This is a piece that I wrote and was published in the London Free Press back in March 2005

An Ipsos-Reid poll conducted last fall revealed that although 95% of Canadians would like to die at home, 75% continue to die in hospital.

In the discussion about the future of our health care system, governments and society continue to skirt an issue that is important, not only in the monetary sense, but also in a wider societal context. This is the issue of end-of-life care and decisions regarding resuscitation.

Possibly no decision is harder to take than the decision to forego potentially life-sustaining treatments. Nevertheless, the stark reality of life is that it must, at some point in time, come to an end. The question for us in Canada in the 21st century is how life comes to an end. We now have at our disposal a nearly endless array of technologies that can sustain some form of life. We have devices that can assist the failing heart, others that replace the kidneys should they fail, ventilators to do the work of breathing when the lungs can no longer do so.

As health care professionals, we institute these treatments with conviction and ardour when we believe that the illness at hand is transient. An otherwise healthy person is struck down prematurely with a life-threatening illness and needs intensive support in the hope that he will recover after a period of hospitalization. But what happens when the underlying illness is not transient? How should the medical system react to the individual with terminal illness? Should we “pull all the stops” and aggressively institute life-sustaining therapies in the case of the individual who is dying from an irreversible illness? If we do that, how will this person die? Certainly not in the comfort of their home, in their own bed, surrounded by family, friends and loved ones. Given our technology, we condemn that person to die in a hospital bed, on a ventilator, surrounded by machines, infusion pumps, alarms and strangers.

Yet the majority of Canadians do not seem to want to die in that manner. This is not an argument for euthanasia or physician assisted suicide. This is about acknowledging that despite the best medical advances we can marshall, we have not, nor we will ever conquered death.

So if a majority of Canadians want to die at home, why is this not happening? Many people, even those with terminal illnesses, have not had frank, open discussions with their families and physicians. It is always somewhat jarring to find out that the family of someone with terminal illness is completely unprepared for their loved one’s death. Second, many patients and their families do not know what to do when a catastrophic event strikes. Calling 9/11 inexorably activates a sequence of events that leads to the placement of the patient on life support systems even if they had previously stated their desire not to have that done. Finally, there is a lack of resources to aid people in coping with dying at home.

How do we solve these problems? I recently heard on a local radio station that a man had “do not resuscitate” tattooed across his chest. The man was a retired paramedic and had himself resuscitated too many people who had advance directives to the contrary. The patients’ wishes were simply not declared to the paramedics.

Granted such a step is extreme. However, it is important that each and every one of us has that frank and open discussion with family members and loved ones about what we want done at the end of our lives. We may decide that resuscitation is appropriate but that prolonged life-support in the face of little hope of improvement is not. We may decide that, when the moment comes, we would not wish to be resuscitated. If so, steps have to be taken to facilitate dying at home. Physicians caring for a dying person can help in accessing resources such as the community care access center and the palliative care team who can support the patient and family during this difficult time.

No one wants to die. But when the time comes, and it inevitably does, it must be resolutely confronted.