CCBI News – Decisions—Palliative Care; Mental Health Problems, Euthanasia; Aging Well—Denmark; Indigenous Health

March 25, 2022

Dear Friends of CCBI,

Information to Make Decisions About Palliative Care

Using a slightly unusual reference, this week I’m quoting an article, “MAiD and Palliative Care in Canada,” posted on ehospice, a website that posts articles on hospice and palliative care from around the world. Its main emphasis is on the need for good palliative care, which is the stance usually expected from the hospice movement. This particular article is from Canada, however, and the author takes a seemingly non-committal approach to euthanasia, leaving the ‘choice’ to the individual. BUT, and this is important, she writes: “In the earlier stages of a progressive life-limiting illness, patients should be invited to understand how their storyline and timeline is likely to unfold; what the various stages of the illness will look like; the anticipated hurdles and illness milestones; how to prepare for the illness to change; what natural death does and does not looks like; what supports are and are not available; options for place of death; and the role of palliative care. Only then can someone truly provide informed consent for MAiD. ” I object to the last sentence, of course, but the author is correct in stating that this is information everyone should have: it is vital in making decisions about palliative care. It is not just a solid basis for informed consent for euthanasia, and the author is clearly saying that full information is not always given and there are other ways people can be helped at end-of-life, beyond being ‘aided’ to end it. As Catholics, we need to know how to plan this all-important stage, and how reassuring it would be to be provided in advance with such full information about palliative care and its possibilities! We continue to reject euthanasia in its many guises: we do not need ‘MAiD.’ Rather, we want to know what to expect in palliation and we need to be reassured that we will not be alone on the journey.

Mental Health

Another article in ehospice discusses the rapid escalation in mental health problems exacerbated by COVID-19, leading to an increase in demands for help, including counselling by chaplains. Society has rightly focused on nursing and medical staff, but has forgotten spiritual helpers. The author tells us that because of the pandemic: “Chaplains have rallied along with mental health professionals to respond, and a survey revealed that although only 12% work in mental and behavioral health facilities, a whopping 70% report spending 25% or more of their time interacting with patients and clients around anxiety, depression, fear, anger, life and relationship stresses, loneliness, addiction, suicidal ideation, and spiritual distress… Almost half of the chaplains surveyed report spending 25% or more of their time supporting colleagues experiencing issues such as emotional distress, burnout, compassion fatigue, and work and home related stresses.” The article drives home several points, first of which is the burning need in society today for spiritual and psychological care. Added to that is the scale of the sheer number of people needing help. Some already had mental health problems, and many others, including overly-burdened healthcare professionals, have also been showing symptoms of distress. Further, the article indicates that not all chaplains are trained in these areas but are pressed into service, given the need for help. More education is clearly needed for their sanity and effectiveness as well as for the people under their care.

All of this should further alert us to the tsunami of mental health problems facing us. Canadian mental health agencies have tried to warn us and to prepare for this, but it’s well known that the budget for mental health is already underfunded. How are we to cope with the numbers in need of help? The article tells us: “Many people no longer see the world as a fundamentally safe place under the eye of a benevolent God who ultimately wants the best for us. Faced with loneliness, isolation, fear, and anxiety, as well as the unfathomable grief that follows sudden, indiscriminate death, many people now struggle to make sense of their experiences during the pandemic and despair of life ever returning to normal again.” These problems raise the spectres of suicide and euthanasia, so what can the rest of society do to help? We could urge government to take these problems more seriously in budget allocations; as individuals, we could contribute more to mental health agencies through volunteering and financial support; we could raise awareness of these illnesses and addictions and try to overcome the stigma still associated with them; we could provide further education in our parishes, church groups and schools. None of these is dramatic and each one is possible…

Euthanasia and Mental Health

Considering the rise in mental health challenges, it is all the more disturbing that in 2023 Canadian law will allow ‘MAiD’ for people with such issues. This move has been hotly contended by prolife advocates and by many mental health professionals and agencies, including CAMH, who see the obvious problems about capacity for consent, the effects of depression on decision-making, the possibility of remediation, and so on. The government, however, is intent on fulfilling its agenda on euthanasia, perhaps judging that society will gradually move towards ‘choice’ in this area, as happened in abortion. An excellent article by Dr Ramona Coelho and her colleagues John Maher, Trudo Lemmens and Sonu Gaind, rejects this extension of the law both in principle and because these mental health illnesses are neither terminal nor incurable. The authors remind government and society: “The impossibility of assessing irremediability is absolutely particular to those with mental disorders and thereby singles them out as a distinctly identifiable group. Failing to recognize this difference is discriminatory and exposes these non-dying Canadians to unjustifiable deaths.” This is absolutely the case and we should register our own objections with our MPS and provincial medical regulatory bodies, not to mention the various Law Societies in Canada.

MAiD and palliative care in Canada – ehospice

Equipping Chaplains for the Current Mental Health Crisis – ehospice

Missing the mark on a profound social change with MAiD for mental illness – The Trudeau government rushed legislation for political reasons. Defenders of the law invoke the right to equality while ignoring danger.

Aging Well in Denmark
Dr Rory Fisher

Denmark provides excellent services for the elderly as part of their National Strategy to allow seniors to age in place with self-reliance, dignity, and self-respect.

The advantages of the Danish approach are well known to Canadians working with the elderly. The Canadian Frailty Network (CFN) arranged a visit to Denmark in 2017. A detailed report is provided on the CFN website entitled “Learning from the Leaders: a knowledge exchange with Denmark.” This provides a comparison between the Canadian and Danish Health care systems. The “Ageing Well Report” from Queen’s University in November of 2020 also details the advantages of the Danish approach. The Danish programs are very favourably mentioned in Andre Picard’s book: “Neglected No More”.

Danish legislation in 1987 prevented the building of any more conventional long term care facilities. Home care is covered by the health insurance program and is available on prescription from a family doctor. Provision of this care is provided by the municipalities. Services are available on a twenty-four-hour basis, and include nursing care, personal care, practical assistance (meals, help in the home) day care, transportation, and home adaptations, all provided with integrated and coordinated management. Short term rehabilitation programs are available for seniors with serious illnesses, or who have been discharged from hospital. Family caregivers may take up to nine months of paid leave to care for a family member. There are annual preventive nursing visits for all those over 75. These comprehensive services allow seniors to age in place with dignity for as long as possible, decreasing the need for institutional care, and relieving pressure on Acute Hospitals.

The Danes are not content to rest on their laurels and introduced a white paper in 2019 entitled” A Dignified Elderly Care in Denmark”. This shows how innovative technology is being used to assist the elderly to stay in the community. These innovations will be addressed in a future newsletter.

As mentioned above, the advantages of the Danish approach to dignified aging in place for the elderly is well recognized by Canadian experts in the field, who have been advocating for similar programs in Canada. The challenges to the health care system will become more marked because of increase in the aging population. Despite this advocacy, politicians and policy makers have not responded with a necessary major investment in home care. If not now, when?

See also National Institute on Ageing (nia-ryerson.ca) for articles on ageing in Denmark.

Denmark’s Long-Term Care System Provides a Dignified and Affordable Way for Older Adults to Age in Place

See remarks by Dr. Samir Sinha, NIA Director of Health Policy Research [who] says, “In Denmark, the elderly live at home in safe homes for the elderly for a longer period of time, and wide doors and large bathrooms have been provided so that there is room for wheelchairs. We do not see that in Canada.”

Colonization And The Health Of Indigenous Persons
Bridget Campion PHD

In a recent Bioethics class I asked students to identify factors beyond medicine or genetics that contribute to health and wellbeing. The list they came up with included: exercise, a good diet, shelter, clean air, safe neighbourhoods, access to greenspace and nature, having friendships and social connections, having meaningful work and an adequate income. This resonates with the conditions necessary for health listed in the World Health Organization’s Ottawa Charter for Health Promotion: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity. These are social determinants of health, that is, physical, environmental, economic and social conditions that affect human health and wellbeing.

I had occasion to watch “The Social Determinants of Health from a First Nation Perspective”, a video prepared by First Nations Health Council, which provided another point of view. As Gwen Phillips, a member of the Ktunaxa nation, explains in the video, for those who continue to live with the devastating effects of colonization, the conditions necessary for health and wellbeing are much more fundamental. For Indigenous persons in Canada, they include reconnection to land and language.

Land is often valued for what might be built on it or for what it contains. For Indigenous persons, land has a very different meaning. It provides the basis for profound personal and cultural identity. According to Phillips, Indigenous people are connected to the land – to the landscape which provides location and orientation, and to the earth which provides nurturing and life. Arising out of this connection in an organic way is the commitment of Indigenous persons to being stewards of the land, cherishing and protecting it. There is a living relationship between Land and Peoples. To have the land torn away from Indigenous Nations is to have identity, sustenance and vocation torn away as well. The suppression of Indigenous language similarly works to eradicate personal and cultural identity. The loss of these very basic foundations, as Phillips explains, leads to personal and cultural crises that are manifested through disease, poor coping skills, and shattered families and communities. It undermines identity and connectedness, both essential to health and wellbeing.

Reconnection to land and language was not on the lists drawn up by the Bioethics students or by the Ottawa Charter for Health Promotion and yet it is fundamental to the health of Indigenous Peoples. This serves as a reminder: in determining the social determinants of health, all voices are needed.

First Nations Health Council “The Social Determinants of Health from a First Nation Perspective” https://www.youtube.com/watch?v=aD-wYpDsooQ

Ottawa Charter for Health Promotion https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference

Pope’s Intention for March

We pray for Christians facing new bioethical challenges; may they continue to defend the dignity of all human life with prayer and action.

Mary, Queen of Peace, pray for us.

Moira, Bambi, Bridget and Rory