I don’t know what a good death is. A beautiful death? I don’t even know if it exists because death is never beautiful. It’s what happens before death that interests me: the end of life. Ending life in unrelieved pain is always unbearable. An unaccompanied end of life suffering is never beautiful. But a relieved and supported end of life can be a precious time, a time when everything is still possible. It is the time before death that can be beautiful.
In Quebec, induced death is part of everyday life. In the more than ten years since it has been legalized, it has become normalized and even trivialized. Supply created demand. At the beginning, assistance in dying was reserved for people at the end of life and then, like a Pandora’s box, the access criteria quickly broadened: it is no longer necessary to be at the end of life and it is now possible to make an early request, even before Alzheimer’s disease causes impaired judgment.
No truly peaceful end to life
I treat and support many patients who are going to die. Some of them want to die. Some ask to die. Of all my patients who have chosen medical assistance in dying (that’s what it is called in Quebec), no end of life has been truly peaceful in my eyes.
What is shown on television or on the networks is only a romanticization of the death caused. The reality is very different and does not appeal to me. No one was able to convince me that this was the beautiful death.
These patients who choose induced death are in control of their end of life and want to control everything: the day and time of their death, the place, the people present at their side, the music, the clothes, sometimes the champagne in the last toast. I do not judge this desire for control and I myself do not know how I would want to manage my own death when the time comes.
But I find that this control often produces inner tension. These patients say they are at peace. However, what I observe looks more like the satisfaction of having everything organized and controlled than true inner peace. They often have only one idea in mind, that of ending it as they have decided. Their heart sees only one half-open door leading to induced death and no longer sees any other possible paths.
Palliative care, another way
Palliative care offers another path. In the interdisciplinary team of which I am a part, we put all our skills and energy into relieving the pain and discomfort of people at the end of life. Contrary to popular belief, palliative care patients are not zombies high on opioids and we don’t just play guitar. There is never any relentlessness and we do not prolong the suffering.
No one wants to suffer or see suffering. Palliative care also means supporting patients and their families so that each end of life is a time open to possibilities: realistic hopes that give meaning, trust and friendships that create or maintain bonds of humanity.
Time to let go
The end of life can then become a time that allows letting go, acceptance of losses and taming the death that is coming. Unlike control and mastery, letting go opens the possibility of a peaceful end of life: a time when we disarm ourselves, where we loosen our grips, where the inner struggle gradually calms down. In this fragile peace, palliative care teams sometimes witness the end of life of great beauty.
I am a palliative care doctor. In conscience and as a team, I want to relieve and support patients who tell me: “I want to die, I want to end it, my life no longer has meaning, I do not want to be a burden for my children, I am afraid of suffering. » For me, these are unbearable sufferings sometimes expressed by a request for assistance in dying. This is why I will never be able to push the four syringes that cause death.
Not that I want to prolong the suffering of patients who ask to die. My conviction lies elsewhere: I must not respond to a request for induced death, but to the distress which is expressed through this request.
At the end of so many relieved and supported ends of life, I remain convinced that we die better in letting go than in control. This is why I am betting on palliative care: it leaves open the door to an end of life that can still be beautiful, where induced death closes it.
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