Good evening.
It's a privilege to speak to you today in my capacity as an emergency and ICU doctor, as a scientist, and as an author of a book on how shifts in technology and society have changed our relationship with death.
Please accept my apologies for attending this meeting while on call in an intensive care unit north of Ottawa. I was invited to appear before this committee after I had committed to serving patients this evening during the Ontario health human resource crisis. Should I have to step away for a medical emergency, I hope it is only briefly.
In my 17 years as a paramedic and doctor, I have seen many people die, but the people I see die are usually different from those we think of when we talk about palliative care or MAID. Emergency department and ICU patients sometimes die slowly from chronic disease like cancer or congestive heart failure. Other deaths come quite suddenly and unexpectedly after a car crash, a severe infection or a ruptured aneurysm.
Many of my patients hope to recover fully and live a long life. To accomplish that, teams of doctors, nurses, respiratory therapists and other professional lifesavers jump into action using medicines and machines, scalpels and science to avert death and pull people back from the cliff's edge. But at the time we initiate resuscitation, the outcome is far from certain. Sometimes no amount of drugs or devices can save a life. Sometimes I cannot make you better.
A modern dilemma has emerged with advances in medicine, which has led to a crisis in dying. For some patients, after a while it become clear that the machines keeping them alive cannot help them recover but are preventing them from dying. Tethered to machines that have failed to restore their health, they exist in a lineal space between alive and dead. Many of us would not want to exist in this way.
Individual values and predetermined wishes are already used by hospital teams to place limits on medical interventions, set goals for care, and alleviate pain and suffering. The rub comes in that the well-intentioned application of technology to save a life often fails to do so but prevents patients from crossing the finish line to die with dignity and peace.
Some might argue that pragmatic similarities between MAID and our current practice of withdrawing life-sustaining technology exist. For some, withdrawal of technology results in nearly immediate death, and comfort is maintained with various medications. But for others, withdrawal of technology results in a lingering that is undignified and sometimes distressing. Even when technology is removed, death, though certain to come, can be slow to arrive.
It's my opinion that Canadians deserve to have a say in their own ending, because now, for the first time in human history, technology can and does prevent nature from taking its course. There is likely a larger role for MAID to play in acute-care settings where consciousness and the ability to consent are often compromised.
Adjacent to the question of MAID is the broader one of how we can better inform Canadians of their choices during unrecoverable critical illness and engage their loved ones in discussions around end-of-life values before tragedy strikes. The challenge that I believe this committee must consider is one that all Canadians must contemplate. Prognostication is often uncertain and always complex. Knowing when the likelihood of a successful recovery falls short of the medical team's capabilities and a patient's own wishes is fraught with difficulty.
I hope today I can assist your deliberations around how advance directives regarding medical assistance in dying can contribute to alleviating this modern-day death dilemma so that no Canadian dies too soon or too late.
Thank you.
