Giving thanks for a good life—and death: Elaine Chin

Planning is key


(Photo: Robert Daly/Getty)

(Photo: Robert Daly/Getty)

Around the Thanksgiving season we often reflect on how fortunate we are as Canadians living in a modern country with so many benefits. However, there are not always happy endings—especially if  in our last days we endure or witness pain and suffering that we can neither resolve nor avoid. Two recent examples bring this into sharp relief.

There is the doctor of infectious diseases, Donald Low, who many Canadians will remember as the calming voice during the 2003 SARS epidemic. Stricken with terminal brain cancer in February 2013, Dr. Low raised the discussion of euthanasia when he posted a September video pleading for the right to take his own life.

This month also marked the release of a book, Five Days at Memorial, by Pulitzer Prize-winning author Sheri Fink. In it, she writes about the fateful decisions doctors had to make at a New Orleans hospital during Hurricane Katrina. While the book leaves the final judgment to the reader, Fink offers details of the events surrounding doctors’ decisions on which patients would be left to die and who would be rescued. Were these doctors heroes because they injected lethal doses of morphine into chronically ill and dying patients so they wouldn’t need to die a slow and lonely death, or were they murderers?

I share these two vignettes not to discuss euthanasia, per se, but to encourage a dialogue at the Thanksgiving table about what we can all do to plan for a ‘good’ death. Why? For one, we’re becoming a nation of seniors given the growth rate of aging ‘boomers’. According to Statistics Canada, in 2011 an estimated 5 million Canadians were 65 years of age or older, and their numbers will double to 10.4 million in the next 25 years. By 2051, one in four Canadians is expected to be 65 or over.

So today I’m asking you to ponder how you may be better prepared to deal with the last days of your life and perhaps those of your loved ones, too. Such decisions are best made unhurriedly and with careful thought and discussion. Think of it as being much like what financial planners encourage us to do—plan for our money to last as we age.

Specifically, I’d like to call your attention to the two useful tools you can give to your physician in advance of a medical crisis (this way everyone is on the same page should you or family members become gravely ill).

The first is a living will. Drafted by a lawyer, this is a welcome document in your medical file. This will outlines for your doctors what your wishes are should you become incapacitated and unable to make decisions about your medical care. Such directives include everything from who has the authority to decide on your behalf, to whether you’d like to be put on life support, and directions for organ donation. Preparing this will remove a lot of stress from loved ones wondering what your wishes may be.

The second tool is a “DNR”—or “do not resuscitate” directive—for a terminally ill loved one. This authority provides your team of health professionals with a mandate to use all necessary means to keep the patient comfortable, but short of advancing to life support measures such as feeding tubes and the use of lung breathing machines.

In my 25 years of practice I have signed several hundred death certificates. And I can sincerely say there is such a thing as a ‘good death’.  When my mother was diagnosed with terminal colon cancer, she was admitted to hospital for palliative surgery—removing a piece of colon to relieve pressure in the bowel.  I provided a DNR for the surgeon. Post operatively, she did not do well. The DNR directive ensured that the health team did not over treat my mother. This is what she wanted and requested. Some nurses said to me that I was “brave” to give a DNR so soon. Perhaps, but I’d rather be told that I was kind in ensuring that my mother had a good death.

And to all my patients, thank you for teaching me that with planning there can be dignity in dying.

Dr. Elaine Chin is the Chief Medical Officer of the Executive Health Centre. Her clinic was the first in North America to offer genetics testing and now tests telomere length as well.