"I have come to talk about life and living; not about dying, but rather, about living life to its fullest, no matter what the time frame." These were the opening words of Dr. Margaret Farncombe at a public information meeting hosted by Action Life (Ottawa) on March 30th., 1998 at St. Paul's University. Dr. Farncombe was eager to explain the nature of the work of her multi-disciplinary team at the Palliative Care Outreach Program which has been functioning for six months in Nepean.

During the welcoming introduction, President Patricia Carroll explained that respect for all human life has been the concern of Action Life for 30 years and we have become convinced that the answer to suffering and terminal illness is not euthanasia but good palliative care. After a preliminary meeting with Dr Farncombe, Action Life felt compelled to make the public aware of the compassionate and important work of Dr. Farncombe and her team.

Dr. Farncombe explained that we have much to learn from people who are dying from a terminal illness. They are the most qualified to tell us what they really want from their loved ones and from their community during the final stage of living. She suggested that far too many people who have not personally experienced some form of disability or illness assume that they would want to die in such circumstances. Actually, what most patients want is good pain and symptom management so that they can enjoy the time left to them as fully as possible with their families, preferably at home.

The media emphasis on costs, hospital cut-backs and the aggressive promotion of assisted suicide and euthanasia create a fear of admission to hospital. Dr. Farncombe said we should not be concentrating on what medicine won't do. She used the example of patients being asked to sign a DNR (do not resuscitate) consent form upon admission to hospital. A better approach is to include patients in the decision making process. After a full explanation has been provided about the relative merits and drawbacks of surgery, medication, chemotherapy, radiation etc., the patients can then decide what treatment approach meets their expectations.

The aim of the Palliative Care Outreach Program is to enhance their patient's quality of life and to help their patients live as fully as possible when the prolongation of life is no longer appropriate; thus, the primary goal of palliative care is to provide pain and symptom control.

At the same time, sensitive and skilled care is required to meet the physical, psychological and spiritual needs of the patients and their families. Whether they are in the hospital or at home, patients can access the Farncombe team by pager 24 hours a day, including holidays and week-ends. All team members do house calls. They see 50 % of their patients at the clinic and 50% in the home. Dr. Farncombe as a palliative care physician is assisted by a supportive care nurse, a Chaplain, two massage therapists and a program director. There are many devoted volunteers who do not deal directly with the patients but who are involved in essential publicity and fund-raising efforts. Many of the volunteers have had loved ones cared for in the program. Both Dr. Farncombe and Chaplain Heather Krull, are affiliated with the Queensway Hospital Foundation.

Not all of the Palliative Care Outreach Program patients are dying from some form of cancer: 25% of their patients are in the end stages of diabetes, congestive heart failure, etc.

Since most patients wish to die at home, Dr. Farncombe explains what can be done to assist them and what cannot be done. She stated that 40 - 50% of people with cancer experience no pain and that although 95 % of any pain experienced by patients can be effectively controlled with appropriate medication, not all pain can be taken away all of the time.

Patients do not ask her help to commit suicide. Dr. Farncombe said the team's objective is to ensure that their patients realize that there is an alternative approach to dying. The sick can be cared for by sensitive and knowledgeable people who will help them to live their lives fully to the end. Dr. Farncombe provided a number of examples of patients who, although initially frightened and confused by their prognosis, came to treasure every extra day of life they were granted.

Two gentlemen who had cared for their wives at home during their final months gave moving and often humourous testimonies about their time together and of the strength their families derived during this period of farewell Their stories certainly confirmed chaplain Heather Krull's belief that those people who fight for every vestige of life have a strong sense of self worth. They know they are loved and they feel their life has meaning.

It is recognized that health funds are often spent on ineffective and useless treatments. Palliative Care Outreach Programs, on the other hand, are cost effective and life effective. We would be exercising true compassion if subsidized palliative care outreach programs were universally available. This approach would allow dying patients to capture life in the face of death.

For further information on the Palliative Care Outreach Program phone or fax 613-723-1184 or call the Action Life office 613-798-4494.