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The Journey of Discernment

Joseph is 58 years old and single. Cancer has progressively taken over his body. After a number of mostly unsuccessful chemotherapies, additional courses of treatment are deemed vain. He is in severe pain as the end draws near. He is transferred to the hospital’s palliative care unit. Once there, his physical pain is taken care of and eased. Volunteers take turns at his bedside to comfort him, as he has little family or friends. Still, Joseph remains dejected. One week after his admission to palliative care, he asks a nurse to help him die quickly, for nothing holds him to life anymore.


Joseph was transferred to the palliative care unit because his death is imminent, and possible courses of treatment to prolong his life are ineffective. His quality of life is now the main focus. Easing the patient’s pain is among the goals of palliative care. Recent years have seen considerable medical advances on this level, especially since pain medication does not shorten the patient’s life. On the contrary, it may actually contribute to prolonging life, since the patient finds himself more relaxed, and therefore able to turn his attention toward himself. Nevertheless, in certain cases, controlling the patient’s pain may heighten his suffering, as he is faced with the crude reality that his death is drawing near. The moral suffering of living then replaces the physical pain. Why live, when one can’t make anymore of life? Joseph’s wish to put an end to his adventure stems from such a place of moral suffering. 


Faced with a request for euthanasia, most health care professionals will immediately answer that Canadian Law and rules of deontology forbid them from heading down that path. Such is the case of the palliative care nurse whom Joseph asked. However, she will take his wish seriously and try to understand its underlying meaning. Joseph has been battling cancer for many years. He is burdened by his battle, and exhausted. It comes as no surprise that he wishes to die. The nurse engages him in exploring what his wish is expressing at a deeper level. Since palliative care involves a multidisciplinary team, the nurse asks Joseph’s permission to discuss his request with the other members, in order to better help him. Joseph’s reply will help her discern his deeper motives. In engaging Joseph as she does, the nurse is actually giving Joseph a sense of control over his life. His possible refusal to inform the team would indicate just how great his suffering is. Should he agree, the nurse may even suggest that he bring up the subject himself, with the team members.

Joseph’s request opens up a dialogue on a more personal level, between him and those people he established connections with. Will this enable him to find a different kind of family? Will he turn away from the open door he is presented with? Whatever Joseph chooses, he is now surrounded by friends. These relationships will allow him to better understand the ways in which his caregivers will opt to see him through the road ahead. For example, Joseph may be overcome with anguish as he gets weaker. In this situation, he may be offered palliative sedation, which will put him in a sleeping state for a few days, in order to grant him the rest he needs. When he awakes, his condition will be re-evaluated. This way of dealing with his final days takes into account Joseph’s suffering, as he faces death with difficulty, as well as his caregivers’ commitment to respecting their patients’ life. 

How are ethics at play in this situation? They are found in the caregivers’ concern of helping people who suffer to face up to the event that awaits them, and to live it responsibly. In Joseph’s case, his palliative care team exemplifies this ethical direction. 



Dr. Hubert Doucet
Unité d’éthique clinique, Centre hospitalier universitaire Sainte-Justine
Associate Professor, Faculté de théologie et de sciences des religions
Université de Montréal 


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