Wednesday, February 12, 2014

24 Hours in Emergency: Is the Quebec Healthcare system ready for euthanasia?

By Amy Hasbrouck

This weekend I had cause to wonder whether the Québec health system will be able to prevent unnecessary deaths under Bill 52, a bill that would allow euthanasia. I accompanied my husband who spent 24 hours in the emergency department at our local hospital. Our experience raised a lot of questions, even if it was not especially negative, and probably fairly typical. I wondered how a health system that is overburdened, with staff who are overworked, in facilities that are overcrowded, can implement the necessary safeguards to protect people from abuse of euthanasia. 

On February 9 at 4:45 p.m. my husband, who has chronic pain in his back and knees, was suddenly seized with pain in his hip worse than a broken bone or a kidney stone. He took his prescription painkillers for extreme back pain (no effect) and I called the ambulance. Once at the hospital, he was put on a gurney in an alcove. It was 5:30.

I asked a couple of employees about getting something for his pain. I was told a nurse would come as soon as possible. Water, was refused him by staff as a doctor needed to see him first. At 6:10 my husband swallowed dry more of his painkillers.

Shortly after that, a nurse gave him a shot of Dilaudid. He had been in agony for ninety minutes, more than half of that at the hospital. I thought: 
“could this health care system handle the kind of pain that would quality Québécois for euthanasia?”
At around 9:30 the Dilaudid started to wear off. A préposée helped my husband undress for the X-ray and medical exam. Her brusque, rapid movements hurt him and sent the pain level back up. He was given more painkillers.

The doctor came at 10 to conduct a brief exam. Then as the préposée wheeled my husband out for an X-ray, she chided him for his request that she take care not to bump the gurney. After that, I sat with him until he began to relax. I then went home to sleep, hoping he would receive his next dose of painkiller.

When I returned in the morning, my husband’s pain had reduced. A different doctor told him the X-rays were normal. After breakfast, a third doctor asked him to try sitting up, and listed the medications he had been prescribed during a 30-second visit. My husband was able to sit, but not stand. We did not learn if, when, and how he would be sent home, or with what support. 

At around 10:30 his gurney was moved to a hallway to free up the alcove for someone else. He joined the more than 20 people in the hallways, overflowing the capacity of both facilities and staff.

Many elderly people were on the non-trauma side of the emergency department, who seemed familiar to the staff. Several appeared in physical or emotional distress, few had anyone to accompany them.

The staff were always in motion. The vast majority were kind and helpful, everyone was overworked. The facility was as clean as it could be considering the volume of people passing through.

Earlier this year, the Journal de Montréal and TVA Nouvelles reported on the overburdened emergency department at the Hôpital du Suroit in Valleyfield. The emergency unit is designed to accommodate 22 people; there were at least twice that number this weekend. This situation is so chronic that the corridors have numbers on the walls to indicate where people’s gurneys are parked. A few have privacy curtains, most don’t.

Geneviève Boileau of the Suroit CSSS is quoted by TVA as saying that the overflow is largely due to the lack of long-term care options for elders, who occupy acute-care beds that would otherwise be available for people who come into the emergency department. I wondered how the quality of life of those people might be improved by having services in their own homes.

After lunch my husband stood up again briefly and took a few hesitant steps, but couldn’t go as far as the washroom. I asked the receptionist if someone could bring his medication, which he hadn’t had for four hours. A nurse deposited the pills on his table half an hour later, after I asked again. The receptionist did not know when a doctor would see my husband, and would not find out.

At 4:30 my husband was able to walk to the washroom aided by a walker we requested. At a little after 5, I asked again whether and how my husband would be able to go home. I was told a nurse would have to make that decision, and would come to see him. An hour later a nurse affirmed that my husband was free to go since he could walk to the washroom. The nurse said no referral for chiropractic or physiotherapy had been prescribed.


I wondered what happened to people who don’t have someone with them, to make sure they got their pain meds, water, a walker, etc.

I wonder how the factory-like environment of the hospital affects the morale of the staff and the self-esteem of patients. Can we really be sure that the health and social service system is not making life intolerable for people, then killing them because they suffer?

Amy Hasbrouck is director of Toujours Vivant-Not Dead Yet, a project of the Council of Canadians with Disabilities whose goal is to unify, inform and give voice to the disability rights opposition to euthanasia and assisted suicide.

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