By Ray Pennings, executive vice-president of think tank CARDUS
The year is off to a hopeful start when it comes to end-of-life care issues. In mid-December, a bill that calls for the development of a national palliative care framework received Royal Assent. That sets the clock ticking on a 12-month timeline on the design of a national framework for how to deliver palliative care through the health system.
This will help balance the picture in Canada following the legalization of doctor-assisted suicide. It also makes clear that affirmation of the choice to die is not what makes for a good death. Autonomy does not transform something that is inherently bad into something good. But adequately preparing for death can help.
Approximately 10 per cent of us will die suddenly, without warning and without a chance to say good-bye to those who are near to us. For the remaining 90 per cent or so, at some point we will receive the news that while the precise time can’t be pinpointed, it will likely be a matter of years, weeks, or days when we can expect our passing. Sure, we may be able to choose from among a medical intervention or three, which may extend that timeline marginally, but the inevitable is near.
I wonder if the question surrounding a good death involves less medicine and more of how we prioritize the remaining time. For most of us, these priorities are likely to fall into some combination of five categories. By happy coincidence, they are congruent with Dr. Ira Byock’s The Four Things That Matter Most: A Book About Living, though I had not read his 2004 book when I came up with my own list.
Firstly, there is someone to whom we need to say, “I love you.” Whatever our status or wealth, death is an equalizer. The value of intimacy and our closest relationships are highlighted at these times and the need to say, with words and deeds, “I love you” to those whom we really love becomes the most important item on our agenda.
Usually, there is also someone to whom we need to say, “I’m sorry.” Living with broken relationships is a plight too common but there is nothing like the urgency of a deadline to resolve things that need to be resolved.
“Thank you” is another priority for those who have a finite number of words and visits to share. There are important people in each of our lives and the reality of the final deadline focuses the mind on who helped us become whom we are and contributed to our successes.
Depending on our station in life, some may feel the impact of our death, not just in terms of our absence, but also from the loss of our care. “You will be ok and taken care of” are words that need to shared with those who depend on us, with the appropriate arrangements put into place to back up those words after we are gone.
“I too will be ok” is the final word that our loved ones need to hear from us. The content and character of this statement will differ significantly depending on your understanding of life and death. Whatever debates we may have about such matters while we are alive, these matters take on an urgency when the inevitably of death is near.
So what does any of this have to do with palliative care and the end of life? Imagine how much less stressful, and less terrifying, anyone’s last days would be if facilitating the five priorities above were part of the care received. Pain management, support for caregivers, and advanced care planning all play an important part in this equation. Tying up the loose ends in life must be part of the equation too. Done well, preparing for death will result in a better life, right to our last breath.