KNOWING THE TERMS
SOURCES: FIRS T THREE DEFINI TIONS FROM THE WAY FORWARD NATIONAL FRAMEWORK: A ROADMAP FOR AN
INTEGRATED PALLIATIVE APPROACH TO CARE (W W W.HPCIN TEGRATION.CA). LAS T FOUR DEFINI TIONS ADAP TED
FROM THE CANADIAN MEDICAL ASSOCIATION, “EUTHANASIA AND ASSIS TED DEATH UPDATE 2014” W W W.CMA.CA
serves Koke. “I’m hoping that the
courage I’ve seen on the part of my
patients will affect how I die too. It
really normalizes things for me.
This is a part of life.”
For Harlos it has to do with “the
very foundation of reality. It is
people in the worst situation they
have ever been in, family and pa-
tient. You can cut through any kind
of fluff and focus on just being there
It was actually in Canada where
the term palliative care was born.
Dr. Balfour Mount coined it – to
palliate means to improve quality
– after starting a new kind of care
at Montreal’s Royal Victoria Hospi-
tal. It was a hospice-like ward – a
palliative ward – dedicated to pro-
viding holistic care to the dying,
inspired by a 1973 visit he made to
study hospice care in England.
It was the first hospital wing of
its kind in Canada.
Dr. Mount, known as the father
of palliative care, did not feel well
enough to be interviewed for this
article. He has lived for years with
the effects of heart problems and
cancer of the esophagus.
The Globe and Mail interviewed
Mount in 2013 and asked, “How are
you going to die?”
This was his answer. “I have had
a permanent tracheostomy for
seven years. With each breath I
take, I realize that I may not be able
to take the next one because it takes
a remarkably small amount of se-
cretions to block the tube.
“I realize that when I become
unable to care for myself, the question gets a lot more interesting.
What I would never ask, even if the
legislation changes, is for a doctor
or anybody else to end my life in-tentionally.… The goal isn’t to kill,
but to improve quality. It is a palliative goal.” /FT
Hospice palliative care: Care that aims
to relieve suffering and improve the
quality of life.
Integrated palliative approach to care
care): Care that focuses on meeting
a person’s and family’s full range of
needs – physical, psychosocial and
spiritual – at all stages of a chronic
progressive illness. It reinforces
the person’s autonomy and right
to be actively involved in his or
her own care – and strives to give
individuals and families a greater
sense of control. It focuses on
open and sensitive communication
about the person’s prognosis and
illness, advance care planning,
psychosocial and spiritual support
and pain/symptom management.
As the person’s illness progresses,
it includes regular opportunities to
review the person’s goals and plan
of care, and referrals, if required, to
expert palliative care services.
Home care: Includes an array
of services for people of all
ages, provided in the home
and community setting, that
encompasses health promotion and
teaching, curative intervention, end-of-life care, rehabilitation, support
and maintenance, social adaptation
and integration, and support for
A physician knowingly and
intentionally provides a person with
the knowledge or means or both
required to end his or her own life,
including counselling about lethal
doses of drugs, prescribing such
lethal doses or supplying the drugs.
This is sometimes referred to as
Euthanasia: Knowingly and
intentionally performing an act,
with or without consent, that is
explicitly intended to end another
person’s life and that includes the
following elements: the subject
has an incurable illness; the agent
knows about the person’s condition;
commits the act with the primary
intention of ending the life of that
person; and the act is undertaken
with empathy and compassion, and
without personal gain.
Palliative sedation: The use of
sedative medications for patients
who are terminally ill with the
intent of alleviating suffering and
the management of symptoms.
The intent is not to hasten death,
although this may be a foreseeable
but unintended consequence of the
use of such medications. This is
not euthanasia or physician-assisted death.
artificial ventilation, nutrition
and similar interventions that are
keeping a patient alive but are no
longer wanted or indicated are not
forms of euthanasia or physician-assisted death.
Karen Stiller of Port Perry, Ont., is a senior
editor at Faith Today.
CARE SHOULD BE
IN THE COURSE OF A
SUPPOR T HOSPICE