At age 72, he’s endured more than 20 years of chronic pain punctuated by excruciating, breakthrough pain. For the past four years, it’s been mostly tolerable after extensive spinal surgery and with daily doses of opioids.
Until now.
After waiting for a year to be accepted as a patient at one of the province’s very few specialized pain clinics, he now goes every three months to have his condition and treatment reassessed. But in the interim period, if something changes and his suffering spikes beyond what’s controlled by hydromorphine and Tylenol 3, his general practitioner will no longer prescribe any extra pills.
Even emergency room doctors have been reluctant to administer more opiates after a few bad falls that recently have driven him to hospital desperate and writhing in agony.
So a few weeks ago this Lower Mainland man went searching for information on whether he would qualify for medically assisted death.
“I can’t imagine living without him,” says his wife of nearly 52 years, who is angry and frustrated. But from her front-row seat to his misery, the retired nurse also can’t imagine how her husband can stand much more.
He declined to speak to me, preferring that his wife speak for him. At their request, the couple’s names are not being used to protect both their privacy and that of the physicians treating him. The couple is wary of attracting any further attention from the B.C. College of Physicians and Surgeons. His physician — whom they describe as “knowledgeable and compassionate” — received a warning letter from the college last fall after ordering more Tylenol 3 to combat an acute episode.
Last year, in the wake of rising deaths from drugs containing illicit fentanyl, the college set enforceable standards for opioid prescriptions with penalties that include stripping doctors of their licences and a maximum fine of $100,000.
The college emphasizes that those penalties have never been imposed. But few physicians are willing to risk being the first.
After years of having his agony controlled to a bearable level that allowed him to lead a relatively normal life, the Metro Vancouver man no longer believes that’s going to be possible.
“Sometimes the pain is excruciating and still tolerable,” his wife said in a telephone interview. “But every time it gets really bad, he says, ‘I can’t do this any more.’ ”
A few weeks ago, he was walking with a cane. Now, she said, “there is no sign it is letting up. Sometimes he has a few pain-free hours, but the doctor has already reduced the opiate, hoping the lesser dose will be enough. It’s not.”
Putting weight on his leg causes excruciating suffering, so he now uses a wheelchair. That’s stripped him of independence.
Even getting prescriptions refilled would be very difficult if his wife weren’t able to do that for him. Again, as part of the war against opioid overprescription, opioid prescriptions are only refilled when all of the pills from the previous script are used up.
By some definitions, this man is an addict. But he’s not out searching for a high. He needs drugs to simply endure and function.
The drug-dependency isn’t because he’s seeking the simplest option. For years, the couple were volunteer trainers at chronic disease self-management workshops and chronic pain workshops, helping others seek out every option imaginable to mitigate pain.
But now, he’s seen his options as having dwindled down to one: assisted suicide.
“He’s very serious about it,” his wife said. He’s got the phone number of someone who might help. But as far she knows, he has not yet used it to find out whether he would meet the five criteria set out in Canada’s 2016 law that legalized medically assisted death.
But she expects him to do it any day now.
Among the assisted dying law’s criteria are that two physicians and/or nurse practitioners must confirm that the person suffers from “a grievous and irremediable medical condition” and that applicants have been informed of “the means that are available to relieve their suffering, including palliative care.”
Ironic, isn’t it? It’s precisely because no one seems willing to relieve his suffering that the 72-year-old is contemplating assisted death.
It’s a contradiction not lost on his wife.
She’s incredulous that treatment for chronic pain sufferers is stuck in the dark ages, or at very least stuck in the era when even cancer patients were left untreated in excruciating pain because of the concern that administering more opioids might result in addiction.
That era, mercifully, has ended for cancer patients and others nearing the end of life. Pain control is the primary focus of compassionate care provided by hospices and palliative care units.