Dane Gibson
Northern News Services

NNSL (Jun 11/99) - You're on call in emergency tonight. An 84-year-old is wheeled in who is bleeding internally. He wears a diaper, has alzheimer's and hasn't been able to recognize his family members in three years. What do you do?

Dr. William Malloy offers three choices: palliative care -- give him morphine and let him die peacefully, authorize blood transfusions, or perform surgery followed by intensive care.

"What you choose and what a doctor must choose are two different things. The doctor's job is to preserve life at all costs," Malloy said.

"The doctor has no choice. No matter how intrusive the techniques are that must be employed, their job is to keep that person alive."

Malloy, who is the author of the most widely used living will in Canada called Let Me Decide, was in Yellowknife last week, holding ethics and cognitively-impaired workshops.

The Hamilton, Ont., doctor said the example of an elderly alzheimer's sufferer is just one of hundreds of possible situations where a living will could be used to express an individual's wishes on how to die.

"More than 90 per cent of Canadians in that situation want palliative care, they want to die comfortably," Malloy said.

"We can continue to demand doctors make these decisions for us, or we can make the decisions ourselves -- and prevent futile attempts to prolong life, which is something that only acts to prolong the dying process."

In the Let Me Decide booklet, the opening statement reads: "In this directive, I am stating my wishes for my health and personal care should the time ever come when I am not able to communicate because of illness or injury."

It goes on to describe different levels of care, methods of feeding and quality of life issues. Even though a living will is not law, they are generally accepted and if need be, directives carried out.

"Most major religions and the Canadian Medical Association have instructed doctors that in the event there are advanced health-care directives -- they must follow them. If a doctor didn't, he'd be sued upside down and sideways," Malloy said.

"In Canada, less than eight per cent of doctors choose palliative care for their patients because so many don't have living wills. It's not fair to leave these essential decisions to health care professionals or family members."

Erica Tesar attended Monday's living will presentation with about 20 other Yellowknifers. She went partly because many years ago when she was 27, she spent nine months home-caring for her mother who died from cancer.

"I think the main thing I learned tonight is that a living will is something everybody can use. It shows that it's our responsibility to take care of ourselves," Tesar said.

"If I was as ill as my mother was, I would love to have the courage and dignity to make a choice to stay at home, be cared for at home, and die at home."

Theresa Crane also attended the workshop. Her husband suffered a heart attack in April of 1997 and she found herself in the position of caring for him until his death eight months later.

"Because my husband was a very healthy man, we hadn't talked about things like preparing a living will," Crane said.

"Now, I see it as an easy way of overcoming the trauma of having to make decisions about aggressive medical procedures for someone you love."

She said educating people is the first step to changing the way people view the dying process.

"The way our society has advanced technologically, people almost expect to be plugged into a hospital and come out the other end fit as a fiddle," Crane said.

"People have to be educated to the fact that this just isn't the case."