Self-administered death made easier

A new drug in Canada will make medically-assisted death easier. It can’t come soon enough.

image: Bayshore Healthcare

If I had a terminal illness that made my life a living hell, I would want medical assistance in dying (MAID). Since it has been legal in Canada since 2016, it should be easy. All I have to do is find a doctor who is willing to administer the drugs. And then make sure I’m living in the right place -that’s where things get tricky, as Horst Saffarek found out.

Horst Saffarek lived in a Catholic residential care facility in Comox, B.C. When his lungs began to fail, he wanted help in dying. The publicly-funded Catholic institution wouldn’t allow MAID at their facility, citing moral principles.

Horst was becoming frailer each day and breathing became difficult. His daughter, Lisa Saffarek, told CBC’s The Current:

“It’s scary, you know, especially when you can’t breathe, every moment is scary.”

Horst was faced with the choice of essentially suffocating to death or he could be transferred to a facility that allowed MAID. He was transferred to Nanaimo where he would have to wait ten days as required by law.

I can only imagine the terror that he was going through: struggling with every agonizing breath and seeing relief being delayed.

“Dad was obviously very frail,” said Lisa Saffarek, “We did need to transfer him. He was ended up, you know, his oxygen levels were falling, and we wanted to try and meet his wishes.”

The transfer from Comox to Nanaimo, an hour and a half ride by ambulance, was gruelling. Horst Saffarek died the day after the transfer without the comfort of MAID.

Not only was Horst Saffarek’s suffering needlessly prolonged, but his family felt anguish as well. Lisa and her sisters had planned to spend the last moments of their father together but they were robbed of that:

“But it just – it took away from us being able to celebrate dad and just to enjoy our last moments with him.”

The law protects doctors by allowing them to opt out of MAID. Institutions have no such legal option. Religious healthcare facilities receive public funding same way that others do. If a procedure is legal, and public funds are involved, how can an institution prohibit it?

In small centres like Comox, religious healthcare facilities are the only ones in town. Because they employees are not necessarily religious, and neither are the patients, the title “religious facility” loses meaning. In reality, they are public facilities with an historic religious origin.

The solution is to take matters into one’s hands. A new drug has been made available to make that happen. Secobarbital, the most common drug used in many countries, is now available in Canada. Unlike existing drugs that can take a long time, Secobarbital is fast-acting, doses are a relatively small in volume, and self-administration is easy.

Existing drugs can take hours, even days, to work. They taste bad. They don’t work if they cause nausea and vomiting, or when the patient falls asleep before consuming the large volume required.

For those who suffer from an agonizing terminal illness but live in remote or small communities where there is only one doctor who doesn’t provide MAID, or they live in a care home that decides to flout the law, Secobarbital could provide relief.

Horst Saffarek’s experience leaves me wondering why I should suffer the vagaries of the anachronistic legacy of institutions, and other’s moral values, that impose themselves on my life and death. Whose life is it, anyway?




No going back on abuse of women

What was once a trickle has become a torrent of reports from women of how they were groped, fondled, molested, assaulted, raped, and verbally abused; how they fought off the unwanted sexual advances of men.

   Sergeant Vicky-Lynn Cox. Photo: CBC

High-profile reports have come out of the entertainment industry. Actress Daryl Hannah told the New Yorker about the consequences of rejecting film director Harvey Weinstein’s advances: “We are more than not believed – we are berated and criticized and blamed.”

Harassment and assault on women takes a toll. Globe and Mail columnist Elizabeth Renzetti talked to dozens of women:

“Some of the women I heard from are in their 60s, 70s and 80s. The pain they carried through the years is palpable. In many cases, they knew what was happening to them was wrong, even if the culture at the time was more accepting of predatory behaviour. Often they told no one. They felt shame for not speaking up or acting. Sometimes that shame has been corrosive though the years and, in other cases, women have pushed it aside (November 18, 2017).”

It’s not just the world of entertainment. Women from many walks of life are speaking up. Sergeant Vicky-Lynn Cox of the Canadian Armed Forces told CBC Radio’s The Current:

“My first incident, without going into detail about my first incident, happened three weeks into the military. From that point on I didn’t really sleep soundly for the next 20 years. I’m approaching on 21 years of service. So I’m recovering from that. For years and years, I didn’t say a thing and for years and years I tolerated the environment around me because of the love of my country and the love of my work.”

Three Canadian comediennes spoke to The Current about the problems they faced. Michelle Shaughnessy said that male comedians think bad behaviour can be excused by saying that it’s just a joke:

“I know there was one incident where a colleague who was a friend, like I think it was kind of like the equivalent of like a drunk dial type thing. Actually sent me like a picture of their penis like the middle of the night, when obviously they had been drinking too much . . . you can mention it to these guys and their first defence is ‘were all comics. It’s a joke.’”

Women who were once afraid that they wouldn’t be believed, who were told “that’s the way it is,” are now speaking up.

It’s no joke. A shift in culture is happening. The more women who come forward, the more that others will be encouraged to do so. And as more women move into positions of power in corporations, government, police, clergy, and the military, the more they will be believed. “The tide is turning,” said Leeann Tweeden, the former model who has accused Al Franken: the high-profile writer, comedian and senator. It’s not enough that Franken “feels terribly” about the accusations.

I have a selfish reason to see the end of bad behaviour by men. I want to live in a society where women don’t have to suspect and fear men. The predatory and toxic actions of men are a burden on us all.

Let’s talk about doctor’s pay

Doctors have been given benefits under incorporation in lieu of receiving wage hikes and that’s not right. Doctors are on both sides of the issue. The Canadian Medical Association has come out against any changes to these benefits while 450 doctors signed an open letter to Finance Minister Morneau in favour of tax reform.

  Dr. Rita McCracken supports tax reform. Photo: Huffington Post

The existing tax system allows for the questionable practice of “income sprinkling” where family members are paid even when they don’t contribute to the doctor’s business. In Ontario, children and spouses are allowed to be paid as members of doctor’s corporate boards.

Doctor practices are unlike other small business. They operate private businesses while being paid through the public healthcare system.

Some doctors are uncomfortable the existing breaks. Dr. Hasan Sheikh says:

“There is nothing unique about a physician’s work that makes income sprinkling okay for them and not for others (Globe and Mail Sept. 22, 2017.)”

As usual, proposed tax changes are political fodder. Some premiers have condemned them, even though the details have yet to be released. Manitoba Premier Brian Pallister calls them “class warfare.” Nova Scotia Premier Stephan McNeil worries about the ability to attract doctors and small business to the province. B.C. Finance Minister Carole James concerns are more nuanced:

“I certainly believe in closing tax loopholes, I believe that’s important, but I also don’t believe there was good consultation done.”

That’s Morneau’s failing. He announced the changes in the downtime of summer and faces a storm brewing in the fall. Only now is he consulting provinces.

One of the doctors in favour of tax reforms is Dr. Ritika Goel. The existing system doesn’t even benefit all doctors fairly:

“So, for example, if you have a single mother who is a physician she would be paying higher tax rate than a mother with a spouse that she’s able to income sprinkle and we don’t believe that’s fair (CBC’s The Current, Sept. 19, 2017).”

Another doctor is opposed to the changes. While acknowledging the issue of tax-fairness, she is bitter about existing compensation. Dr. Brenna Velker told The Current:

“I think that as physicians, you know, we all understand that those who make more money need to pay more tax, that’s how society works. The problem that I think a lot of us are running into is that we’re feeling really beat down. So, any of the forms that I fill out and of the phone calls that I make, or you know, e-mails, or anything like that, any other communication with my patients is unpaid. You know, it really leaves a bad taste in your mouth.”

Doctors deserve fair wages. They are dedicated and hard working. They incur more student debt and they start earning money later in their career.

“Let’s stop talking about propping up a broken tax system that benefits some Canadians and not others based on the title of their profession and not the nature of it,” adds Dr. Sheikh.

Instead of granting doctors dubious tax breaks, they should be given appropriate pay and benefits that dignify their profession.

The problem is doctor distribution, not shortage

The number of doctors in Canada is increasing faster than population growth says Dr. Michael Rachlis on CBC Radio’s The Current:

  photo: Nancy Bepple

“We’ve been increasing the number of physicians at about three per cent per year for the last 10 years and the population is only going up at one per cent per year.”

Another of the panellists on the program, Dr. Danielle Martin, author and VP at Women’s College Hospital, warns of a surplus of doctors:

“In fact you know in some parts of the healthcare system, people are worried about a glut and you hear stories of people coming out [of medical schools] and being unable to find a job.”

That’s certainly not the view from the streets of Kamloops. NDP candidate Nancy Bepple regularly visited lines of people lined up at a clinic to see a doctor. An estimated 30,000 Kamloopsians don’t have a family doctor (one-third of the population). In B.C. overall, it’s 15 per cent.

Why can’t people find doctors if there’s so many of them? Are they hiding?

Well, some of them have chosen to work for a salary rather than billing for each patient. They work exclusively in hospitals says Dr. Chris Pengilly of Victoria, another of the panellists. He calls them “hospitalists.”

They prefer to work only 40 hours a week. Who can blame them? And they are paid better. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. After paying staff and rent, a family doctor would have to earn $400,000 a year, to take home that much; and work longer hours with less support.

The choice is obvious says Dr. Pengilly:

“So anybody coming out of medical school with a big student loan, which do you think they’re going to go for? A family physician [with] no time in hours a week or a hospitalist 40 hours a week and $300,000 with minimal expenses?”

Furthermore, hospitalists don’t want to work alone says Dr. Rachlis “Well, I say good for them that they’re looking to work in teams with other groups, with other physicians.”

One-half of Canada’s physicians focus on sports medicine or palliative care, says Dr. Martin:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

The current model is not working because doctors no longer want to work in the silos of a fee-for-service practice.

It’s ironic that the provincial government has created a hospital environment which doctors prefer to work but one that removes them from the general public.

The solution is obvious but the BC Liberals have been slow to implement it: Build walk-in clinics and hire doctors on a salary basis. Everyone, doctors and patients alike, will be happier.

It’s going to cost more because the government will own the clinics. But the alternative, privately-built clinics, is a failure. The reason that two walk-in clinics in North Kamloops closed their doors is because doctors don’t want to work for less in an environment where they don’t have the same support that hospitalists enjoy.