Monday, August 24, 2009

Palliative Care Expert: The Terminally Ill Do Not Get Optimum Pain Control

An article in the Montreal Gazette quotes Dr. Balfour Mount, the founder of Palliative Care services at the Royal Victoria Hospital:

Unfortunately, most of the dying do not get palliative care or have access to optimum pain control, he said.

Palliative experts have become very good at treating pain by switching and combining classes of medication so that most patients remain pain-free and alert.

"So the option for society is how do you make that available," he said.

Although framed as a compassionate concern for the suffering of others, doctors that increase morphine and other analgesics to toxic levels "reveal ignorance and lack of training. Why would you legalize killing somebody to fix a problem? What if it was an in-grown toe nail?"


People want relief from pain, depression and isolation, and it's a rare situation where nothing can be done, Mount said, including offering palliative sedation when other options have been exhausted.

But that's not the same as euthanasia, he said. "The intent is not to shorten life but to provide quality life."

Among the risks of legislating euthanasia is that safeguards aren't fail-proof, he said, including that the decision respects the patient's wishes.

Mount recalled a patient with advanced cancer who didn't have long to live. His wife asked for help to die.

"They were married 50 years, a great warmth between them. She was sitting by his side and holding hands (with him). She was speaking on his behalf ... 'After two years of battling cancer, Joe has had enough, he's had a wonderful life but he's tired.' "

Mount returned to Joe's room later and suggested that perhaps on some level Joe felt like he was being a burden to his family. "And Joe started to cry, and said, 'That's exactly right.' There had been an unconscious pressure on this man to feel that euthanasia was an answer."