Tuesday, August 20, 2013

Dr Balfour Mount: Reflection on palliative care and euthanasia.

The following article is an excerpt of an article that was published in Le Devoir on February 1, 2010. This article was translated by Google translate.

Dr Balfour Mount
[...] In 1973, Dr. Balfour Mount, surgeon clinical urology oncology at the Royal Victoria Hospital undertook a study on the care of terminally ill patients in their institution. The observation was troubling. "I knew the hospital staff were very knowledgeable, caring and provided the best possible care to their patients. Medical technology, we implemented fine, but we omitted the fact that there is a significant difference between the pathophysiology of the disease on which to focus our efforts and the subjective experience of the disease that is influenced by what we are as a person. 

Because there are physical, psychological, social, spiritual aspects, or financial, that affect this experience," said Dr. Mount before recalling that "when we cannot hope to extend the life, the goal is to improve the quality of life, which is specifically the goal of palliative care. However, patients were often told that we could not do anything for them. It made them feel that they occupied a bed that we needed for a patient who we could do something for," says Dr. Mount. "This attitude reflects our lack of understanding and ignorance of what can be done for those patients who are the sickest in our health system. We did not satisfy the psychosocial or physical needs of these patients. No one had looked at what could be done for the adequate control of symptoms, including pain, in this patient population." 

Doctors, who were unable to admit to the family that there was no hope for the patient offered another chemotherapy, not knowing what else to do. "Requests for euthanasia often result from a rejection of the aggressive and inappropriate care," says Dr. Mount, for whom euthanasia is totally incompatible with palliative care, although he concedes that both aim to reduce suffering. "The length of life is beyond our control, and it is not for us to decide," said Dr. Mount, for which the legalization of euthanasia would place the most vulnerable in our society at danger as people with disabilities and the elderly, sometimes feel like a burden to their family and society.

Precious time

The last weeks of life are "the most precious time of family life" because this is when people resolve the unresolved cases where we can say the love and attachment that is brought to the family. "This is an important moment of sharing that can soften the death of the person who is dying and who can make the next 40 years calmer and happier for those who survive. This time holds tremendous potential that is lost if the person were euthanized," said Professor Mount lamenting the fact that death is a topic taboo in our society. "We must help people to dramatize death. It must make them see death as a natural phenomenon, a normal event," he said. 

Dr. Mount is shocked to hear leaders of hospitals still say that palliative care is expensive, implying perhaps then that euthanasia would likely reduce costs. He is outraged by the falsity of such a claim, he has clearly demonstrated 30 years ago, the effectiveness of a palliative care unit with a dozen beds at the Royal Victoria Hospital and a program of home care services to the island of Montreal that was intended to help people die at home. [...]

Teaching patients

Dr. Mount humbly spoke about his patients who were received the best teachings. One of them, a brilliant young man of 30 years, nicknamed Chip, a member of the Canadian Olympic ski team, which before his cancer "he looked like a Greek god and excelled in everything he did." He confided to Dr. Mount, shortly before his death, when he became skeletal as the survivors of Auschwitz, he "had the best year of his life." 
"I had a wonderful life, turned to the outside world. During this last year, I made an inner journey and it was the most amazing trip of my life, "he told him without the knowledge of his family." 

This patient has taught me that you can not judge the suffering of others" because, even in his terrible physical condition, dying became the best moments of his life. In his case, "his family probably suffered more than him," said Dr. Mount. The search for "meaning" in our lives is probably what most concerned about dying, says Dr. Mount. Some, like the skier Chip, find it within themselves. Others find in a narrow "connection with others." Many people establish this ("healing connection") with "music or some other form of art, or with nature", while many others find meaning through a "spiritual connection with reality Supreme" which can be "quantum completeness or god." In his study, Dr. Mount noticed that people who had found the sense of completeness lived a great inner peace and were not overwhelmed by anxiety and fear of death as those who had not found it. And to help them, Dr. Mount reiterates the importance of controlling their symptoms and to create an environment around them in their own image - and not one that is believed to be the best for them - allowing them to feel safe. He finally stresses the need to listen to the patient in order to help them find the kind of connection that soothes. [...]

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