Dr. Faith Cranfield:

I thank the Senator for asking about the wish being transient because that is fundamental to why we are concerned. We meet people daily who wish their lives were over. Our response to that is to "lean in" as Professor Harvey Chochinov said; to respond to it by seeking to understand why. I will try to illustrate this with a story as to why, perhaps, the idea of having the choice available to be dead as a solution to someone's situation is a risk to that person.

I want the committee members to try to imagine Mary. She is a grandmother. She looks after her grandkids after school and she is preparing for her other daughter's wedding. Mary finds herself sick. After months of chemotherapy she is in pain daily but is afraid to take morphine, because it is morphine. She is tired all the time and is trying to struggle with managing the household, which she has always done and watching her husband make a hames of it but he is doing his best. They are just arguing, which they have never done before. She is not able to mind the grandkids and watches her daughter, who is struggling to find reliable childcare. Mary, who always looked after everybody, is not able to do it any more because of her illness. They are all protecting one another and no one wants to talk about what will happen and that Mary will die. Nobody wants to talk about the wedding. Mary nearly falls over one day and just says, "God, I wish I were dead" in front of the family. That family absorbs her helplessness and feels helpless themselves. They just want her suffering to end too. For Mary, having that wish to be dead available would carry much more weight when she is considering what she will do next. If she meets palliative care, they treat her pain, they educate her to use morphine. She no longer has the pain controlling her so that it overwhelms her and makes her think of the future, what it might be like to die and how scary and painful it will be. They can let her take control of the pain. She is not so tired because she is managing her pain and because she is also learning how to manage fatigue. It is all right, for example, to take a nap in the afternoon. She then has energy for the family in the evening. She then gradually has a facilitated conversation with her family. They talk about the things that nobody wants to talk about and they address the wedding. This wedding will happen. Will Mary die at the time of the wedding? What happens is that they allow these really tricky conversations. The wedding is brought forward. Mary attends the wedding. Everyone enjoys it. They enjoy the ritual and being able to think about what it was like before Mary got sick and to have all of those memories and real conversations in anticipation of her time well before she dies.

That is what palliative care is. We describe it in biopsychosocial and it all sounds very technical but the reality is Mary's story. Mary is any one of us. It is people you know and it is people I know. If the healthcare professional also responds to Mary's wish to be dead with the same sense of helplessness and overwhelm as Mary and her family and just wants to end the suffering and on their menu is, "Yes, I can help you to die. I can make that happen for you", the risk is that she would have a death without any of those moments or celebrations I have described.