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?

Wednesday, November 28, 2007

Dying With Dignity

From where I sit the above expression must be an oxymoron. Who, these days, dies with dignity? No longer do men dual with pistols for the maiden’s virtue or the honor of their family. We seem bent on criticizing the people who defend our country and often loose their lives in doing so. And our sick and dying, in this country of plenty, rely largely on their family and loved ones to care for them in community beds that are conscripted by the system. Don’t misunderstand me; patients should have the option of dying at home, but how about taking the cost of an acute care bed and transferring that cost allowance to the patient and his/her caregivers. Why should the system benefit from conscripting loved ones?
Perhaps we pride ourselves in the fact that we now can keep most patients reasonably comfortable during their terminal illness, but here is a news flash: “There is more to suffering than physical pain, and there is more to maintaining ones dignity during the dying process than crying with pain”.
I suppose at any time in our lives we could take the attitude that we are dying, and in my experience, some people seem to have that attitude (these are the people that most of us would rather not hang out with, no matter the age); but there is something about dying over a short period of time that is demoralizing. How does one maintain their dignity when one month you are an independent, self reliant individual and six months later you are dependant on a caregiver to attend to any and all of your basic needs, even the simplest thing (sitting propped up) without feeling shaky, insecure, and anxious? How can one maintain their dignity when one cannot pull covers up to be warmer in the night without help, not to mention toiletry and other personal hygiene issues?
Yes, we still have a long way to go in medicine before we can make claim to the expression “Dying with dignity”. Oh, I know. We can say that dignity comes from within, but what are the ingredients of that dignity. I would venture to say that each person is unique in what comprises their dignity. Certainly in the old west the cowpokes wanted to “die with their boots on”. To me this meant that they wanted to die doing what they enjoyed doing, certainly not dying in a bed. Some people loose dignity when confronted with pain, some in loosing their independence, and some simply by watching themselves deteriorate in appearance. Others seem to maintain their dignity in spite of all the things mentioned above.
Recently I have been given an example of dying with dignity. In spite of all of the above and more, this person maintained her dignity through the love of her family and friends and her ability to love them in return. She went through the various treatments, suffered their side effects, and tolerated the disappointments, because she still was able to love and be loved; and when this was no longer possible, she took control of her situation, stopped the intake of all fluids and died quietly within five days. She knew that even healthy people die within a week or so without fluids. She made the decision; she took the responsibility. She didn’t want or ask for someone to “assist” her “suicide”. She asked only for comfort measures; and she didn’t whine about the fact there is no “euthanasia” law in Canada. She died in the arms of her loved ones, in her home, in her bed, with dignity. The last thing she would have wanted was for that final control to be given to the state or some other person. And we should all say “Amen” to that.

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