I've heard several times today and from various different witnesses the idea that there really is nothing we can do for existential distress, that there is no effective treatment and that there's no effective approach. I have to say, I've been working in palliative care for the last 35 years exclusively in the area of looking at end-of-life distress, existential distress, psychiatric and psychological distress.
For 15 years, I've been the co-editor of the Handbook of Psychiatry in Palliative Medicine, psychosocial care for the terminally ill. This is a book that will be coming out in its third edition this coming September with 45 chapters from various different experts around the world, so the idea that there is nothing that can be done is really something that I have to take exception to.
There is a massive literature that is out there looking at ways in which we can start to mitigate end-of-life distress. I'm also the co-editor of a regular journal called Palliative & Supportive Care, a journal that is entirely devoted to addressing end-of-life distress of the existential kind. This notion that MAID is the only card in our deck I think is terribly unjustified, and there are various different approaches that are available.
For instance, one of the things that causes a great deal of suffering in patients nearing end of life is an undermining of their sense of personhood, an assault on their sense of dignity, if you will, so we find ways to try to affirm personhood. This has us looking at everything from the attitudes and disposition of the health care provider, teaching them and training them that their own outlook and their own disposition can have a profound influence on the patient's sense of well-being and sense of dignity, to more formatted kinds of interventions.
One intervention we call the patient dignity question, where we ask about what we would need known about that individual in order to take the best care of them possible. It's an opportunity to put personhood on the radar.
Then there are a number of psychotherapies. I mentioned in my brief that I've developed dignity therapy, which is based on generativity and giving people an opportunity to leave a legacy. Gary Rodin in Toronto is developing CALM therapy, and Bill Breitbart at Memorial Sloan Kettering has been looking at meaning-centred therapy.
I would not want to leave the committee with the impression that this notion that there is nothing to be done about existential distress. Unequivocally, obviously, that is being done with some intent or purpose that I can't claim to understand, but we need to understand. We need to know that there's a whole cadre of professionals around the world. This is not just a Winnipeg event or a Canada event; this is a global effort to try to address, understand and mitigate distress that is being tested, by the way, with research, including randomized control trials that show its efficacy.