Professor Harvey Chochinov:

There were many questions but I will try to answer some of them relatively briefly in order that we can at least touch on some of the key ideas. The Senator asked about intensive caring and what we can do to try to incorporate intensive caring more broadly. I am certainly doing everything I can to make this as universally available as possible. As I said, I published a paper in the Journal of Clinical Oncology and there are, at this point, 1,000 downloads per month. It was the topic of an invited lecture in honour of the Dame Cicely Saunders at King’s College London this year, so I am doing what I can to get the word out. Essentially, the ideas embedded in intensive caring are really at the heart of palliative care. The essence of intensive caring, in some ways, is old wine in a new bottle, but if that bottle makes it more attractive for up and coming learners to know the essence of palliative care is about these core principles and provide patients with affirmation and respect that are based on connectedness, that will serve palliative care well.

The Senator asked what we can do to maintain patient dignity, which is a very important question with respect to this issue of hastened death. The reason I embarked on studying the issue of dignity in the first instance is that some studies in the Benelux countries showed the reason patients had sought out assisted death more than any other reason, according to Dutch physicians who reported on this, was a lost sense of dignity. We have begun to study dignity and have been doing so for a number of decades, again, not from a vantage point of a political agenda or with a moral axe to grind. We are empiricists, so we have produced literature that shows dignity means different things to different people and if we are to support dignity, we need to do more than, for instance, simply trying to support or reinvigorate patient autonomy. Folks at Death With Dignity, for example, will say autonomy is the penultimate reason patients should be able to access assisted dying. We know maintaining dignity extends far beyond that.

At the risk of repeating myself, this is actually from a table in one of the papers that we published, if you look at what impacts patients' sense of dignity, according to patients, first and foremost is not being treated with respect or understanding, feeling a burden, feeling they no longer have control, feeling they have not made a meaningful or lasting contribution. The list goes on. That is in descending order.