Dr. Doris Barwich, MD, CCFP (PC), is a retired palliative-care physician and former Clinical Associate Professor in the Division of Palliative Care at the University of British Columbia. She was the inaugural Executive Director of the BC Centre for Palliative Care and previously co-led Fraser Health’s Palliative Care program, where her work included advance care planning, population health, and palliative-care program development. Her career has encompassed clinical palliative medicine, health-system leadership, and research, and she has served in leadership roles with the Canadian Society of Palliative Care Physicians. In 2018, she received the Eduardo Bruera Palliative Medicine Award in recognition of her contributions to palliative medicine and leadership.
Conversations about MAiD often begin with questions of rights, autonomy, suffering, and choice. Dr. Doris Barwich begins somewhere closer to the bedside. After more than three decades in palliative medicine, she has accompanied patients and families through the fears and uncertainties of dying—and witnessed how those fears can change when people receive skilled, compassionate care. In this conversation, Barwich reflects on the development of MAiD in Canada, the difference between anticipated and experienced suffering, our cultural attachment to independence and control, and the importance of ensuring that choice remains genuinely informed. But she also tells stories: of relationships restored, forgiveness offered, families reunited, and people discovering meaning in time they once dreaded. Along the way, she offers a compelling account of palliative care as a “middle way”—neither hastening death nor unnecessarily prolonging it, but helping people live fully until the end.
Names mentioned:
Kay Carter, Gloria Taylor, Viktor Frankl, Canadian Society of Palliative Care Physicians, Canadian Medical Association.
Radix: Thank you so much for taking the time to conversate. I’m especially grateful because, with a topic as significant as this, it’s important to hear from a physician with actual years of hands-on work with patients and leadership in healthcare administration, particularly in palliative care and hospice. You’re uniquely positioned to help us think through this subject. And conversations about dying—and about MAiD—certainly can be uncomfortable. So, to begin, would you tell us a little about yourself and how you came to this work?
Dr. Doris Barwich: Certainly. I began my career as a family physician and practiced for about five to ten years before starting part-time work in hospice. That gradually became the focus of my career, and for the past thirty-plus years I’ve worked almost exclusively in palliative care. Palliative care was a natural fit for me because, as a spiritual person, I appreciated its wholistic approach. It addresses not only physical needs but also emotional, psychosocial, and spiritual concerns. More than any other area of medicine, it focuses on caring for the person rather than simply treating a disease or managing a list of problems. I found that model deeply meaningful—walking alongside people, offering expertise, support, guidance, pain and symptom management, and helping them navigate what is often the most fearful season of their lives.
A great deal of palliative care is simply helping people understand what is happening to them. When people understand the process, they often regain a sense of agency, even in circumstances they cannot control. That became especially significant as conversations around MAiD emerged, because a small but growing number of patients began asking whether they could avoid the suffering, uncertainty, and fear that often accompany dying by choosing the timing and manner of their death.
Control is a powerful value in our culture when it comes to this discussion. Many people have lived their lives believing they are the masters of their own destiny, so it is not surprising that they would also want to determine how they die. In Canada, the MAiD conversation initially became framed largely as a question of rights. In most other countries, assisted dying was presented primarily as a last-resort option for the relatively few people experiencing truly intractable suffering. In Canada, however, the Carter case shifted the discussion toward an issue of individual rights. Kay Carter had traveled to Switzerland to access assisted dying because of complications related to spinal stenosis. Later, Gloria Taylor, who was living with ALS [amyotrophic lateral sclerosis], argued that by the time she wished to end her life she would likely be physically unable to do so herself. The question then became whether a person with that level of disability should also have the legal right to access a hastened death.
As a result, Canada adopted physician-administered euthanasia—what we call Medical Assistance in Dying, or MAiD. That differs from the system used in much of the United States, where physicians prescribe medication but the patient chooses whether and when to take it. Switzerland and other countries have their own variations as well, so it’s important for Canadian and American audiences to recognize that these are not all the same practice.
Radix: Thank you for clarifying that difference.
Dr. DB: Alongside my clinical work, I also served in leadership roles within palliative care. I was a regional medical director responsible for services across a health authority serving more than two million people. We worked hard to develop a continuum of care: physicians, nurses, social workers, chaplains and volunteers supporting people in their homes whenever possible; hospital-based palliative care units for those needing more intensive symptom management; and hospice residences for patients who could no longer remain safely at home or lacked the necessary caregivers.
I’m particularly proud of that work because our goal was to ensure that, wherever someone was in their illness, there would always be people ready to walk alongside them. In smaller communities, the same physician might care for a patient at home, in hospice, and even provide consultation within acute-care hospital settings. Much of our work involved helping patients and families understand end-of-life decisions, navigate complex situations, and manage symptoms. Pain control, especially for people with advanced cancer, is critical, but so are issues like shortness of breath, nausea, vomiting, and constipation. Those are the very practical challenges people face every day.
Around that medical care was a much broader team—social workers, chaplains, volunteers, and others addressing the emotional, relational, and spiritual dimensions of illness. Palliative care has always been a team approach, caring for the whole person rather than simply treating a disease.
Radix: One of the things that stands out in palliative care is the compassion people experience. Could you speak a little about that?
Dr. DB: People often ask whether this work is difficult. Research now shows that when we care for another person—not merely because it’s our job but because we genuinely have compassion—both the caregiver and the recipient benefit. That mutual growth creates ripple effects that extend well beyond the immediate relationship.
I remember one man who came into hospice absolutely terrified. Throughout his life he had struggled to cope. He had lost his job, gone through a divorce, become estranged from his children, and drifted away from church. He was deeply isolated. Through palliative care he encountered something he hadn’t experienced for a long time: people who simply cared about him. We contacted his church, and someone began bringing him communion every week. Volunteers visited regularly and gradually became companions during that season of his life. Instead of simply waiting to die, he actually began to thrive. He was reconciled with his children. He was able to go out for dinner with his daughter. He attended the baptism of a grandchild.
Those moments in a person’s life matter enormously. They remind us that palliative care is fundamentally about helping people live as well as they can for as long as they can, while recognizing that death is a natural part of life. We also help manage the fears surrounding dying, but our first task is always to support living well until the very end. That’s why the work is so rewarding. There is something deeply human about it. In many areas of medicine you’re treating diseases. In palliative care, you’re accompanying people.
Radix: That’s a wonderful picture, and it strikes me that stories like that rarely receive the same attention as the public conversations around MAiD.[1] Your example reminds us that life still has meaning … right to the very end.
Dr. DB: Oh, absolutely! And here I can speak from my own experience. For much of my career I worked in administration and leadership, including serving as president of the Canadian Society of Palliative Care Physicians while the MAiD legislation was being debated. During that period we partnered with the Canadian Medical Association to host town halls across the country, sponsored by Maclean’s[2] magazine. They gave Canadians an opportunity to discuss what assisted dying might mean while also learning about what palliative care actually offers. Those conversations were valuable because people came with a wide range of opinions. The issue was before the courts, so there was genuine public debate. It also allowed us to explain what palliative care could provide at the end of life.
One thing that became very apparent was that organizations supporting MAiD, such as Dying With Dignity, were extremely well organized, well funded, and highly committed. I remember attending an all-day educational conference for palliative care professionals. There were a number of attendees who clearly weren’t there because of an interest in palliative care itself. Only later did it become obvious why. The final session was a panel discussion on MAiD, and when questions opened they had already lined both microphones with supporters, ten people deep, ensuring that nearly every question reflected a single viewpoint. They had been willing to sit through an entire day of unrelated sessions simply to shape that final discussion. That illustrates both the organization and determination behind the movement.
Radix: This is something that everybody should be paying careful attention to—where is the funding coming from—because it is shaping the thoughts of society, right?
Dr. DB: It is. There is also a great deal of public misunderstanding. People would sometimes ask why palliative care opposed providing adequate pain relief at the end of life. They assumed that was what MAiD meant. Once I explained that MAiD involves intentionally ending a person’s life, many were genuinely shocked. They would say, “That’s not what I thought people were talking about.” Here is the thing: the language surrounding MAiD is often framed in very reassuring terms—medical support, dignity, avoiding suffering—and that can leave people unclear about what is actually being proposed. Hopefully conversations like this, and more articles on the topic, help people better understand both what MAiD is and what it is not. It is not the same thing as providing excellent pain control and compassionate palliative care at the end of life.
Radix: For someone who has never seen or read about this process firsthand, what does applying for MAiD actually look like in Canada? What are the timelines, and how does the process typically unfold?
Dr. DB: It depends largely on how urgently someone is seeking MAiD. Take someone who has received a diagnosis with a prognosis of perhaps six to twelve months. If they’re someone who likes to plan ahead, they’ll naturally begin asking, “What are my options?” Often their concerns aren’t simply about dying. They’re worried about pain, about losing independence, or becoming a burden to their family. A common comment is, “I don’t want my spouse changing my diapers.”
Most people have a threshold in mind—a point beyond which they feel life would no longer be acceptable. That threshold is often especially important for people who have lived their lives valuing independence and control. Some people therefore contact the MAiD team early, complete the required assessments by two physicians, and receive approval. That approval is valid for twelve months. In effect, they now have what they see as an exit strategy. When they’re admitted to hospice they’ll often tell us, “I’ve already been approved for MAiD,” and the documentation simply becomes part of their medical record. Whenever I meet someone in that situation, my next question—because it’s a really important one—is always, “Help me understand what you’re afraid of. What would make you want to activate that decision?”
The answers are remarkably consistent. People fear pain. They worry about becoming a burden on their family. They’re afraid of isolation, of being forgotten, of feeling that everyone else’s life has moved on while they’re simply waiting to die. That’s where palliative care begins. We ask, “Let’s see what we can do about those concerns.” We address symptoms, support families, relieve loneliness, and try to reduce the fears that are driving the request in the first place.
One of the fascinating things we observe is that people’s goalposts often move. Someone who once said, “I could never live if I needed diapers,” eventually reaches the point where getting to the bathroom has become painful and exhausting. Suddenly a catheter or incontinence care doesn’t feel degrading anymore—it feels like relief. Something that once seemed unimaginable becomes entirely reasonable because their circumstances have changed. They discover they’re still treated with dignity. They’re still the same person. The people around them don’t see them differently. Life simply continues.
Radix: That idea of the “goalposts moving” is fascinating. It suggests that what we imagine beforehand will be intolerable may look quite different once we’re actually living within that reality. Perhaps that’s one reason decisions of this magnitude need some time and space to emerge within a person’s lived experience.
Dr. DB: We actually see that very often. Good care doesn’t necessarily eliminate suffering, but it frequently changes how people experience it. There are other patients whose greatest struggle isn’t pain but simply the feeling that dying is taking too long. Historically, in palliative care we distinguished between someone expressing a wish to die—saying, “I’m ready. I wish this were over”—and someone actively requesting that their life be ended. Those aren’t necessarily the same thing.
When symptoms become especially severe, another option is available besides MAiD: palliative sedation. This is typically considered only during the final days or hours of life, particularly when symptoms such as extreme shortness of breath have become refractory—that is, we’ve exhausted every reasonable medical treatment and the suffering remains overwhelming. People often fear suffocating more than death itself. In those circumstances we can use medication to reduce consciousness to whatever degree the patient desires. Some people choose to be sleepy but still wake to visit with family. Others choose to remain fully asleep. The goal is not to hasten death but to relieve otherwise uncontrollable suffering during the natural dying process.
Families often find great comfort in knowing that the option exists, particularly for patients who have decided they do not want MAiD. They ask, “Is there anything else you can do?” The answer is yes. Even when symptoms become intolerable, we still have ways of caring for people compassionately. One of the things we try to do throughout palliative care is provide what I often call a roadmap. We help families understand where they are in the journey. If someone is changing week by week, we’re probably looking at the final months. When changes become noticeable day by day, we know we’re entering the last weeks. When changes occur hour by hour, we recognize that death is likely very near. That kind of guidance helps families know when it’s time to call relatives, gather loved ones, or simply prepare themselves emotionally for what’s coming. Understanding the process often reduces fear because people can make sense of what they’re seeing rather than feeling overwhelmed by uncertainty. Some patients, however, reach those final days or weeks and decide they simply cannot continue. At that point they initiate a MAiD request.
Radix: What does that look like?
Dr. DB: The process involves assessments by two physicians: one who determines eligibility and another who agrees to provide MAiD. In urgent situations the process can often be completed within forty-eight to seventy-two hours, sometimes even more quickly if death appears imminent. There is no mandatory waiting period in those circumstances. Another important development has been the introduction of what’s called a waiver of final consent. Originally, patients had to be fully awake and capable of giving consent immediately before MAiD was provided. Now they may sign a waiver indicating that, should they lose decision-making capacity through confusion or declining consciousness, they still wish the procedure to proceed. That change addressed a practical problem. Early on, some patients refused adequate pain medication because they feared becoming too sedated to provide final consent. In that sense, the waiver has actually improved symptom management because people are no longer forced to choose between good pain control and preserving eligibility for MAiD.
Some patients ultimately decide that, with their symptoms well managed, they’re comfortable allowing death to come naturally. Others still value the certainty and control that MAiD offers, particularly during the final weeks of life. Those decisions are then coordinated with family, and the MAiD provider comes to carry out the procedure.
Radix: It almost sounds as though someone who intentionally plans ahead might actually end up wanting to live a little longer than someone who waits until the very end. Is that fair to say? If so, that implies that thinking ahead is important.
Dr. DB: I think so. I remember one woman from the early days of MAiD. She suffered from severe shortness of breath, which was incredibly distressing. She was already an anxious person, so anxiety combined with the sensation of not being able to breathe was a very difficult combination. She had scheduled MAiD, and we all knew the date had been set. Then, on the appointed day, she arrived at our pain and symptom clinic. I asked how she was doing, and she told me, “I couldn’t go through with it.” The day before, her brother had called and said, “Why are you doing this? You’re not a dog. We don’t put people down. We put dogs down.” That conversation gave her pause.
So we adjusted her medications and did everything we could to make her more comfortable. She had also been diagnosed only very recently with an extremely aggressive disease, so everything was happening at once. There was the shock of the diagnosis, the treatments, the rapid decline, and the relentless breathlessness. It was all new, all overwhelming. In the end, she did proceed with MAiD about a week later because, for her, things eventually became intolerable. I can understand how that happens. Sometimes the pace of decline itself becomes part of the suffering.
What I’ve found, though, is that the more time people have to adjust—to think, to process, and to come to terms with what’s happening—the less they’re living in crisis. Most of the people we care for in palliative care experience a gradual progression from months, to weeks, to days, to hours. That slower progression allows them to adapt. They begin saying, “This is my new normal.” Their world gradually becomes smaller, but it doesn’t happen all at once. As that adjustment takes place, the panic often subsides. It also gives us time to establish support systems, educate patients and families, and, perhaps most importantly, build trust.
I remember another man who, right at the end of his life, asked to be put to sleep through palliative sedation. By that point we’d built a relationship with him. He was in hospice, experiencing a severe breathing crisis, and every time he struggled the doctors and nurses responded quickly and competently. Over time he came to trust that, when he needed help, it would be there. That trust matters.
It’s sometimes more challenging when people choose to remain at home because the response isn’t immediate in the same way. Even so, home-care nurses visit regularly, families are taught how to use medications, and the entire team works to anticipate problems before they become crises. Many of the fears people have are eased simply by knowing someone will respond when things change unexpectedly. Good palliative care doesn’t remove every difficulty, but it often removes the fear of facing those difficulties alone.
At the same time, medicine has become remarkably successful at keeping people alive much longer than would once have been possible. In a sense, we’ve created the circumstances that now lead some people to say, “Medicine contributed to this situation, so medicine should also provide the solution (i.e., MAiD).” For many people, the decision isn’t primarily framed in religious or ethical terms. It’s far more pragmatic. They think, “I don’t want this. I’m a burden to my family. Let’s just get it over with.” That’s often how they understand it.
Radix: One of the things I’ve heard repeatedly—and it matters, because, again, people’s assumptions are shaped powerfully by what they think to be the facts—is that many people who choose MAiD do so because they’re experiencing unbearable physical pain. While that certainly happens, it isn’t necessarily the primary reason.
Dr. DB: No, it usually isn’t. More often it’s an existential question. People reach the point where they think, “I’m done with this. What’s the point? I’m dying anyway. Whether I die today or two weeks from now doesn’t seem to matter, and I don’t see any value in what those two weeks might hold.” If someone has lived within a largely materialistic framework—making decisions, exercising control, consuming, planning—then choosing the timing of death can seem like a perfectly logical extension of how they’ve lived. They simply ask, “Why wouldn’t I?” This is where sometimes spiritual care comes in.
Hospices offer spiritual care. Chaplains visit regularly and make themselves available, although I honestly don’t know what percentage of patients choose to use those services. Many will welcome a prayer or a thoughtful conversation. The gentleman I mentioned earlier is a good example. For him, the chaplain was simply another man, someone closer to his own age when most of the clinical staff were women. He appreciated having someone who could sit, listen well, and simply be present. The chaplain also helped reconnect him with his local church so that people could visit, bring communion, and support him during that season. Sometimes that’s exactly what’s needed. In other situations, family members are the ones who would like more spiritual involvement, while the patient declines. Ultimately, those decisions remain with the patient.
Here’s the thing:If you’re working in palliative care, you have to accept that people now have choices. Whether or not you’re personally involved in MAiD depends on who you are and what role you’ve chosen, but my responsibility has always been to support people as fully as I can for as long as I can. My goal is to ensure that whatever decision they make is genuinely informed—that they’ve experienced good care, understand their options, and know they have support. An informed choice is only possible when people have actually experienced what palliative care can offer.
Radix: When we initially spoke together, you touched on something that struck me. It seemed you were saying that those most interested in MAiD are often people who have been accustomed to being in control—people who are affluent, successful, and used to directing the course of their lives. When that sense of control disappears, especially within our consumer-oriented culture, the question becomes, “If I can no longer do what I want, what’s the point?”
Dr. DB: I really do think there’s something to that. Many ordinary people who’ve never lived with that strong sense of personal autonomy simply don’t approach the end of life that way. Their lives have often been centered more around family than individual self-determination. When family gathers around them, they’re loved, supported, and cared for, and they don’t necessarily see a reason to bring that season to an early end.
There’s also an important sense that we’re modeling something for those who come after us. How do we face suffering? How do we respond when life becomes difficult? Many people simply believe you do your best, you persevere, you call your family, people show up, and together you carry the burden. For people whose lives have been shaped by faith, suffering is understood as part of the human experience. It’s difficult, but it isn’t meaningless. We often say that people die much as they’ve lived. If that’s how you’ve lived your life—surrounded by family, accepting hardship, trusting others—it’s often how you’ll approach dying as well. That doesn’t mean concerns never arise. People are often very sensitive to the impact they’re having on those around them. They’ll say, “My wife can’t keep doing this,” or “I’m becoming too much of a burden.”
But then you also see the other side. I’ve watched spouses lie beside a dying husband or wife for days, refusing to leave the bedside. Sometimes we have to encourage them to go home, rest, and let another family member sit for a while. Other spouses visit only briefly each day, and their partner is grateful even for those twenty minutes. You see the entire spectrum of human relationships. That’s why it’s so difficult to make broad assumptions about why people make the choices they do.
Radix: That point you made on modeling is really interesting.
Dr. DB: It is interesting, and I have seen some really beautiful things. As well as the not-so-beautiful. What concerns me about this whole MAiD thing is something I’ve seen happen several times in recent years. I’ve had older friends—women in their eighties, perhaps beginning to experience mild cognitive difficulties or recovering from an acute medical event—who have been unexpectedly asked whether they’d considered MAiD. One woman had fallen, hit her head, and was temporarily confused. While she was still recovering, someone suggested that perhaps she should think about MAiD. She was shocked and horrified. Understandably, that experience became the story she told everyone afterward: she needed care and reassurance, yet someone suggested ending her life instead.
I’ve seen something similar among veterans living with PTSD, chronic pain, or other long-term disabilities. Some have been offered MAiD simply because they’re living with ongoing suffering. That deeply troubles me. It also deeply troubles the people being asked. They’re doing their best to live meaningful lives despite pain or disability, and suddenly someone appears to be judging that life as not worth continuing.
That’s not what MAiD was intended to be. It should never become a quick solution simply because a physician thinks, “I wouldn’t want to live like that.” If someone chooses life, our responsibility is to help them live that life as fully as possible for as long as possible. Our first instinct should never be to present death as though it were simply another form of care. Care means supporting life, relieving suffering, and helping people flourish within whatever circumstances they’re facing.
I have a close friend whose husband has advanced Parkinson’s disease. Every time he’s admitted to hospital, she feels she has to fight to ensure he receives appropriate care because there’s an underlying attitude that says, “Well, MAiD is available. Wouldn’t that be easier?” But he’s been very clear: he wants to live. I’ve encouraged her by saying that, when the time truly comes, they’ll know. Perhaps he’ll eventually say, “Next time let’s stay home rather than going back to hospital.” Or perhaps she’ll recognize that he’s reached the point where further interventions no longer make sense. Those are natural decisions that families often arrive at together. But until then, why would we push someone toward a choice they haven’t made? That simply wasn’t the culture of medicine years ago. I worry that the existence of MAiD lowers the threshold for even raising the possibility.
That’s one reason I was so concerned about proposals to extend MAiD to people whose primary suffering was mental illness. My own daughter has struggled with severe depression and has attempted suicide several times. She once said to me, “Mom, if this had existed back then, I might not be here today.” Every time she went to the emergency department, people told her, “Your life matters. We’re going to help you. We’re going to find treatment. This isn’t the end.” Today, if someone instead says, “We can refer you for MAiD,” the message changes dramatically. Thankfully she’s now living a good life. But she often reflects that she might never have reached this point if those earlier responses had been different.
That’s my concern. I think MAiD is increasingly being raised in situations where it simply isn’t appropriate. I remember that, in the early days, one health authority was drafting a policy that would have required every patient with a certain stage of illness to be informed about MAiD. I objected strongly. I asked, “When someone comes to you for birth control, do you immediately begin talking about sterilization?”
Radix: [Laughter]
Dr. DB: Right? Of course not. That’s a conversation that, if it ever happens, comes much later. After some serious consideration. Likewise, when someone has just received a serious diagnosis, the first message they need to hear is not, “You know, you could end your life.” For someone who is frightened, vulnerable, and trying to understand what’s happening, that immediately raises disturbing questions: Why is my doctor bringing this up? Are they telling me my life isn’t worth living? What am I missing? That shouldn’t be where we begin. We should begin by saying, “We’re going to care for you. We’re going to do everything we can to help you.” That’s the vocation of medicine, and that’s one of my deepest concerns about where we’ve arrived.
Radix: Speaking to something you were mentioning earlier about rights and responsibilities and whether MAiD is a right, something Viktor Frankl once said comes to mind. He suggested that the Statue of Liberty on the East Coast should be complemented by a Statue of Responsibility on the West Coast. We rightly speak a great deal about rights and freedoms, but perhaps those need to be paired with obligations and responsibilities. Especially at the end of life, our decisions aren’t made in isolation; they also affect our families and those who love us. Sometimes people are making decisions in moments of intense emotional crisis. I’m not sure they’re always able to imagine what life might still hold beyond that moment.
Dr. DB: Exactly. That’s why informed choice matters. People often can’t imagine what’s on the other side of the experience they’re facing. We see that all the time in palliative care. From a distance, someone imagines a future situation and thinks, That would be unbearable. But when they actually arrive there, it often becomes something much more practical. My own mother reached that point. She had always said, “I never want to be handicapped.” Eventually she needed to be cared for in bed, including wearing incontinence products. I remember saying to her, “Mom, you’re not handicapped. We’re simply doing what’s safest and easiest given where we are.” None of us would choose that situation, but once you’re there, you make the best of it. People often tell me I’m very practical. I usually reply that it’s because of the work I do. Every day you’re faced with difficult realities, and the question becomes, “All right, this is where we are. What can we do now?” You don’t spend your energy wishing reality were different. You help people make the best of the reality they have.
Radix: I love stories—because they inform and form us. Experiences during end-of-life matter. Anyway, last time we spoke, you told a story about something that happened in palliative care that has stayed with me. I think a daughter said something like, “You gave me my mother back.” Can you tell that story again?
Dr. DB: Oh, yes—that was a remarkable experience. We cared for a woman who had spent years living on the streets because of addiction. She eventually came into the hospital, was diagnosed with stage-four cancer, and we helped find housing for her. She had two daughters from whom she’d been estranged. One had unfortunately followed a similar path of addiction, while the other had built a stable life and worked as a care aide. When their mother was admitted to hospice, both daughters came to visit. Within a day or two, the daughter who struggled with addiction had a major argument with her mother and left. We never saw her again.
The other daughter essentially moved into the hospice for the final three weeks of her mother’s life. At first there was still some substance use, and I suggested trying a different medication that I’d found helpful with other patients. It significantly reduced her cravings. More importantly, she decided she wanted those remaining weeks to be different. She said, “I don’t want that life anymore. I don’t want those people around me anymore. I want this time to be about my daughter.” That was her choice.
At our hospice, whenever someone dies, we accompany the body in a procession to the elevator before they leave us. At the end of that procession, her daughter turned to us and said, “Thank you. You gave me my mother back.” She said those three weeks were how she would remember her—not all the painful years of addiction, but those final weeks when they were truly together again. Those are extraordinary moments. They’re one of the great gifts of palliative care.
I remember another man from much earlier in my career. Shortly after receiving his diagnosis, he attempted suicide. He had a ten-year-old son and, by his own admission, hadn’t been a particularly good husband or father. I remember saying to him, “You still have an opportunity. You have time to redeem this season. Your son is watching how you face this. Perhaps these months can become something different from everything that’s gone before.” He embraced that idea. Those remaining months became a very good season for that family. A terminal diagnosis forces people to ask, “Now what do I do with the time I have left?”
Some people discover that, even if they have only a few months, they can leave their family with very different memories than the ones they’ve created over a lifetime. To me, that’s one of the great gifts of hope. Palliative care isn’t only about helping people live as well as possible physically. It’s also about helping people see that, despite past mistakes, there’s still time for reconciliation, healing, forgiveness, and love. Many people have spent their lives trapped in patterns they never seemed able to escape. Then suddenly, near the end of life, there’s an opportunity to step outside that cycle. Some embrace it. Others don’t. But when they do, the transformation can be extraordinary.
I remember another son who came to visit his dying father. Before going into the room, he broke down and said, “My dad introduced me to drugs. I’ve lost my family because of that. How am I supposed to walk in there and pretend everything’s okay?” We told him, “You don’t have to pretend. But perhaps you can go in with the hope of connecting with your father in the best way that’s still possible.” When we spoke with his father, he immediately said, “Is my son here? I want to apologize. That’s what I need to do.” So we went back to the son and asked, “Would you allow your father to say he’s sorry? Would you allow him to ask for your forgiveness?” He agreed. That conversation didn’t erase the past, but it changed how the son would remember his father. There was acknowledgment. There was ownership. There was repentance. Those are the kinds of things people miss if they see end-of-life care only through a medical lens. We’re privileged to witness those moments because that’s the work we’ve been called to do.
Radix: Thank you for sharing those stories. As someone who loves words and stories, one thing that stands out to me in everything you’ve shared is the possibility of redemption. Even at the end of life, there seems to be the possibility of reconciliation and restoration.
Dr. DB: Absolutely. People often think of dying only as something tragic—an enemy that has to be fought until the very end. But there comes a point when death itself can become something different. Suffering is real, and it can be very hard, but there can also be a welcome end to suffering. That’s the philosophy of palliative care. We neither hasten death nor prolong it unnecessarily. We accompany people. Most of medicine operates from a “fix it” model. Palliative care is different. We recognize that, when something can no longer be fixed, people still deserve to be accompanied with honesty, compassion, and hope.
I remember one woman arriving absolutely furious after her husband had been told he had six months to live. She looked at him and thought, He’s dying right in front of me, yet no one was willing to have an honest conversation about what was happening. Sometimes that’s exactly what’s needed. We have to be willing to say, “Yes, from what I’m seeing, I think we’re probably in the last days or perhaps the last week or two. So how can we help? What do we need to put in place?”
Once people understand what’s happening, they can begin making meaningful decisions. We mobilize support, manage symptoms, control pain, preserve awareness whenever possible, and help people find their own way through. Palliative care isn’t simply a choice between suffering and ending life. There’s another path. I often describe palliative care as the middle way.
Radix: What a salvific message. Before we finish, I’d like to ask one final question. Imagine you’re speaking to a room full of thoughtful pastors and church leaders. What would you most want them to hear?
Dr. DB: I’d begin by encouraging them to understand their own relationship with suffering and death. That’s something chaplaincy training emphasizes. Why did that situation trigger me? Why did I react that way? If we’re afraid of dying ourselves, we’ll inevitably communicate those fears to the people we’re trying to help. Pastors are often the first people families call when a crisis begins. One of the great gifts they can offer isn’t having all the answers. It’s their presence—the calm, hope, and reassurance that say, “We’ll be here with you. You don’t have to walk through this alone.” Those things help people discover that perhaps they really can face what’s ahead.
I have a friend who’s trained as an end-of-life doula. People call her not because she has magical solutions but because they know she’ll know what to do. When someone’s driving their mother to the hospital in a panic, they need someone they can call—someone who understands the road ahead. Pastors can play a similar role. Help families gather the people they’ll need around them. Every situation is different, so every support team will look a little different. Encourage people to involve palliative care sooner rather than later. Much of what people fear about palliative care simply isn’t true. They think it means giving up, when in reality it’s about helping people live as fully as possible for however much time remains.
Just as importantly, make space for honest conversations. When fears are spoken aloud, they often lose much of their power. Once people begin talking, they frequently realize that the things they feared most may never happen—or that, if they do, they’ll have people beside them to help carry them. I’d also encourage churches not to wait for a crisis before becoming involved.
I know of one woman whose husband had dementia. He’d been one of those faithful men who was always serving—setting up chairs, helping wherever he was needed, deeply involved in the life of the church. As his illness progressed, she phoned the men’s group and asked whether someone would simply come over once a week to play crib with him. That’s all she wanted. Not counselling. Not a Bible study. Just companionship. Another man continued picking him up for the men’s breakfast for as long as he could participate, even if he contributed very little. He still belonged. Those small acts matter enormously because illness is profoundly lonely. People gradually disappear from church life, and before long they are forgotten. Churches need to think intentionally about how to keep those members connected—to bring communion, to visit, to include them, and to remind them that they’re still part of the body of Christ.
Years ago, while we were developing a Compassionate Communities initiative, a student visited churches throughout New Westminster to ask whether they would be interested in supporting frail elders in the community or hosting educational evenings on subjects like advance care planning. Most churches declined. Many essentially said, “We’re already busy looking after our own people.” I understand that pastors carry enormous responsibilities. But I also think this is an area where churches have tremendous opportunity. At our own church we held a short series on palliative care and advance care planning. One woman complained throughout the sessions because she didn’t want to think about any of it. A few months later she came back and said, “Now I understand why I needed this. My brother-in-law became seriously ill, and I’m the only one in the family who knew anything about what we’re facing.” That’s exactly the point. We often don’t realize we’ll need these conversations until suddenly we do.
We have so many older adults living in isolation, and so many caregivers quietly burning out. One woman eventually left her church because, after everything her husband had contributed over the years, almost no one came to visit when he became ill. She felt abandoned by the very community they’d spent decades serving. That shouldn’t happen. Not every pastor has the gifts or the time to provide extensive pastoral care personally, but churches can develop that capacity. Ministries like Stephen Ministry, trained lay visitors, elders, and volunteers can become an extraordinary support network.
The more people who surround someone with genuine care, the less likely they are to conclude that they’re simply a burden whose time has come to leave. If our understanding of ministry ends with preaching sermons and conducting funerals, we’ve missed something essential. The ministry of presence—the quiet work of accompanying people through suffering, frailty, and death—is one of the Church’s greatest callings.
Radix: [Clapping] Amen, amen. Thank you. That was a wonderful message, and it touched on so much of what makes life beautiful—and how, at every stage of life, we can contribute to helping one another live it fully. And I didn’t even give you notice of that last question!
Dr. DB: [Laughter] I always have something to say. I don’t get to talk very much anymore now that I’m retired. Nobody asks.
Radix: Well, thank you. I’m glad I asked! I really appreciate your time, wisdom, words, and stories.
Dr. DB: You’re very welcome.
[1] This is a complex issue; however, here are a few links you can click on to read more. https://www.theglobeandmail.com/business/article-simons-faces-criticism-for-campaign-highlighting-medical-assistance-in/; and https://assistedlab.ch/visual/all-is-beauty-the-most-beautiful-exit
[2] A quite established and respected publication within Canada going back to the early 1900s.