The quality of mercy

In their CMAJ commentary, Cook and colleagues1 point out deficiencies in end-of-life care in Canada, in particular that many people receive unwanted life support, and are cared for in institutions when they would prefer to die at home.

Unfortunately, the authors do not mention the obvious corollary to avoidance of unwanted life support, namely ending a life that is becoming more intolerable with each passing day. The lack of such an option in Canada must be a fundamental component of any discussion of end-of-life care.

It may be that skilled nursing and appropriate medication in a modern palliative care setting can alleviate most physical suffering. However, for some people, the chief misery at the end of life may not be from physical suffering, but from the loss of privacy, dignity, purpose and independence.

Even though suicide is a legal act, helping someone end his or her life remains a criminal offence. In spite of polls indicating that a majority of Canadians believe such assistance should be available if requested, the present federal government is clear that it will not change the law; the Canadian Medical Association also seems to prefer the status quo.

In the end, it all comes down to one simple question, “Whose decision should it be?” The answer can be found in another question, “Whose life is it?”