He seems far too young to be dedicated to minimizing suffering at life’s end, but that is, indeed, Dr Downar’s mission. His three specialties are inter-related: critical care, ethics and palliative care.
Palliative care changes the focus from cure to comfort. This sensibility doesn’t fit with the military language often used in healthcare situations: battling, fighting, giving up, winning, losing. Dr Downar’s take puts that tough language into ‘life’s end’ perspective:
“In healthcare, you’re always fighting. At life’s end, what your fighting for changes and what one person means by fighter is different than for another. The goal is to determine what you’re fighting for.”
When people are asked about Cardiopulmonary Resuscitation (CPR), they often answer without understanding what is involved, and what the consequences may be. CPR can cause pain and suffering, and studies show that the survival rate after CPR in the hospital is very low.
“When the heart stops, it’s usually not a random event. For 95 per cent of the population, death is a predictable event caused by a chronic and incurable disease.”
Dying has become a foreign concept for many boomers
“An unanticipated consequence of modern medicine is that many adults have never seen someone die. It’s not like previous generations where the dying were attended to at home.
As a result, we have trouble accepting death, and we may request therapies that will fix a small problem but actually worsen the quality of life for a dying person. We need to be comfortable with the idea of improving care by NOT trying to ‘cure’ some problems, such as a pneumonia in a person with a terminal illness.”
The value of less can lead to a more humane and human end of life
“What may be offered – the most aggressive care – may not be best, but often it’s the ‘default pathway’ that’s followed – hospitalization, treatment, medications – appropriate for acute care but can mean needless suffering at life’s end.”
Dr Downar is quick to emphasize that what he’s talking about is not in any way assisted suicide or euthanasia, but rather allowing a natural death, emphasizing comfort rather than prolonging life.
His suggestion: a 3-way conversation about end of life care – with family, healthcare professional and loved one in question.
Dr Rebecca Sudore whose Physician Faculty Scholars Programs is “Enhancing Advance Care Planning in Diverse Elders with Limited Literacy” shares her surprising conversation with her grandfather as caregiver for her grandmother. The surprise was that, as the appointed surrogate decision maker, her grandfather wasn’t aware of his wife’s wishes. The article is entitled: Can we Agree to Disagree.
Dr Downar is at one of Canada’s key health institutions for establishing ‘best practices’ – University Health Network – and as such he is dedicated to working with his colleagues to ensure a palliative approach for all dying people. As he points out,
“palliative care may not save many lives, but it can make end of life a more peaceful process”