Ever since industrialization brought about urban living and the breakup of extended families, increasing numbers of Quebecers have been dying in hospitals and alone, instead of at home and surrounded by their families. Let us consider a few numbers:

• More than a third of Quebecers now live alone, compared to 12 per cent in the early 1970s.
• In 15 years, 26 per cent of Quebec’s population will be over 65, compared to 16 per cent in 2012, so there will be a lot more dying going on soon.
• Depending on the region, 40 to 80 per cent of those who need palliative care do not currently receive it.
• There are 110 fewer palliative care beds in Quebec than the government-regulated ratio of 1 per 10,000 population requires.
• ^•      Although 75 per cent of Quebecers would prefer to die at home than in an institution, only 10 per cent do die at home (the lowest proportion in Canada).¹

As these numbers show, the question of how we die has now become, both technically and morally speaking, an urgent one. Bill 52, an Act Respecting End of Life Care, was a response to this emergency. The introduction to the bill states that its purpose is to “ensure that end-of-life patients are provided care that is respectful of their dignity and their autonomy.” But in addition to talking about the right to palliative care, the bill included medical aid in dying as one of the forms of respectful end-of-life care Quebecers would be offered. Another term that appeared was terminal palliative sedation (a slower form of euthanasia than lethal injection).

The Quebec Palliative Care Association asked the authors of the act to remove the word palliative and call a spade a spade. The authors had also avoided the term euthanasia, as well as physician-assisted suicide. With Quebec’s reputation for having one of the highest suicide rates in the world, they didn’t want to be seen to be endorsing suicide. But this forest of euphemisms could not conceal the fact that Bill 52 would have given us the right, under certain conditions, to oblige a doctor to kill us. Whether the request respected the conditions prescribed by the act was considered a medical judgement.

Doctors have never before been asked to see ending a patient’s life as medical treatment, or to judge whether a patient’s request for euthanasia should be complied with or not. For 2,400 years doctors have taken the Hippocratic oath, by which they swear “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” Oddly, the onus is on those who defend the norm, i.e. the refusal to kill. The breaking of an age-old taboo against physicians taking human life may seem appropriate in our rational and scientific age. Yet the stories told to justify it are laced with emotion and anecdote, while opposition to it is often reasoned and dry, and and makes for poor TV.

I work with a medical research team that is studying shared decision-making between doctor and patient. They are trying to change the age-old model of doctors telling their patients what to do, and instead are trying to train doctors to involve their patients in decisions about their care. But doctors are busy, their habits are hard to change, and many patients – especially the elderly – don’t want to make decisions. They just want to be told what to do. If the doctor won’t tell them but persists in asking about their concerns, the patient will simply say what they think the doctor, or other influential people in their lives, want them to do. In other words, patients are afraid of being a bother. In addition, depression is the strongest determinant of suicidal ideation and desire for death in those with serious or terminal illness, but often goes unrecognized and untreated.²

The importance of Quebec’s recent débat de société on Bill 52 was overshadowed in the media by the Charbonneau Commission and the Charter of Values, and an election announcement killed the bill. But it will return³ – and resolving the shocking shortage of palliative care services in the province, a fact that no one contests, will continue to be held hostage to the controversial definition of euthanasia as a form of care.

Why should people be left to suffer in pain? They shouldn’t. Two thirds of Canadians do not get the palliative care they could benefit from. But according to the most recent statistics from the state of Oregon, where euthanasia was legalized in 1997, the top five reasons for requesting euthanasia are not physical pain or fear of pain. They are (1) “loss of autonomy” (89.9%), (2) “less able to engage in activities making life enjoyable” (87.4%), (3) “loss of dignity” (83.8%), (4) “loss of control of bodily functions” (58.7%) and (5) “feelings of being a burden” (38.3%).⁴

In Quebec, it would hardly be surprising if elderly people losing autonomy felt they were a burden. Hospital beds are choked with frail elderly people who cannot be sent home but for whom there is no place in long-term care facilities.⁵ Home care services are chronically understaffed and underfunded, and many elderly people are being cared for by exhausted relatives or spouses at home. Is the offer of euthanasia as a form of medical care at this particular moment in our history really a coincidence? And is it appropriate, given this historical context?

Amy Hasbrouck of the Canadian Council of People with Disabilities insists that this is a civil rights issue: we have policies to prevent suicide among young people, and among First Nations, and some people are detained or even incarcerated against their will for attempting suicide. Yet suicidal people who were born disabled, or have become disabled through age or illness, are to be offered suicide as a “care” option or even helped to commit suicide. They are somehow in a different category. This is surely a double standard.

Whether we look at it as a religious issue or a civil rights issue, euthanasia, which means “good death,” strikes deep into the heart of our values, and makes us all ask us what we really think life is and ultimately, perhaps, to whom our lives belong.

Quebec Catholics resisted the threat of a lonely institutionalized death valiantly until the 1960s with their “good death associations” under the protection of St. Joseph, patron saint of la bonne mort (because, with Mary and Jesus at his bedside, he had the very best death). In exchange for annual fees, fellow members would inform you that your death was imminent so that you could prepare yourself. They would also make sure you did not die alone: in fact the whole association would promise to be there for your last rites. Members would prepare your body for burial, accompany your coffin all the way to the cemetery without cost, and if necessary look after family members left behind. Members also prayed – not to avoid pain, but above all to avoid fearing death. They prayed to St. Joseph for un bon trépas (a trépas is a crossing over), which meant dying in full awareness of our last moments, and having enough time to prepare for the last sacraments, including reconciliation with God and our friends and family.⁶

In a Quebec that is now militantly secular, this tradition is long forgotten. Although Quebecers still see a bon trépas as one that we can control, what we fear now is not so much a sudden, unprepared death but a slow loss of dignity and autonomy. Perhaps this is what French historian Philippe Ariès meant by the “unbearable emotion caused by the ugliness of dying.”⁷

Many of the opponents of the new bill are doctors, and especially palliative care doctors. They do not want euthanasia to be associated with health care. Why should the appointed decision-makers not be lawyers? Or a special professional group, called, as a McGill professor of medicine suggested, euthanologists? Partly because if it comes under health care, which is a provincial jurisdiction, the federal government cannot legislate against it. But it also has to do with our changing expectations of what health should mean.

The World Health Organization defines health as “a state of complete physical, mental and social well-being.” Perhaps this is why we look to the health care system, a crucial part of our identity, to help us face death. Perhaps because we lack any other institution to turn to for discourse about good, evil, happiness, life and death, we load the health care system with this ambitious responsibility, our total well-being, transforming it into what American ethicist Stanley Hauerwas calls an institution of secular salvation, or an alternative church.⁸ It fosters a hope that we will get through life without suffering. Death is out of place in this vision, and has been seen by hospitals and by many doctors as a failure. Preparing for it has not therefore been seen as a worthwhile use of money and resources.

However, inspired by Dame Cicely Saunders, the palliative care movement has invited us to turn and look at death squarely in the face again, providing compassionate and technical care (pain relief) for people for whom there is no chance of recovery. She coined the term total pain to describe the physical, spiritual, psychological and social suffering of the terminally ill. Palliative caregivers’ experience of accompanying people through such pain makes their perspective on euthanasia particularly important.

The directors of the hospice in Quebec City are unequivocal in stating that euthanasia has no place in their institution. They have seen people who said they wanted to be helped to die, but who changed their minds when they came to believe they are as important in their dying as in their living. They have seen families who wanted their loved one’s life to end because they themselves could not face seeing their loved one’s diminishment and suffering.

These are delicate moments, full of fragility, requiring infinite patience and deference as well as technical expertise. It is at these moments that physicians will be asked to judge and pronounce on the request to be helped to die. If family and the patient know this is now a possibility, how will it change their relationship to that physician and to their other caregivers?

The hospice’s statement steers away from rights talk and religious talk. “Death is not a right – it is a terrible and ineluctable fact,” they write. But they do ask us to think about what dignity is. We are all nostalgic about our youth as we get older, and we tend to confuse dignity with physical capacity, or even with the peak of our independence and strength. But this nostalgia distracts us from an important dimension of dignity: that it is intrinsic to us, and cannot be altered by our age or our mental and physical condition. It is stuck to us from the moment we are born to the moment we die. It is intimately and mysteriously linked to the fact that we will all die one day. As the hospice puts it,

Perhaps human life reaches full dignity in the very fact of its finitude, and perhaps having the courage to be afraid is the realization of that dignity. Perhaps the fear of being a bother to our families is offset by the possibility that this inconvenience is an opportunity for them to prepare for their own deaths. Perhaps the stripping away of our powers at death in fact has something to offer those who remain.⁹

Rather than being an individual possession, dignity is relational in its essence, and is something that we must recognize, acknowledge and protect in one another, whether we are old or young, weak or strong, demented or in possession of our faculties, until death us do part.

Continue reading “The total pain of dying” →

Every morning I cross the Plains of Abraham. As I write this in February, it was about minus 12 degrees this morning, and through the trees I could see a hazy pink sun and its reflection on pans of pink ice floating up the steaming St. Lawrence River. A perfect Quebec winter day. It is the Plains of Abraham that make Quebec City a wonderful place to live.

Winter and summer, whether on skis, on bikes or on foot, I almost always meet friends there. Almost all of them are francophone – not surprisingly, as anglophones are 2 per cent of this city’s population. My newest friend is a deaf woman (anaphone?) and we speak by writing things in the snow for each other. It never occurs to any of us to fire muskets into one another’s hearts.

But 250 years ago, on these Plains, the English and French did exactly that. And there are men in this world who like nothing so much as to relive these historic battles. They dress up in authentic, hand-stitched battle dress and scrupulously imitate the companies’ movements down to the exact second and centimetre.

The National Battlefields Commission, the federal body that oversees the Plains of Abraham, announced that such a historical reenactment was going to take place on the Plains to commemorate the 250th anniversary of the Battle of Quebec in 1759. The debate that this unleashed went on for over a year, becoming so vitriolic that the Grand Chief of the Huron-Wendat Nation, Konrad Sioui, stepped in and said that he would be prepared to formalize an alliance among the parties, bury a hatchet, plant a white pine, and smoke a peace pipe together.

My inbox filled up daily with emails from friends here and elsewhere, each reacting to the developing crisis in different ways. The time for symbols of peace has not yet come, argued one friend. Some progress has been made, he said, but “the Queen of England is still the Canadian head of state, and the British lion and unicorn still loom larger on our coat of arms than the tiny token fleur de lys. The conquest is therefore still relevant today and we can’t ‘bury the hatchet’ while the very symbols that define the country continue to reek of the old Empire.”

For a couple of weeks, the way the story was told in the Montreal Gazette or the National Post was so different from that in Le Devoir or La Presse or my local Le Soleil that you would almost think we were living in different countries. Some (in the English media) ranted about victim mentality and bad losers. Others questioned whether the historic complexities behind this battle could really be discerned by peering from a distance through the smoke and bluster of a reenactment.

One of the ignominies of the French defeat at Quebec was that General Montcalm was so contemptuous of his Canadien troops that he didn’t bother to train them, thinking them too ignorant, even though he had several idle months over the preceding summer in which to do this. The result was that in the heat of battle the Canadiens disastrously broke rank at a key moment. If the French had won the battle and maintained attitudes like Montcalm’s, when, if ever, would France have granted sovereignty to the Canadiens?

Historian Denis Vaugeois aptly remarked that to really understand what happened it would be more useful to reenact the Treaty of Paris, where Britain offered to give back New France and France chose to keep a few Caribbean islands instead.

Dramatic reenactments, argued another historian, are one of the oldest forms of history-telling that we have, and have often served the purpose of reconciling groups with ancient feuds. When I lived in Nepal some years ago, I saw a vivid demonstration of this historian’s point. Every year, there was a reenactment of a battle that had once taken place between our village and the neighbouring village. The reenactment took the form of a football game between the young men, and villagers said it was a safeguard against repeating the battle. Quebec City has had its own legendary football wars, not between anglophones and francophones but between the anglophone Irish Catholic high school and the anglophone Protestant one. Football games can be a dangerous as a substitute for war, however. El Salvador and Honduras waged a six-day war over a couple of soccer games in 1969, as recounted by Ryszard Kapuscinski in his book The Soccer War.

In the end, the reenactment of the battle on the Plains had to be cancelled to prevent another battle. The reenacted violence of 1759 was most violently objected to by Patrick Bourgeois and Pierre Falardeau, members of the Quebec Resistance Network, who threatened to disrupt the event by hurling rocks and excrement. While Jean Charest and Stephen Harper hid in the bushes, other conscientious objectors offered to fling sandbags or golfballs and burn down the encampments of reenactors. Headline writers had a field day with the cascading ironies. In late February my morning paper bore the headline Bataille des Plaines annulée pour raisons de securité (Battle on the Plains cancelled for safety reasons). As a friend pointed out, “If only someone had thought of that in 1759.”

The issue exploded into several connected ones: Falardeau and Bourgeois’s sovereigntist newspaper, Le Québécois, had been receiving 80 per cent of its advertising revenue from the Bloc Québécois and the Parti Québécois, suggesting that these political parties, too, were in favour of violence. The parties briefly withdrew their advertising. Then a cry went up: the Plains should be “patriated” to Quebec, so that creating tasteless federalist celebrations out of an ignominious defeat would be history.

I live a block from the Plains. My father lived a block from the Plains and played there as a child, and so did my grandmother. My great-grandfather’s house backed onto the Plains, and he was a staunch member of the Literary and Historical Society of Quebec, the oldest learned society in the country, whose members persuaded the Governor General to intervene to save the Plains from developers and create a park instead. Just as the reenactment was going to be followed by a reenactment of the Battle of Sainte-Foy, which was won by the French in 1760 (to no avail: they were unable to retake Quebec City), the park was originally going to include the site of the Battle of Sainte-Foy, so they could call it a draw, and then perhaps everyone would be happy.

Because my ancestors were theoretically on the winning side, we have been politely not mentioning who won for so long that we thought everyone had forgotten. But I was wrong. Historical sensitivities are still close to the surface – like the sabre my grandfather found once on the Plains long ago – and can be quickly sharpened on the ever-ready political grindstone.

The Conquest is still a delicate issue because those who were conquered are still not an independent sovereign nation, and if this is a sore point for some, it cannot be turned into a public spectacle for the amusement of tourists. Although the reason given for cancellation of the event was the threat of violence, there was also a groundswell of public opinion against it. People were finally rising up not so much against the telling of an uncomfortable history, but against the Disneyfication of Quebec, which is selling its soul, including its culture and its history, for the tourist dollar. And that is a protest I can join with my whole heart. Having translated mountains of tourist literature over the past ten years, I can testify that no stone is left unturned, nothing is left unspun or unsung, everything that makes Quebec distinct has been mis en valeur. Ad nauseam.

The other goddamned side of the coin

Old wounds may not have completely healed, but there is a new openness to seeing the city’s history from different “cultural perspectives” – in other words, not just the French-Canadian version of events.

A few years ago, I was invited to write a history of the English-speaking peoples of Quebec City by the Commission de la Capitale Nationale du Québec. The resulting two-volume history was subtitled “The Hidden Face of Quebec City,” and was published simultaneously in both languages. It covered 400 years of Quebec City’s history, from New England captives taken to live in New France, through the 19th century when anglophones were more than 40 per cent of the city’s population, to the little village of anglophones today, now less than 2 per cent of the population. I wrote not just of the Scots, Irish and English who came to Quebec, but also about the immigrants of Jewish, Chinese and Greek origin, most of whom became anglophones because, before Bill 101 reversed it all, as non-Catholics they were not welcome in the Catholic (French) schools. I was also concerned to show that “les Anglais” were not all ruthless merchants or snobbish aristocrats; some were soldiers, sailors, tradespeople, refugees, prisoners, servants, prostitutes and even slaves. The story also covered the founding by anglophones of many educational, charitable, religious and cultural institutions, some of which survive to this day.

There was no editorial interference with my interpretation of events, except the excision of a rather innocuous old story about Jacques Parizeau objecting to the presence of women in men’s clubs. Our only argument was over the title. I wanted to call it Les Maudits Anglais (The Goddamned English), but this, I was told, was not funny. We settled for the more innocuous The Anglos.

Four years later, the English version remains one of Amazon’s best-selling books on Quebec City. But it was the reaction to this book among francophones that almost convinced me the Bataille was over. The interest was astonishing. I have been asked to speak to countless francophone schools, colleges, historical societies and other associations throughout the region. After presentations I have been approached by hundreds of people with anglophone ancestors who knew very little about this side of their heritage.

“Why did the anglophones all leave?” is one of the recurring questions. Some know more about Montreal’s anglophone history, which is different from ours in Quebec City. I tell them that numbers first began dropping dramatically when British soldiers left at Confederation. They dropped again when the new railway bypassed Quebec City and the Lachine Canal opened Montreal for business. Anglophones moved on quite simply because as speakers of English they were mobile.

But people also want to hear me talk about the FLQ and the nastier side of what some anglophones experienced here in the 1970s. They want to hear my reaction to Bill 101 (enacted in 1977 in the first months of the PQ’s first term). Few have ever heard a Quebec City anglophone perspective on these events, or on Quebec history in general, and they are curious. I speak about people I know who felt personally threatened by the FLQ violence, and children who dared not speak English on the bus. Sometimes I also tell my audience that even though I was born here, as were seven previous generations of my anglophone ancestors, thanks to Bill 101 I have no right to send my daughter to school in English because I happen to have been in England when I went to school. The reaction is often one of outrage. But I also speak of my overall support for Bill 101, and about my enjoyment of living in two cultures and two languages, and the privilege I feel in being able to raise a bicultural daughter. I feel accepted and appreciated as an anglophone in Quebec and I make it clear that I have no hesitation in identifying myself as a Québécoise.

I was interviewed by many local and national radio and TV stations, sometimes several times. The only interviewer who put me on the defensive was André Arthur (now an independent MP), who accused me of minimizing the “genocide” committed against anglophones in this city.

Andrée Pomerleau from Radio Basse-Ville, a leftist community radio station, had read the books from cover to cover – a first in my experience – and kept me on air for an hour. She has a deep knowledge of her community, and yet like many others who interviewed me, she had never heard a word about this side of the history of her city.

Lack of observation was not the problem. Most anglophones here are so bilingual that they pass unnoticed. The only remaining physical signs of a historical anglophone presence are those engraved in stone. The rest – school names, names of institutions, commercial signs – were removed after 1977 in a move that Josée Legault called “shock therapy.” While monuments to anglophones are thin on the ground, the city is liberally endowed with statues of francophone men in grey suits (looking particularly cold in February). In a prominent position, indeed, is a statue of a Frenchman whose sole claim to fame in Quebec was shouting “Vive le Québec libre!” in Montreal in 1967 (I do not think Sarkozy will get a statue: he recently provoked fury in Quebec by suggesting that sovereigntists were sectarian and aggressive).

Anglophones have been fairly discreet about this official lack of interest in their contribution to the city’s history. Not long ago my brother, who is president of the Literary and Historical Society, called me to ask what I thought about transferring all the Society’s archives to the Archives Nationales du Québec. The Literary and Historical Society was founded in 1824 to collect and protect documents relating to the history of Canada. In addition to helping save the Plains of Abraham from developers, the Literary and Historical Society was one of the founders of the Historic Sites and Monuments Board of Canada and the National Archives of Canada. It has always jealously guarded its independence. As the only English-language library in Quebec, for example, it has resisted repeated advances to join the city’s public library network. Many of the older generation of Quebec anglophones would be very unwilling to give their family records to the Quebec National Archives. Having had very good relations with the archives in my own work on my book, however, I waxed eloquent to him about how well the archivists will look after them now, and how times have changed – that anglophones no longer need to worry about their heritage being dismissed.

When these latest skirmishes on Plains occurred, I wondered for a moment if I was too hasty. Perhaps we had better hang on to those archives for another couple of hundred years. But on reflection, I don’t think so. In spite of my book, which was perhaps needed to redress an imbalance, I don’t think anglophone history should be a separate petite histoire. I want to know both sides of the story, and I want my children to know both sides. I want them to know how French Canadians lived before the Conquest. I want them to know about how the English burned farms up and down the St. Lawrence and bombed Quebec to smithereens. I want them to know how they repressed the rights of French-speakers, and why Bill 101 was a necessary, if flawed, piece of legislation. I also want them to know that the 1774 Quebec Act was progressive and groundbreaking legislation in its time, in terms of the way the conquerer chose to treat the language and institutions of the conquered; that it was the Scots who brought a belief in universal education to our city; and that anglophones welcomed thousands of destitute immigrants in the 19th century.

Sharing the luggage rack

As I have discovered, there is a new openness to anglophones and a genuine interest in their contribution to Quebec City’s history. But in spite of Bill 101 ensuring that most immigrants become francophone, there is still deep ambivalence about this relatively new, nonethnic Québécois identity that includes not only me but all immigrants to Quebec.

Growing up in England where I took the train to school every day, I saw or participated in the following scenario many times: A couple is travelling in a train compartment. They are pleased and relaxed to have the compartment to themselves, and spread their belongings around. When a second couple boards the train, the first couple are irritated to have to move their things, have their intimate conversations overheard and listen to the loud conversation of the newcomers. Then a third couple enters the compartment. This time the first two couples are both annoyed. As they are forced to move yet closer together, friendly glances of resignation are exchanged, and they feel a new solidarity in opposition to the newcomers.

Quebec historian Gérard Bouchard is fond of train allegories too:

New Quebecers know very well that they have climbed onto a train that left the station a long time ago, and that they can’t get rid of the train’s point of departure or the route it took before they got on – just as immgrants would not think of challenging such sacred cows of historical memory as the French and American revolutions … need to present the historical memory of francophone Quebec in a different way: without diluting it, but emphasizing what is most significant in it for the present and future and making more visible how “other” Quebecers have fared and what they have contributed to the development of Quebec society.¹

Or throwing our historical baggage into the same rack.

A year ago, at the reasonable accommodation commission hearings in Quebec City, I heard a great deal of frank hostility toward the latest comers. And I saw Gérard Bouchard, one of the commissioners, shake his finger at his fellow Québécois for being unwelcoming to strangers and aggressively overprotective of their culture.

“René Lévesque would be ashamed of you,” he scolded. Gérard Bouchard has worked hard to develop a model of Québécois nationhood that is civic and pluralist rather than ethnic, but his scolding finger precisely illustrated the difficulty of transiting from homogeneity to diversity in Quebec. He spoke exactly as an elder brother would address his younger siblings after the death of their father. His co-commissioner Charles Taylor, as an anglophone Quebecer, could not and would not ever have spoken in this way. And ironically, the familiar, familial way Bouchard spoke to his fellow Québécois may no longer be possible if they embrace his pluralistic vision of what the fellowship of Quebecers should be.

When it comes to his home territory of the Saguenay, Bouchard perhaps wishes his ancestors had been less welcoming than they were to the 19th-century Scots and English immigrants to the region, including some of my ancestors. In his books he characterizes them as uniformly merciless exploiters. When it was suggested that a historic statue in honour of the most prominent anglophone family be moved to a more central location in Chicoutimi, Bouchard led a successful campaign to cancel the project. “The project … celebrates a symbol of the social domination of our ancestors,” he wrote in 2004. This time it wasn’t a federalist institution that had proposed it, but the mayor and townspeople. No one threatened to hurl anything, but Gérard Bouchard had spoken, so the mayor cancelled the project.

Now it’s April, and since I began writing this article I’ve been to and come back from Rwanda, where the genocide of a mere 15 years ago is commemorated annually by the survivors who now run the country, where no one is allowed to identify themselves as Tutsi or Hutu, and where, this year, the whole education system switched from French to English overnight. I’m happy to be in Quebec, where historians weigh in on civic decisions, where civilians weigh in on historical issues, and where people say publicly what they think and then Gérard Bouchard tells them off for saying it. I’m happy to be in Canada, where after the storm about the reenactment blew over, the papers began to reveal a more sensitive consensus about how the reenactment may not have been in the best taste, after all. And it doesn’t even bother me too much that it took Pierre Falardeau threatening to hurl excrement to settle the matter.

Continue reading “Battle on the Plains of Abraham Cancelled” →