All I want is a good death. Is that too much to ask?

Like most Canadians, I’d like to die in my home surrounded by friends and family.

Or second best, a home-like setting like the lovely Kamloops Hospice House.  That peaceful setting is where my wife spent her last days as she was dying of cancer.

Kamloops Hospice House. image: CFJC Today

But contrary to Canadian’s wishes, only 15 per cent die at home.

More often we die in hospitals; more than comparable countries.  Most Canadians, 61 percent, die in hospital. Far more than the Netherlands at 30 per cent. And although we like to boast about our health care system, only 20 per cent of Americans die in hospitals according to a report from the C.D. Howe Institute (Globe and Mail, Oct. 26, 2021).

We die in hospitals in the most unpleasant way, hooked up to tubes and machinery that unnecessarily delays the inevitable. Our lives may be prolonged slightly but the declining quality of life is hardly worth the price of suffering.

Canadian cancer patients have the highest rates of hospitalization in their last six months of life (87 percent), compared to England (83 percent), the Netherlands (77 percent) and the US (75 percent).

It’s so unnecessary.

Cancer patients whose condition is stable or reacting positively to treatment don’t require hospitalization. Those dying of cancer, as was my wife, typically require assistance with activities of daily living only in the final weeks or months of life. Terminal cancer patients differ from those dying of almost every other illness -those dying of other illnesses typically require assistance for many months or years before they die.

Older Canadian cancer patients are more likely to die in hospitals and less likely to receive palliative-care.

Palliative care primarily focuses on improving comfort and quality of life, often avoiding hospital-based, invasive, costly and potentially inappropriate care. Palliative care is preferably delivered outside of acute care settings, including in patients’ homes.

It’s not the fault of doctors in hospitals or because healthcare workers are unfeeling or uncaring. It’s because of the way the system is structured.

There are too few palliative care beds.  Canada has one-half the number of hospice and palliative-care beds as the United Kingdom. 

Treating patients at end of life in hospitals, rather than palliative care beds, is expensive.

Our per capita hospital costs are US$21,840. Canada’s costs are 18 per cent greater than that of the U.S., 100 per cent greater than Netherlands, and 233 percent higher than England. Canada’s relatively poor performance in terms of costs and quality of end of life care is clearly related to the high use of hospitals.

The authors of the report suggest the following remedies:

1 Canada must stop treating end-of-life care as acute care.

2 Palliative and end-of-life care must be provided across multiple healthcare settings. It cannot be the sole responsibility of hospices and palliative care facilities.

3 Training for clinicians, caregivers, even for patients must be provided recognize the end of life period.

We must have a frank discussion about death. Unless we know the signs of death’s knock on our door, we will be poorly prepared.

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Continental divide with U.S. widens

We used to think we were becoming more like our American cousins. In 2002 58 per cent of Canadians thought we were; now it’s only 27 per cent.

    “Weirdo” image: CBC

There’s more to the shift than the election of President Trump. We are maturing and are more confident. And it has to do with the realization that we are fundamentally different.

Those differences are revealed in response to a relatively simple statement: “The father of the family must be master in his own house.”

Because values are clustered together, response to that statement reveals other values says pollster Michael Adams: “Patriarchy is only one of more than 50 values we track, but it is clearly among the most meaningful. It is also a value that is highly correlated with other values such as religiosity, parochialism and xenophobia, and views on issues such as abortion, guns and the death penalty.”

American response to the statement cycles up and down. When asked in 1992, 42 per cent agreed. Support for patriarchy went up during the Bush presidencies and back down to 1992 levels during the Obama years. The election of President Trump has restored patriarchy to record highs.

Canadian response has been relatively constant for decades -in the low twenties.

It’s a versatile analysis. It also reveals the degree that immigrants adopt Canadian values. Thirty-five per cent of Canadian immigrants agreed with statement; not surprising when most immigrants come from male-dominated countries. In the U.S., substantially more immigrants agree with patriarchy at 56 per cent, even though they are from the same countries as in Canada.

I’m impressed with the way that Adams has of cutting through the clutter of public opinion. I wrote about his research in 2004 in my column for the Kamloops Daily News . Back then he was examining the connection between patriarchy and religiosity. “Canadians have more confidence in their ability to make moral decisions without deferring to religious authority,” said Adams.  As a percentage, twice as many Americans go to church weekly as Canadians, twice as many believe the Bible is literally true, and twice as many say religion is important to them.

In the same column, I argued that the continental divide is marked by something other than just the U.S./Canada border. Progressives on both sides of the border share the same “country.” I find that when I talk to people in the U.S. states of the Pacific Rim, they sound remarkably Canadian. Adams recent research confirms that progressive/populist divide in the U.S. Support for patriarchy is less strong in the coastal states than the Deep South.

Swings in U.S. support for patriarchy reveal a national insecurity. Psychoanalyst Robert Young has studied the psychology of populist movements. “When people feel under threat,” says Young, “they simplify; in a reduced state people cannot bear uncertainty.”

This siege mentality that currently grips the U.S. under Trump indicates just how insecure some Americans feel. Before 9/11, fundamentalist saw modernity and pop culture as a threat to core values. After September 11, the threat became global with the loss of jobs overseas.

The reasons why Canadians don’t want to become more like Americans is becoming ever clearer, as are the reasons why some Americans appreciate Canadian values.