What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Monday, January 30, 2006

More on Assisted Suicide

Why is it that we humans always want to “put the cart before the horse”? In today’s Calgary Herald there is a front page story about Dr. Jose Pereira leaving Calgary and taking a position at the University Hospital in Lausanne, Switzerland. Apparently, assisted suicide and euthanasia have been approved at this University since Jan.1st of this year and they are bringing in Dr. Pereira as a counterbalance to their euthanasia policy. Dr. Pereira has stated: “you can’t engage in physician assisted suicide until you’ve provided good and adequate palliative care. In most cases, when the patient receives palliative care, they rescind the request for euthanasia”. However it would seem that, in fact, the University Hospital in Lausanne, Switzerland, has in fact “engaged”!
It should be stated that palliative care does not simply refer to end stage cancer care but to any and potentially all disease conditions that can be terminal. Thus it has the potential to be an enormous part of any health care system. But why didn’t the Swiss bring in Dr. Pereira FIRST, then, after implementing an aggressive palliative care program, look at the need for euthanasia and assisted suicide. Would not the criteria and laws pertaining to these activities be more specific and appropriate? Previously I spoke of Calgary’s palliative care program starting with an acknowledged need in the community by the people and the caregivers. It then grew into a very treatment effective and cost effective program capped finally 4 to 5 years ago with the recruiting of Dr. Pereira at the University level. Its success was a needs driven, not cost driven initiative and now other countries are looking at it as a model. Yesterday, I talked about the case of Mrs. Houle who assisted her son in committing suicide. What a travesty, but what a flagrant example of a community health need that was not addressed in a timely or appropriate manner.
Dr. Hamilton Hall, the Back Doctor, once told me that he did not give pain pills to his back patients on their first visit to him. Instead he prescribed a battery of exercises and activities to relieve the pain and would see the patient in 24 to 48 hours. At the second visit the patient would have experienced some relief and would be a believer in the exercise program and carried on with it. If he would have given pain pills on the first visit, the patient would have been a believer in the pain pills and compliance with the exercise program would have been poor. The conclusion is: the best program is not always the easiest or the quickest and conversely, if the easiest and quickest is experienced first we may never implement the best. Personally, I believe that if we as a society can afford a trial that involves a twelve member jury, lawyers, judges, and millions of dollars of expense to decide the loss of a person’s freedom for two or three years, we should be able to afford a pretty complex “decision making” system before someone’s life is taken from them, albeit with their consent. Is it my paranoia or do we rush into the quick, easy, and cost effective solutions in our thirst to preserve Canada’s Medicare system in its present state? Are there possible alternatives that are difficult, compassionate, slower, and possibly even more cost effective? This directly relates to our discussions tomorrow on sustainability of a Universal Health Care System.

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