Title: On Living Wills
By: George Smitherman

In the time since the 2004 Health Accord between the Provinces and the Federal Government improvements in access and the timeliness of access have taken place. As Federal and Provincial Ministers of Health begin long drawn out discussions in advance of the Accord’s renewal in 2014 we need to hope that the debate about Health Care offers more than the weary battle lines and talking points of the past.

Obviously the challenges of providing adequate and timely care in an environment where the prevalence of chronic disease is on the rise and where aging are present is tough enough to begin with, that our governments are, for the most part, wallowing in deficit and debt could be enough to lead some to despair.

Perhaps it’s counter intuitive to suggest, but I think the fact that this renewal discussion takes place in a time of constrained fiscal resource is helpful because leaders will be forced off of simple bromides in favour of the kind of reform that can produce sustainable results.

Medicare has served us well. It has contributed to our economic competitiveness and despite unavoidable criticism our Medicare system is producing advances. Even with the prevalence of diseases such as cancer and diabetes, Canadians are living longer.

As a Health Minister I often felt that “non cash items” were overlooked for the contribution that they could make to the sustainability of the system. And after nearly 5 years at the helm of Health Care in Ontario I felt that leadership time and not money was the resource in scarcest supply. Of course any government that makes these points risks being written off as a cheapskate or characterized as lacking in compassion.

But allow yourself to contemplate the cash savings that would occur if our hospitals were not under pressure from families to enlist heroic efforts to extend the life of our elders even if the extension of life had nothing to do with their quality of life. Take a look at the data about how we consume health care resources and you will quickly see that our final days and weeks prove costly.

My father lay in a hospital bed for nearly 8 months at the end of his life. Stricken by a severe brain stem stroke that left him with only the capacity to move his eyes. The care he received was exemplary. The love of his family was resolute. But the prospects for progress were, regrettably non-existent.

Witnessing my father’s final days made me a firm believer in the notion of a living will. A document that allows me, at a time when my mind and body are in fine form, to dictate to the system and to my family what my chosen path looks like. It’s a process that allows me to dictate that Quality of trumps Quantity of Life.

Medicare is a values driven enterprise and it’s cherished by Canadians to the point that it’s deeply entrenched as a source of pride, part of our culture. It reflected the ambition of a young country to do the upmost for its people. People who were for the most part young.

And since the 1960s when it came to life it has served us well. But as we look to the future we cannot conclude that doing it the same old way is going to work any longer.

Rethinking whether services currently being delivered in hospitals could or should be delivered in clinic settings is an important discussion for sure.

But if I want my two babies to enjoy the competent system that I have enjoyed then that means I need to be prepared to do more than expect that more cash will be tossed into the system. The long term sustainability of Medicare cannot be achieved without a contribution of the non-cash variety from the insured.  

Exercising a living will on a voluntary basis, or better yet obligating all Canadians to exercise their views in a legally binding document could save billions of dollars and enhance the dignity of Canadians in their final days.