Dying and Pain Is The Number One Fear
20 Oct 2010
Woody Allen once joked, “I’m not afraid of death I just don’t want to be there when it happens.” A world-wide survey by the Lien Foundation in Singapore recently reported the prime worry of the elderly was dying in pain. It listed England as the best place to die. Canada and the U.S tied for 9th place.
As a physician I’ve always known that pain was the overwhelming fear, particularly for cancer patients. I also knew that heroin has been available in Britain for 90 years to ease final agony. This triggered a visit years ago to England to witness its use and the question of why it wasn’t used for this purpose in Canada. I didn’t realize my probe would engender so much controversy.
British pain specialists shot down the myths about heroin held by critics in North America. The most asinine view is that terminal cancer patients become addicted to heroin. They don’t because it’s used for pain relief, not pleasure. But even if it did, who gives a tinker’s damn about that problem when patients have only days or hours to live?
Cancer specialists at Thomas’s Hospital in London told me some patients were receiving 1,500 milligrams (mg) every four hours for pain when 5 mg is the normal dose for post-operative pain. If patients experience a remission in their cancer they could be weaned off heroin in three weeks.
North Americans continue to claim that morphine is as good as heroin. But it’s a pharmacological fact that heroin is stronger, passes through the blood brain barrier faster and provides a sense of euphoria. I’ve never seen anything wrong with giving dying patients a feeling of euphoria. Moreover, Scotland Yard told me that fears in Canada that hospital pharmacies might be broken into was nonsense as it had not happened in Britain.
I reported these facts in my column and received thousands of letters of support. Then the unexpected happened. I was severely criticized by the Canadian Cancer Society, RCMP, The Pharmacy Association and some cancer specialists as being an uninformed, headline seeking medical journalist.
This began a five year battle with critics during which time I formed the W. Gifford-Jones Foundation and received financial support from readers. On December 20, 1984, the government responded to public pressure and legalized heroin for terminal cancer patients.
But they imposed inane restrictions. Heroin had to be kept in guarded unknown locations in Canada and transferred to hospitals under police escort. Some hospitals required doctors to appear before a committee to present their case for heroin. These obstacles resulted in such small amounts of heroin being used by doctors that heroin is no longer imported into Canada. It was a dreadful error.
My Foundation was left with $500,000 which was donated to the University of Toronto Medical School to establish the W. Gifford-Jones Professorship in Pain Control and Palliative Care which does an excellent job teaching the care of terminal patients of all kinds.
Now The Lien Foundation must be congratulated for creating a “Quality of Death Index”. It considers the quality of death as important as quality of life. But it should not depend on what country you live in, or what part of that country, that determines how well you will be cared for in your final days.
It will take a mammoth effort for Canada and the U.S to overtake England and other top countries in this field. In Canada only 10 to 30 percent of those who need it receive end-of-life care.
Today we spend huge amounts of money on battles with death that cannot be won. All too often I see patients cruelly subjected to painful and useless diagnostic and so-called therapeutic procedures when what they need is hospice care.
Unfortunately Woody Allen and others cannot escape being there when death arrives. But there would be less fear if we knew that painkillers and other palliative help would be available. Being # 9 is not good enough for Canada or the U.S.
The long fight to legalize heroin is documented in my autobiography, “You’re Going to Do What?”
