Looking back in history, the struggle to attain the freedom for individuals to make important choices about fundamental issues in life has been one of slow progress.
For a long time there was no freedom of speech or religion. If you expressed an opinion contrary to what the government, the church and most people around you wanted you to believe or do, you were ostracized, or worse, ended up in jail or were condemned to death.
The freedom for women to be recognized even as persons and to be able to vote, the freedom to choose to give birth or not, all were achieved after a long and difficult struggle against strong opposition.
I have never met anyone who would opt to get Alzheimer’s and no longer be able to recognize any of their loved ones, nor any volunteers to suffer a major stroke, depriving one of the ability to speak, to become totally dependent on others to be fed and receive personal care.
Yet thousands suffer such a fate.
All too many times I have cared for these unfortunate people, knowing that they did not really want the kind of care I was obliged, as a doctor, to provide in the absence of written instructions to the contrary. I had known many of them while they still had the freedom and ability to give explicit directives what life-prolonging measures they would find acceptable or reject if they lost the facility making those choices.
Most would not write down their wishes.
Once a person has lost a healthy brain and sound communication skills without leaving a legal document directing me how to care for them, I am left with the duty to preserve life at all cost, no matter how futile and contrary to what I suspect they would have chosen.
Many people think that granting power of attorney to a trusted family member or friend would safeguard against a prolonged and miserable dying process.
Unfortunately this document does not give that power where it concerns a person’s health care.
With all the fabulous techniques to help people, we can also prolong the dying process for weeks or months without any prospect of cure or improving the quality of life.
But this is not necessarily a desirable course of action, defying mother nature when your number is up.
Anyone has the freedom to choose and put in writing if you would accept or reject being tube-fed if you can no longer swallow after a stroke. You can choose if you want to be resuscitated or not in case of a cardiac arrest. You can decide in advance if you want or not to find you are permanently connected to a ventilator, unable to speak, swallow until you finally die despite these life-prolonging techniques. And there many other important reasonable choices you can make before it is too late to do so.
There are excellent documents available to help people making those choices. Fraser Health developed a very useful booklet called “My Voice,” available just for the asking, at no cost. Many doctors have them available in their offices or ask the people at the public health office, or go on line and connect to advancecareplanning.ca.
Completing these documents will protect the person against unwanted interventions and prevent forcing the family having to watch their loved one dying a very prolonged and miserable death.
Completing a written directive and giving it to your doctor and your next of kin will eliminate the need to ever avail oneself of an assisted suicide in most cases once the legislation will allow such a choice.
Withholding certain potentially life-saving measures, according to the patient’s wishes, will facilitate a more humane end.
Yet there are circumstances where the availability of the choice of assisted suicide would be the most appropriate one.
When the patient suffers greatly and there are no effective treatments, and yet death is still some way off, that person should have the right to choose to decide to die now.
In the jurisdictions where people can make that choice, there are no reports of abuse, because the legislation is very precise who is eligible to make that choice.
Currently, one person had been given that right by a clear-thinking judge, but that right has been taken away again by the government appealing that decision.
Therefore, nobody in Canada has that right. But the movement to attain that right is gaining momentum, and I am sure will come about to benefit courageous people like Gloria Taylor.
Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.
