Canadian Death Confusion

By Doug Magill

During my recent trip to Vermont to deliver my son to his senior year at Norwich University I was fortunate to share an evening of wine and conversation with three Canadian gentlemen on the porch of the Washington Inn in Saratoga Springs, New York (see The Canadian Conundrum).  The perceptions displayed by my new friends relative to health care had lots of liberalism sprinkled with assertions of governmental wisdom and an almost sentimental longing for easy answers and opportunities to appear compassionate for those less fortunate.

In explaining the totalitarian tendencies of such bodies as the Independent Payment Advisory Board (IPAB), a part of Obamacare, I explained that the IPAB  would not only be responsible for declaring favored treatment options but also would be effectively determining life spans.  There were the obligatory snide comments about Sarah Palin’s “death panels”.  Rather than let the slight slide I acknowledged that that was exactly what was being envisioned.

Offended “harrumphs” ensued and I challenged the Canadians to explain how it could be otherwise.  The one drinking and smoking the most opined that perhaps it was best that experts defined when it was time to say goodbye.  I asked, How would someone be qualified to be an expert on the best time for your death? And be able to make that decision in good conscience and explain it to you and your family?

Puzzlement replaced certainty.  Some vague answers about medical training and experience in life decisions would probably be necessary.  Okay.  Instead of a death panel we now would be declaring a need for Death Experts.  I asked them to ponder how some overworked and underpaid bureaucrat would be educated enough, wise enough, and knowledgeable enough to make that decision in lieu of families being weighted with that responsibility.

Nervous coughs and shifting of chairs.

I posited the example of a heart stent being needed after a heart attack when my smoking companion was in his eighties – when, even under the best of circumstances, he might receive only a year or two more of life.  The medical experts would probably deny him the care due to cost.  But, what if his daughter was being married in six months, and he could have the joy of seeing her walk down the aisle, and she would have the memory of his presence.  Would that be important to him?  Vigorous agreement.  Shouldn’t that be your decision, even if you had to pay out of your own pocket for those precious six months?

Now there was some grumbling about unfair examples.  Not backing away I said that was the point.  Sometimes life isn’t fair, and we have to make difficult and painful choices.  But, the patients and the families should be the ones to make those choices.  I pointed to them and said they were well off enough that they could find options to suit their decisions later in life because that was what being successful and saving money gave them (some startled looks but nods of agreement).  The problem with government control of health care was that it would be the poor and the middle class who didn’t have those resources who would suffer, and have choices be taken away from them.

When all is said and done, cost will dictate what choices are given, and the ones doing the analyzing will never consider the costs of a daughter unable to have her father see her married, or a child born, or any of the other millions of things that give life meaning.  Even if for only a little while longer.

Cost control through government dictates will squeeze the meaning out of many lives.  And we will all be poorer for it.

I gave some examples of what is happening in the National Health Service in Britain:  Patients denied medicine because of cost.  Waiting agonizing years for treatment.  Being left in corridors for days and weeks without being tended to or the bedding even being changed.  Bed-ridden patients not being given water for hours on end.  Patients being inadvertently left to starve to death.  Patients being given the wrong drugs due to the inattention of the staff.  “Do not resuscitate” orders being given without the knowledge of patients or families.  Orders being given to hospitals to not deliberately postpone surgery in hopes that the patient will die or pay to have the operation performed privately.

Within the last year the NHS has raised the threshold to qualify for treatment, increased the wait times for non-“life-threatening” surgeries, cut more than 20,000 jobs and shut several hospitals.  And many treatments that we consider a normal part of health care in the U.S. are not available in Great Britain.  Last October 20 percent of hospitals were cited for not providing the legally mandated minimum standard of care for elderly patients.

There was one muted squawk about the Canadian system having some good things, but even his brothers didn’t bother to try to argue that.  I mentioned that a recent Canadian survey of patients with chronic conditions revealed a large majority were dissatisfied with the care they were receiving.  And there is still a requirement to pay out-of-pocket for a number of services and medications.

They knew that Canadians headed to America when things got serious, and that privatization was creeping into the Canadian system because of the awful wait times.  I informed them that friends of mine who had moved to Canada for professional reasons were appalled that they were interviewed by doctors to see if they were healthy enough to be a patient.  That is because the system forced doctors to see so many patients and only for such limited times, and they were paid a relatively meager salary, that they didn’t feel they could afford to take on unhealthy patients.

Embarrassed silence.

I explained that this was the inevitable result of government health care when the driving force is cost control, not quality of care and certainly not quality of life.  Required patient visitations and maximum consultation times are already being dictated in some large systems like the Cleveland Clinic, and will be forced upon all system in the U.S. because of government mandates.

I tried to get them to understand that in many ways Obamacare is just another means by which liberals will raise taxes, even though they are not called that, and try to redistribute wealth.  Dr. Donald Berwick, Obama’s choice to head Medicare, stated publicly “Excellent health care is by definition wealth redistribution.”   He also explained, “It will not be a question of rationing, it will be a question of whether we ration with our eyes open.

I left my Canadian friends thoughtful and silent with one final thought:  We may die unexpectedly, or we may have a choice as to how long we shall prolong our lives.  It should be our decision if possible, or that of my sons and daughter, not a stranger who doesn’t care about me or my family and only sees me as one more cost to be eliminated.

It’s not the things we do in life that we regret on our death be, it is the things we do not.  Randy Pausch

Doug Magill has enjoyed many wonderful vacations in Canada and worked there for a time.  He is a voice-over talent and freelance writer and can be reached at


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