Have end-of-life talk now, urges palliative care doctor

COVID-19 is changing both the way we live and the way we think about dying. 

Deciding how we want to go is a deeply personal choice. Some want all the stops pulled out — resuscitation, intubation, IV hydration — do not go gentle, etc. Others are resigned to letting nature take its course, wishing only to avoid undue pain.

Either way, there's a soothing euphemism for that decision: "advanced care planning."

Miriam Mottiar is an anesthesiologist and a palliative care doctor at The Ottawa Hospital. She's urging people to form a plan, and to discuss it with their nearest and dearest. Otherwise, Mottiar said, families often ask for every last effort to save a loved one's life, when in some cases that's the last thing the dying person wanted.

In the weeks since COVID-19 struck, Mottiar, 37, has provided end-of-life care to people who've had strokes, late-stage cancer and dementia. The key difference now is that their families are no longer at their bedsides because visits to hospitals and hospice care facilities have been all but banned.

"It's a real source of sadness, for our patients and for us as human beings and physicians," Mottiar told CBC's Ottawa Morning. 

In the new COVID-19 context, she's brokering these end-of-life discussions remotely.

"I'm having conversations that I never would have had on the phone with family members … because they can't come in anymore. Very sensitive conversations," Mottiar said.

It's not just people in palliative care who are having these conversations. Dr. Brian Goldman, a CBC host and emergency room doctor, recently put his end-of-life wishes down in a tweet.

"I think that's really brave," Mottiar said. "We live in a society that is death-denying. To make a statement like that publicly and to have that conversation with your family? It's hard. It's really, really hard." 

Mottiar, who has two boys ages three and eight, knows that firsthand. 

"Last week it really started to hit home. My husband and I had a conversation around our end-of-life care wishes. We updated our wills. We talked to my brother-in-law and sister-in-law about taking our kids if we were to both die. We made sure our life insurance was up to date. I gave my husband a list of my usernames and passwords. And I wrote letters to my two boys in the event that I were to die, they would have something to read from me," she said.

I told them how important they are, that they're the most important things that I've ever done, and I wanted them to know that.- Dr. Miriam Mottiar

"I know that sounds dramatic. I don't think we know how this is going to look, but I wanted to be prepared in case something happens to me. And it was hard," Mottiar said.

"I told them how important they are, that they're the most important things that I've ever done, and I wanted them to know that."

The advice she's been sharing for years with palliative patients and their families has suddenly become very real, and very personal.

"I might get sick. I'm young and healthy, but I still might not live through COVID-19, and I want to be prepared."

Putting those gut-wrenching thoughts down in writing has taken a weight off Mottiar. "Now I can set aside my worries … and really focus on my work," she said.

'A gift to your family'

Mottiar said getting prepared for one's death is a "gift to your family. You relieve your loved ones of that burden and that guilt of having to decide … whether someone lives or dies."

So how do you broach the subject with your own family?

Mottiar recommends families check out Speak Up Canada as a place to start. But at its most basic, it involves sitting down and having a conversation with your partner or friend or "substitute decision-maker," and talking about the point at which you no longer want to prolong your life.

And in the meantime, savour the life you have.

"When I come home from work now, my husband says to my kids, 'Mommy's dirty. You can't touch her.' And so I go and take off my clothes put them in the washing machine and I have a shower. I'm excited for the day when I can come home from work and my kids can hug me again."