Throughout the ages, death was familiar, simple and public. Death was a common event, occurring in every age group, an accepted part of life.
Life expectancy at birth stayed between 30 and 40, century after century, except when it dropped into the 20s during famines, wars and plagues. It did not begin to rise until the late 19th century for the average person.
Life spans have been growing ever since in Canada, from age 60 in 1920 to 81 at the latest census.
That is surely something to be grateful for, especially since many of our elderly remain healthy and active. But our modern health care system has also made it possible for a person to survive with multiple chronic, deteriorating conditions. This, in turn, has expanded the need for end-of-life planning and palliative care for a broad range of conditions. Unfortunately, Canadians rarely discuss death or prepare for the end-of-life.
Many doctors haven’t learned how to lead discussions about death with their patients, while most patients don’t want to talk about it with their doctor. Yet the inescapable fact remains that the mortality rate for humans is 100 per cent.
Since the introduction of antibiotics, societies have had an abiding faith that scientific medicine will overcome disease. The data suggests that when critical illness is at hand, people often do want many forms of aggressive medical treatment.
Why should anyone accept death when it can be postponed? The fear of dying is powerful. Our health care system has responded to this demand. Questions about quality of life and end-of-life care are secondary and poorly supported.
There are consequences for both the patient and the budget. The application of high–tech medicine has saved many lives, but at other times has ruined the dying process.
For example: “What if the patient does survive his high-risk surgery, but then has a long, painful post-operative course? On discharge from hospital he needs help with the activities of daily living, feels that he is a burden to his family and is eventually confined to a nursing home.”
From a financial perspective, researchers in Manitoba found that inpatient hospital expenditures for patients in the final six months of life consumed 21 per cent of the provincial health budget.
Death used to occur at home amid a circle of family, friends, and children. The process was usually short.
Now, dying can be lingering and painful. While most Canadians desire to die at home, nearly three-quarters die in hospital and 20 per cent of these in intensive care units.
It is not unusual to see people dying in hospital rooms without privacy, without support for their needs or the needs of their family.
I have written this column based on the medical literature and on two major reports: Senator Carstairs’ 2010 Raising the Bar: A Road Map for the Future of Palliative Care in Canada, and, The Royal Society of Canada’s Expert Panel’s 2011 End of Life Decision Making.
It is also based on my 30 years of experience as a critical care physician. I will continue exploring these issues in future columns.
Dr. Peter Zalan is president of the Health Sciences North medical staff and co-chair of the Sudbury ALC Steering Group. He writes monthly columns for Northern Life about the health care system.
Posted by Laurel Myers
