The Opioid Crisis is a Palliative Care Crisis

People are dying.

This is the reality that haunts me as I make my way to work this morning – to start another day as a professor of palliative care nursing.

In my work, death neither surprises nor disturbs me. I have sat by the bedside of countless people as they took their last breaths. I have stood with grieving family members, moments after their loved one disappeared from them forever. I have taught students how to care for people who are in the throes of heartache, and I have interviewed hospice nurses whose typical patient will live for only two weeks.

People die. This is a fact about life that I not only understand and accept, but that I honour and embrace. Believe me or don’t, but death can be beautiful.

This morning though, as I make my way to work in my warm winter coat, the images of good and peaceful deaths that have been the soul of my professional life are replaced with something darker. Today I’m not thinking of patients warm and cozy in their beds, with family at their side, and with around-the-clock nursing care to safeguard their comfort and their dignity. This morning I am thinking about the six Canadians who will die later today, likely on the street, from an opioid overdose. The six people who, like the six yesterday, and the six the day before that, have been neglected and forgotten by our health care system and by our society at large.

What are the names and the ages of these people who will die today? Where and when were they born and whom did they love? Will someone be there to hold them as they breathe for the last time? Will they be outside? Will they be cold? Will they be scared?

Palliative care, as a field, has spent the last half-century pioneering and refining an approach to care for dying patients that honours the totality of who they are as human beings. We focus on our patients’ lived experiences and their legacies, their family relationships, their values, their passions and their pleasures. We do this because we believe that the end of life is just as important as the beginning, and that on the bases of human dignity and shared humanity, everyone deserves their best chance at a good death.

Opioid overdose deaths are not good deaths. They are preventable. They are lonely and isolated. They are a national tragedy.

For fifty years, palliative care providers have felt the pull to care for those at the margins of a health care system that can’t be bothered with the dying. When Cicely Saunders opened the first hospice in London England in 1967, she sought to create a space where dying people would not only receive the medical and social care that they needed, but also where they would feel that their lives were important; that they mattered.

In her words, “You matter because you are you, and you matter to the last moment of your life”.

And so today, I am calling on my fellow palliative care nurses to acknowledge Canada’s opioid crisis as a palliative care crisis. We need to learn the lessons that people who use drugs are teaching us. These are lessons about life and death, about quality of life and suffering, and about how social forces such as poverty, stigma, and mental illness are shaping their end-of-life experience.

I teach my students that the social value of palliative care nursing lies in its unwavering commitment to improve the quality of life and alleviate the suffering of people who live with life-limiting conditions. If this idea has any meaning at all, we must acknowledge and act in the face of the opioid crisis, which is reshaping the landscape of death and dying in this country.

David K Wright, RN, PhD, CHPCN(C), Assistant Professor, School of Nursing, Faculty of Health Sciences, Co-Director, Nursing Palliative Care Research and Education Unit, University of Ottawa.



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