My first impulse was to say, of course — resuscitate her, keep her alive as long as possible. But what does it mean to be alive? My mom, who had always been on the go, enjoyed her friends and children so much, who was active in her church and was a part of my life every day, had been wheelchair bound and in a nursing home for about three years following a massive stroke. She depended on others for almost everything and seemed withdrawn much of the time but was always happy to visit with me almost every day as I stopped by on my way home after work. She didn’t socialize much with others in the nursing home but loved seeing her friends from church. Her life, as far as I could tell, was bearable. However, after she was admitted to hospital, her ability to interact became more limited. At first, she was able to converse but that ability lessened after each small stroke. It was after one of these strokes that the doctor called me. As it turned out, mom had a conversation with the nurse and made the decision for me. She did not want to be resuscitated and, as painful as this was, it was the right decision for her.

Finally, after months in the hospital, my visits with mom consisted of spending most of our time together adjusting her pillow. She would become quite agitated and pull her pillow back and forth behind her until it landed on the floor. I would pick it up and adjust it carefully, she would relax for a moment and then the whole process would begin again. I would try to chat with her but had no sense that she comprehended what I was saying, nor did she initiate any conversation. Was this sufficient reason not to resuscitate? She died following another massive stroke and her DNR order allowed her to pass away peacefully and in no pain.

It seems to me that the Supreme Court decision is an extension of the decision not to resuscitate that we already have available to us. According to The Globe and Mail, “The Supreme Court of Canada’s ruling says physician-assisted suicide should be available to a competent adult who ‘clearly consents to the termination of life and has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.'” This leaves many questions that will need to be addressed by the government and arbitrated through case law, but for one woman, speaking on CBC, whose husband had ALS, the lack of such a law meant that, having made the decision to end his life before the disease had robbed him of all that could be described as a life of some dignity, he had to end his life earlier than he might have chosen as he needed to be physically able to take care of the necessary details himself, and he had to die alone as he could not involve others in his death as they could be held legally liable. For her, the Supreme Court decision was too late for her circumstances but was something she celebrated.

When I was preparing my will, I asked that my family ensure that no heroic efforts be made to continue my life should I be robbed of a sufficient quality of life to ensure dignity and a level of comfort that was tolerable. Although I’ve never been close to having to think about these issues in any imminent sense, I recall the unbearable pain I experienced when a huge bruise bubbled up on my leg. How would I deal with this level of pain if I knew there was not going to be an end to it? I don’t know but I do know that the Supreme Court decision opens up possibilities that are a double edged sword that must be approached with a commitment to honouring life while enabling each one of us to consider deeply when our life should end. What that will look like is a conversation we need to have with our loved ones and as a community of care.

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