Film provides lesson on dignified dying

Did you see “Cas and Dylan” at Cinéfest? Cas is Dr. Cas Pepper who gets bad news — he has a malignant brain tumour.

He refuses admission to hospital, surgery and radiation. Instead, he plans the time and place of his passing. Using the medical knowledge unavailable to most of us, he ends his life peacefully, without need of assistance from others.

A real-life physician, Dr. Donald Low, died recently from a brain tumour. His obituary was published in the Globe and Mail.

“Don was afraid of a prolonged period of being totally dependent on his family for his most basic needs,” the obituary reads. “Don found it impossible in Canada to avail himself of assistance to die with dignity.”

You can listen on the web to his YouTube video shot eight days before he died.

The old textbook term is “euthanasia.”

It’s defined in the Oxford English dictionary as ‘bringing about a gentle and easy death, especially in the case of incurable and painful disease.” The practice has long been considered unacceptable for physicians. Hippocrates is said to have written, “I will give no deadly drug.” Nevertheless, there is now increasing support for the legalization of assisted dying.

Let me describe what is legal in Canada.

A 78-year-old man is admitted to hospital after a fall at home. His physicians diagnose advanced lung cancer. They discuss the various treatment options with him, including chemotherapy.

He understands the chemotherapy has a 70-per-cent chance of extending his life by two years. He refuses treatment and indicates he wants to go home.

Is it legal for physicians to respect this refusal, knowing treatment could extend his life?

Canadian courts have recognized the right of patients to refuse consent to medical treatment or to demand that treatment, once commenced, be discontinued. This right has been recognized even if it may result in death.

A 75-year-old man is dying of stomach cancer. Despite being on morphine, he is suffering greatly. The physician explains to the man’s daughter that further increases in dosage may, in fact, shorten her father’s life as morphine can depress breathing. The daughter begs the doctor to increase the morphine anyway, saying she cannot bear to see her father suffering.

The provision of potentially life-shortening symptom relief is legal — if the intention is to ease pain and suffering. If the intention is to shorten life, the action is illegal.

Is there more to Dr. Pepper’s case? Maybe.

If we sometimes turned down the big surgery, if we chose against a feeding tube, if we say no to chemotherapy, there might be less need for contemplating dying poorly in indignity. The time remaining may be better spent at home in the midst of family, sharing memories and saying words that should not remain unsaid.

We should ask about choices. There are often treatment options, ranging from doing everything technologically possible to a blend of therapeutic and palliative measures that will best preserve the individual’s quality of life to concentrating on comfort measures and palliation that will ensure a good death.

While we debate the role of assisted dying in Canada, know that we do have the legal right to refuse things be done to us.

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.