How to die better

Some changes are positive, but some look frightening

It’s hard to fathom, but the once untouchable subject of death and dying is rising to the surface of the New Normal, rather like a prehistoric creature that has been growing for centuries and is now, finally, crawling ashore. It might be just a blip in the public conversation or the start of something good. It could even be one of the few positive outcomes of the Covid-19 nightmare.

In a death averse culture like ours, conversations about death generally don’t happen until it’s literally too late. But in a pandemic, death is ever present, and perhaps the daily reminders that people do die has made us less squeamish, more willing to confront the inevitable. So, when two stories about dying are published in the mainstream media in one day, something is happening. Yes, Virginia, on October 25th, CBC News and The Globe and Mail both published pieces on dying in Canada.

First off, there was Andrew Picard, the chief health correspondent for the Globe, with a story that demonstrates how Canadians excel at dying badly and in the most expensive fashion. While the vast majority want to die at home; only 15percent actually manage that, instead expiring in hospitals ‘over medicated and under cared for’. In the US, only 20 percent of the population dies in hospital, while 61 percent of Canadians, often unwillingly, end up there. The cost of dying at home and hiring much needed help are astronomical, clearly only for the wealthy or those who don’t mind being bankrupt at the end.

Canada spends more than any other advanced nation on end-of-life care, but we have so few actual palliative care beds that it’s a bad joke. The palliative care system, such as it is, is not part of the larger Health Care System. (It’s unclear why, but it is privately funded). Worst of all, the Long-Term Care facilities, the ones where nearly two thirds of all Covid deaths occurred, offer no palliative care facilities at all. This seems like a strange oversight, since most people who go there die within a few years. It was those facilities that kept dying seniors from their families while offering nothing much in terms of humanity and empathy. They are badly undergoverned in all provinces; in Ontario they had even stopped the regular inspections the provincial government is obliged to do. It’s no overstatement to say that dying in Canada is a lose/lose/lose situation.

Picard doesn’t explain why we persist with a system that is clearly unresponsive as well as expensive. He doesn’t mention legal Assisted Dying either, nor the other, admittedly limited option, which is to sign a Do Not Resuscitate Agreement while you’re still able. But at least he has started what is sure to turn into a longer ‘conversation’. And maybe there will be a shift towards a more humane and less costly way of dying. This is a much-neglected area of our beloved Health Care System. One can only hope that public awareness will pressure legislators to force the private as well as public long term care facilities to offer palliative care. But that could mean a long wait, this being change-averse Canada.

https://www.theglobeandmail.com/opinion/article-dying-in-canada-is-costing-a-fortune-and-worse-its-not-how-we-want-it/

Meanwhile, there are other ways to approach death and our final hours, and it is already happening. The second article, by Andrew Lupton of CBC News, is about assisted dying, legal in Canada since 2016 and updated into a better law with better protection, in March of this year. It’s not as if most Canadians choose this way to exit our planet, but the numbers are rising. In 2016, just 1000 Canadians chose that option; in 2020, just under 7,600 did. While still a controversial idea to some, the Canadian Medical Assistance In Dying (MAID) protocol looks like one of the very few positive achievements of the Trudeau government.  https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

But during the pandemic, it too became very difficult to do properly, pushing people to look for alternatives. The market is stepping in because nobody else is. It sounds a bit callous, but really, would you prefer to die in hospital, bristling with tubes and nothing but a sheet protecting your privacy? Details like that are important.

During the first part of the pandemic, many people were looking for a comfortable but neutral place in which Assisted Dying could be done and found few places willing to do it. In desperation, they approached funeral homes for help. They didn’t want it done at home for obvious reasons. They wanted a pleasant and neutral environment. A couple of funeral homes in Ontario decided that this was a service they were ideally trained to provide. One such place has already done 22 MAID procedures. They offer a well-appointed room, a TV that can show private photos, and they provide snacks and professional staff to help out if needed. This is something new, but it seems like a practical and sensible idea. Whether it will be adopted across the country remains to be seen. But perhaps it is a sign that Canada is moving towards finding more humane, affordable, and lasting solutions to the long-standing problems of end-of-life care. It’s a start.

Which brings me to the final, more bizarre aspects of how to care for the old. Japan has the most oldies on the planet, and being Japan, has come up with a robotic answer to our problem. Meet Sophia, the most lifelike and famous robot ever, and her pal Grace, specially designed to take care of the elderly.

Naturally, David Hansen, the owner of Hansen Robotics in Hong Kong and ‘creator’ of Sophia and Grace, had nothing but good intentions. I created Sophia to humanize robotics, he intones, apparently unaware that the road to hell is known to be paved with good intentions. Grace, Sophia’s dark haired medical twin, looks like a demonic offspring of the Addams Family, with something vaguely threatening in her dark eyes. But Hansen did succeed in making her very human, insofar as she can lie with the best of us. Asked by ABC’s Nightline interviewer if she had been vaccinated, ‘Grace’ replied YES, without batting a robotic eye. Well, that is reassuring.

Hansen sincerely seems to believe that ‘Grace’ can not only administer medical procedures but also alleviate loneliness, as he explains with that tell-tale gleam of the mad inventor in his eyes. He’s convinced Grace will administer robotic grace to us all and we will be so grateful, in the end.

I don’t know about you, but for me, I would rather die in the totally dysfunctional Canadian Health Care System than spend one hour in the ‘company’ of this female version of the Terminator. Please. I want our old, bad, human system back. Do not abandon me to these proto humans. They literally scare the life out of me.