Relieving suffering
CMAJ 1998;159:1081
In response to: R.W. Dunn
I read Dr. Dunn's letter with considerable dismay. My purpose was to describe in some detail what "ethical care at the end of life" actually means in clinical situations and to outline the positive, effective and proactive role that physicians must take in the relief of suffering. My intention was to describe what is ethical practice and what can be effective in helping patients and their families. If all seriously ill and dying patients, regardless of their disease, were to receive the type of care presented in my article, the present burden of suffering in our country and elsewhere would be greatly reduced.
Contrary to persistent popular belief, dying patients who are cared for attentively rarely request euthanasia or assistance with suicide, or, if they do, the desire for early death can be closely associated with treatable depression.1 Surely it is our professional and moral responsibility to diagnose and treat the depression, provide a supportive relationship and affirm the worth of the patient.
Debates about this subject have taken far too much of the stage in recent years in Canada — at our professional meetings and in the popular press. A special Senate committee made recommendations that did not support changes to the law but rather urged that the development of accessible, effective services in palliative care be made the number one priority for health care in Canada.2 We can only imagine how much further ahead we would be in our care of seriously ill and dying patients if the energy that has been devoted to the debate about euthanasia and assisted suicide had been directed instead to establishing such services.
Excellence in palliative care, not euthanasia and suicide, should be the focus of our resources, energy and skills.3 Our major ethical concern should be to address the issue of why we continue to tolerate continuing pain and suffering when we know what is required to relieve them. Indeed, on this point, I agree with Dunn: we should not insist on "suffering to the end." Rather we should insist on the relief of suffering — both physical and emotional — throughout the course of illness, so that the end, when it comes, is painless and peaceful.
There is much to be done. Let's not waste any more time.
Elizabeth J. Latimer, MD
Professor
Department of Family Medicine
McMaster University
Consultant Physician in Palliative Care
and Pain Management
Hamilton Health Sciences Corporation
Hamilton, Ont.
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References
- Chochinov HM, Wilson KG, Enns M, Mowchum N, Lander S, Levitt M, et al. Desire for death in the terminally ill. Am J Psychiatry 1995;152(8):1185-91.
- Special Senate Committee on Euthanasia and Assisted Suicide. Of life and death. Ottawa: Minister of Supply and Services; 1995.
- Latimer EJ. Euthanasia and assisted suicide: the wrong issues in the care of dying people. Can Fam Physician 1997;43;189-91.
