Professor Harvey Chochinov:

One of the difficulties here is whether there are forms of suffering that are unyielding to any form of intervention. I remember a colleague in palliative care for several decades who said that he could count on one hand the number of people who may have met eligibility criteria. The problem with legislation is that although legislators can put down a policy, that policy is then implemented by healthcare practitioners. Healthcare practitioners exercise judgment. We have people in Canada who have specialised in medically aided dying. There are some people who have actually provided hundreds of patients medical aid in dying.

The other point I want to make is on who has irremediable suffering. How do we know whose suffering is irremediable until we expose them to and make available to them all that palliative care can provide? By way of illustration, we are grappling with the issue of what is irremediable suffering for somebody who has mental illness. The example I have suggested is that we consider what are the worst and most dire medical conditions that we can think of. Think about the biggest artery in the body rupturing in an aortic aneurysm. The likelihood of dying of an aortic aneurysm if unattended is approximately 100%. If someone arrives at an emergency department with a ruptured aortic aneurysm and has surgery the likelihood of survival is approximately 70%. At the time of arrival which patients have an irremediable rupture? We only know the answer to this question once the surgery is performed. Whose suffering can we not attend to? We will only know this after we have the opportunity to be attentive.

Years before legislation was initiated I looked after a man with a brain tumour. This was in a large US hospital. He wanted to die. I told him that it was not legal but I was prepared to be with him and to be attentive and try to find out who he was and what the sources of his suffering were. He would complain about the limitations of what this meant. One day I told him he was under no obligation for me to be there. He looked at me like I had gone stark raving mad and asked me whether I was crazy. He told me those conversations were the only thing keeping him going. It is difficult to identify in advance whose suffering is irremediable. If we are intent on trying to be attentive to suffering we need to address all of suffering, knowing that in the vast majority of instances we will be able to be effective.