Canadians deserve a say in how they will be treated on their deathbeds, says Wilbert Keon, a Conservative senator and leading heart surgeon.

Dr. Keon says physicians have to make complex medical and ethical decisions in about four of 10 deaths, and we should all have a say in framing national guidelines to regulate those decisions.

“When the time comes for a patient to go, there’s always a great deal of debate on the part of relatives and the patient on what is best for the patient.”

He said national guidelines could save some patients from needless pain, avoid last-minute threats of litigation, and make it easier for physicians, patients and families to make the necessary decisions.

Dr. Keon co-sponsored a Senate bill last spring to help protect physicians from being prosecuted for withdrawing medical services from terminally ill patients, or inadvertently causing death by administering drugs intended to relieve pain.

He now says that bill didn’t go far enough, and led some people to fear that it would encourage euthanasia, which he opposes.

The bill, framed by Liberal Senator Sharon Carstairs, died when Parliament was dissolved for the June election. Dr. Keon said he hopes a broader piece of legislation will be introduced this fall, and kick off a national debate.

“There has to be extensive consultation with the public, medical and legal people and the clergy, because it’s an enormously complex and difficult subject.”

He said increasingly sophisticated medical technology is forcing more and more terminally ill patients and their families to make complicated decisions about how and when they want to die. Although there are no Canadian data, a study of the 129,000 deaths in Holland in 1990 suggested that physicians are now making such decisions in about four of 10 deaths.

“There is a tremendous amount of confusion about how far you can go in withdrawing treatment, how far you can go with pain control,” said Dr. Keon, director of the Ottawa Heart Institute.

“We need to protect family and patients from decisions being taken by medical practitioners without appropriate guidelines and legislation to direct them. Decisions about how much sedation should be given, when it should be withdrawn, when life support should be withdrawn, and when nutrition becomes counter-productive and is causing more suffering.”

Last spring’s Senate bill would have amended the Criminal Code to protect physicians from prosecution, provided that patients or their families had been consulted. Dr. Keon admits that no physician in Canada has ever been prosecuted for prescribing pain-killers that inadvertently hastened a patient’s death, but he said some terminally ill patients are in pain because physicians are afraid of the legal risks in giving so much pain-relieving medication that ti could cause death.

“We’re afraid of a retrospective review of the (medical) chart, and the suggestion that perhaps we were not justified in doing this or that. I think we can do something helpful to overcome that difficulty.”

Dr. keon said medical societies have developed guidelines for physicians on such decisions. but he said there has not been enough public input into those guidelines, and no central guiding force to promote them.

He believes Health and Welfare Canada should play a role in developing the necessary guidelines.

Larry Librach, director of palliative medicine at Mount Sinai Hospital in Toronto, said what is needed more than new guidelines or changes in the Criminal Code is greater education of physicians and the public.

He said physicians who say they’re afraid of being prosecuted for causing death through pain medication “are poorly educated. Physicians have all sorts of excuses for not controlling pain.” He said all drugs, including penicillin, carry risks, but many physicians don’t realize it’s almost impossible to kill a terminally ill patient with morphine, partly because such patients normally have become habituated to morphine.

Dr. Libracy said the key to making good end-of-life decisions is good communication between physicians and the patient or family involved. He said he doubts that legislation can be developed to adequately cover all the situations involved in such decisions.

– The Ottawa Citizen via Pro-Life E News Canada