Special Report: Last Wish
Published Wednesday, March 31, 2010 2:57PM EDT
Sean Holland and his partner Robbie are embracing every moment they have left together, knowing the inevitable end is coming soon.
"I have metastatic renal cell carcinoma," said Holland. "This is kidney cancer."
The devastating diagnosis came three years ago, and since then, tumours have invaded other organs, including his lungs.
"95% of people who have kidney cancer that has metastasized die within five years, so the prognosis was never very good," said Holland.
His laboured breathing, coupled with the sound of an oxygen tank, are constant reminders of his failing lungs.
"They could resolve it by putting tubes in me, but that's one of my greatest fears, to be hooked up to a machine and to die that way," said Holland.
Difficult as it is, he is coming to grips with his death, by refusing cancer treatment and moving into the palliative care unit of the Montreal General Hospital.
It's not home, but Holland is comfortable knowing he will be able to sleep through the suffering that will come with his last breath.
"It relieves so much anxiety about it actually happening, about actually dying," said Holland. "I'm not caught worrying about the sort of horrible things that could go awry."
Ethics of euthanasia
The ethics of euthanasia are being debated in Parliament, the National Assembly and around the dinner table, but it's the people who are facing death and their doctors who make the most profound arguments.
Dr. Manual Borod, head of palliative care for the MUHC, says sedation is a last resort for terminally-ill patients like Holland.
"We certainly offer them options in terms of treatments," said Dr. Borod. "If all these treatments fail and a patient is worried about choking to death, for instance, being offered the possibility of sedation, if that came about, is often very reassuring to a patient."
The intent is not to end a life, but to allow a relatively painless death.
Palliative sedation "perfectly legal"
The head of Quebec's Medical Specialists argues the act is tantamount to euthanasia, and that it is perfectly legal.
"We prefer to call it palliative sedation," said Dr. Gaetan Barrette. "But in reality, by the book if you read a definition of euthanasia, that's what it is."
The terminology is controversial.
While palliative sedation is widely accepted and practiced in Quebec, the idea of doctors taking a more active role in euthanizing patients is highly debated.
"It really comes down to intent," said Dr. Borod. "When we give opiods in increasing doses with the intent to end somebody's life that would be considered euthanasia. If we give a sedative with the intent of a patient sleeping that would be a sedation."
When it comes to his own practice, Dr. Borod says that doctors in Quebec are not killing their patients, and he wants no part of it.
"I may prefer to resign than be asked to terminate patients's lives," said Dr. Borod.
Public consultations expected
Quebec's Dying with Dignity commission is preparing for public consultations on euthanasia.
Medical Specialists say it's time to talk about Quebecers having access to euthanasia if they are facing imminent death.
"We hear day after day, patients who would like to have access to that, what they believe to be a solution for their own end of life," said Dr. Barrette.
However it seems that for every patient who advocates wanting to end their own life because of a terminal illness, there is another, just as vocal, who is opposed.
Gazette columnist Hugh Anderson stridently and persistently argued against euthanasia.
"The thing about the right to die at the time of your choice is that somebody does have to have the right to kill you," said Anderson.
"3,000 people were euthanized in the Netherlands last year," said Anderson, and that is a slippery slope he did not want Quebecers to negotiate.
Anderson died on March 3, 2010, after a battle with cancer.
Legal in several countries
The Netherlands, Belgium, Oregon, and Washington state all permit euthanasia or assisted suicide.
One of the most famous agencies for arranging the end of a life is Dignitas in Switzerland.
"You can fly in in the morning and be dead in the afternoon," said Anderson.
Suffering from ALS, Craig Ewert did just that in 2006, with a film crew in tow.
The Suicide Tourist documents his trip, and his fatal ingestion of barbiturates.
"If I don't go though with it, my choice is essentially to suffer, and to inflict suffering on my family and then die," said Ewert in the documentary.
Anxiety about family a key issue
Ghislain Leblond lives with a mysterious degenerative disease that's slowly claimed 80 percent of his body over the last 45 years.
It's debilitating, but not deadly.
"A scenario for me is, I might find myself totally paralyzed and a prisoner within my own body," said Leblond.
While palliative sedation is an option for terminally ill patients, it's not considered for someone in his condition, and Leblond argues only a doctor taking an active role would allow him to die with dignity.
"Being in that bed, bedridden, for years, I know I'm going to be a burden, a psychological burden," said Leblond. "If I knew that in that case I was able to resort to regulated euthanasia, my life now would be much lighter."
Leblond's group is calling for a law permitting euthanasia, with a set of safeguards similar to those in Bill C-384, the proposed legislation currently before parliament.
Proposals include ensuring the patient be of legal age, lucid, in physical or mental pain, or suffering from a terminal or incurable illness.
Dr. Barrette says it does not give doctors the right to kill, but instead "it gives the patient the right to choose. We do not want to have the decision in our hands."
The debate is far from settled.
"We have to look at things beyond the individual patient. What would be good for society as a whole?" asked Dr. Borod.
Regardless of what legislators decide, the answer will have to balance dignity, compassion, and respect for the dying.