Dr. Balfour Mount, shown here in 2013, died recently at the age of 86.Christinne Muschi/The Globe and Mail
“It is possible to die healed,” Dr. Balfour Mount famously said.
What he meant is that, while physical healing is not always possible, anyone can heal emotionally, spiritually, and relationally before they die.
In short, inner peace, and a better death, can be achieved – with good palliative care.
Dr. Mount – known as the father of palliative care – died recently, at age 86.
Fittingly, poetically even, he spent his final hours surrounded by family in the ward of the McGill University Health Centre named for him.
You can bet that when he died, he died healed. Because for the past five decades, he healed many people – directly, and indirectly.
There are few doctors who have had more impact on patient care than Dr. Mount. It is not exaggeration to say that he changed the world, at least for those at end-of-life.
The origin story is well known. In 1972, Dr. Mount, a cancer surgeon, attended a lecture by Elisabeth Kübler-Ross, author of the book On Death and Dying, and that got him thinking about how his patients died.
He conducted a small study, and he was appalled by the findings. In short, cancer patients suffered, and little was done to ease their suffering. “To die in hospital was a catastrophe,” Dr. Mount said.
In 1973, he contacted Dame Cicely Saunders, the founder of Saint Christopher’s, a hospice in London featured in Ms. Kübler-Ross’s book. Witnessing the “whole person” care offered there was life-altering.
Dr. Mount was determined to offer hospice services to his patients, but in the hospital and not in a stand-alone hospice. He talked the administrators of McGill’s Royal Victoria Hospital into funding a pilot project. The rest, as they say, is history.
Dr. Mount coined the term “palliative care” because, in French, the word “hospice” had negative connotations; it was the name given nursing homes where people went to die – and not well. The etymology of the word “palliative” means “to improve the quality of.”
Dr. Mount gave up his career as a cancer surgeon and dedicated himself full-time to palliative care, and became its greatest champion. He did most of his advocacy quietly, shunning the media spotlight. But when he spoke – to administrators, to university classes, to church meetings, and at conferences – he invariably left audiences in tears.
Canadian postage stamps in Dr. Mount's honour were released in 2020.Christinne Muschi/The Canadian Press
Dr. Mount called his patients his “teachers of suffering,” and spoke eloquently of the need to address their “existential dread” as much as their physical symptoms.
It was something he knew intimately, having endured three bouts of cancer himself – testicular cancer at age 24, esophageal cancer at 60, and carcinoma of the bladder in his 80s.
Today, thanks largely to Dr. Mount, virtually every large hospital in North America has a palliative care ward. The field has also evolved to address suffering during any illness, regardless of prognosis.
We also have medical assistance in dying, a development Dr. Mount vehemently opposed – he was convinced palliative care, when done right, could ease anyone’s suffering.
Today, the field is divided on whether MAID is an integral part of the continuum of care, or whether actively accelerating death undermines the spirit of palliative care.
What is inarguable, however, is that here in Canada, access to palliative care remains woefully lacking. Only 58 per cent of Canadians receive palliative care at end-of-life, according to data from the Canadian Institute for Health Information. And that number probably overstates the reality, because there is no information on what palliative care people actually receive, why they qualify (or don’t), and who decides whether they receive it.
Services at Quebec end-of-life care home reflect growing demand for MAID
Too often, it’s a checkbox exercise – a quick transfer to the palliative ward hours before someone dies. Worse yet, those most likely to die – people over 85, and those living in nursing homes – are the least likely to get palliative care.
As the CIHI report states: “Palliative care should be accessible to all Canadians regardless of their age, their sex or gender, the expected path of their illness, their community, their socio-economic status or their culture. Our analysis shows, however, that this isn’t the case.”
Dr. Balfour Mount was a truly great Canadian, a healer on a global scale.
If want to truly honour his legacy – and we should – we must endeavour to make palliative care the norm, to ensure that every Canadian has “a good death,” when they want and where they want, whether in hospital, in a hospice, or at home.
To do so, the system needs to start by healing itself.