British columbia
Dignity in Death
Dr. Margaret Cottle is a palliative care physician in Vancouver, BC. She has cared for many patients, helping to ensure that they pass away loved and dignified. Dr. Cottle spoke with the deVeber Institute about palliative care, medical assistance in dying (MAiD) in BC, and the story of a dear friend who found dignity in death.
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amuel (please note, his name has been changed for this article) had been suffering from kidney disease for some time and the kidney dialysis was no longer working. As a doctor himself, he knew all too well the implications of his illness. Rather than continuing to seek treatments that were burdensome and ineffective, he chose to stop dialysis and opt for a palliative approach to his care. However, being ill in a hospital bed was not easy. While he knew that this was the right decision for himself and his family, he felt as though he had nothing left to do.
Indeed, the most commonly cited reason for requesting MAiD is the loss of ability to engage in meaningful activities and one that Dr. Cottle has witnessed many times. The concept of “dignity conserving care” was championed by Dr. Harvey Chochinov who began studying it after noting that a ‘loss of dignity’ was almost always included in the reason given by patients who desired euthanasia. Dignity conserving care is care that bolsters the dignity of the patient and often includes open dialogue and questions such as, “What do you want your family and loved ones to remember about you?”
Samuel and his two grandsons
Palliative care recognizes the patient as a whole person whose suffering is the result of a unique combination of these components. Treating the patient means treating each of these — that is treating the “total pain.”
In Samuel’s case, his physical pain was under control. However, emotionally, psychologically, and socially he was suffering. As a close friend, Dr. Cottle knew exactly what he needed: a mission. So, when Samuel’s daughter called asking for help, Dr. Cottle had a message, “Please tell him (Samuel) that what we really need in our world right now is people who are willing to show that you don’t have to have a medical termination in order to have a dignified death. You have an opportunity to show those lovely grandsons of yours what a dignified death looks like. You still have a lot you can pass onto them. So, tell him from me that he’s got a mission.”
Please tell him that what we really need in our world right now is people who are willing to show that you don’t have to have a medical termination in order to have a dignified death. You have an opportunity to show those lovely grandsons of yours what a dignified death looks like.
As a family doctor in a small community, Samuel had a large, welcoming practice and a strong conviction that dying with dignity is dying loved rather than dying by MAiD. But he was needing to be needed. The mission suggested by Dr. Cottle was the motivation he needed to live out that belief. According to Dr. Cottle, “he locked onto that and he did that with a vengeance.”
Shortly after, Dr. Cottle received a picture of her friend with his grandsons. The photo (used by permission from his family) captures Samuel, lying in bed with his grandsons flanking him on either side. He is explaining to his grandsons what it means to be a part of their family. The two grandsons’ faces are attentive and sincere as they eagerly take in these final pieces of advice and family history from their grandfather. Precious moments like these, Dr. Cottle says, would have been lost had his “total pain” not been treated by reminding him of the wisdom he still had to share with his children and grandchildren.
Samuel had spent his life and career fighting to show, on many fronts, that death is not a solution to suffering. He spent his last days showing how beautiful it is to die loved and to choose to love while dying.
He spent his last days showing how beautiful it is to die loved and to choose to love while dying.
Local Resources
British Columbia Hospice Palliative Care Association
Vancouver Hospice Society
Delta Hospice Society
Palliative Care Access and MAiD
The senior’s population in British Columbia has increased significantly in recent years. According to Statistics Canada, the 65 and older population of British Columbia has nearly doubled in the last 20 years, now with over 1 million individuals in the age bracket.
In response to the changing demographic, in early 2024 the province received a promise of $733 million in federal funding to improve health care for seniors over the next five years. This funding is designed to help expand home and community care, increase access to palliative care and improve the state of long-term care.
British Columbia has one of the highest amounts of MAiD recipients in Canada. Between 2016 and 2022, there have been just over 9,000 deaths by MAiD in the province. This is the third largest amount across Canadian provinces and territory, behind Quebec and Ontario. MAiD deaths in British Columbia in 2022 were the most on record and an increase of 23.9% from the year before.
As with each year since 2019, in 2022 British Columbia had the second highest percentage of MAiD deaths as a proportion of all deaths in the province at 5.5%. The average age of MAiD recipients in British Columbia is 78 years old, on par with the Canadian average of 77 years old.
References
British Columbia age distribution 2001 to 2021. Statistics Canada. 2024 August 22. https://www12.statcan.gc.ca/census-recensement/2021/as-sa/fogs-spg/alternative.cfm?topic=2&lang=E&dguid=2021A000259&objectId=1
“Fourth Annual Report on Medical Assistance in Dying in Canada 2022.” Government of Canada. Health Canada (Aug 2024). https://www.canada.ca/en/health-
canada/services/medical-assistance-dying/annual-report2021.ht
“Second Annual Report on Medical Assistance in Dying in Canada 2020.” Government of Canada.
Health Canada June 2021. https://www.canada.ca/en/health-canada/services/medical-assistance-dying/annual-report-2020.html#3_0 See section 4.3.
The Canadian Press. (2024, February 12). “B.C. receives $733M in federal health funding for seniors' care.” CBC News. 2024 August 22. https://www.cbc.ca/news/canada/british-columbia/bc-seniors-federal-health-funding-1.7113211