Whither medical care?

The affaire Terri Schiavo, which the death of the Pope finally took off media life support last week, raised important questions among many North Americans about living wills and what constitutes life, not at its beginning, but at its end. Many of these recent arrivals to the house of thanatophilia, including, doubtless, a host of self-affirmed culture warriors invigorated by a "debate" manufactured and encouraged by the news networks, would do well to consider the end of an individual's life, not merely the end of times and the inevitable redemption of the strong.

The death of John Paul II (the Hebrew niftar, signalling the completion of one's life, seems a more appropriate term in this case), marked by the Pope's refusal to be propped alive by machine (to the dismay of the zealots across the Atlantic who invoked his name), is worth another look. As is Les Invasions barbares (The Barbarian Invasions), Denys Arcand's fine 2003 film, which I happened to watch yesterday afternoon.

Arcand reunites the principals from his 1986 succès Le Déclin de l'empire américain (The Decline of the American Empire), who have grown apart, as friends do, to celebrate the end of one friend's life. Reunited by the son of paliative Rémy, the group gathers to reminisce, catch up and reflect on the meaning of their own lives. The conversation, generally consisting of a delightfully embracing wit, eventually turns to the subject of intelligence, which we are told doesn't exist in a vaccum: the grouping of Michelangelo and Leonardo, coupled with Raphael and Machiavelli, is invoked, as is the trio of Plato, Socrates and Euripides. In fact, the experience is so genuine and loving that you hardly remember that Rémy's life is coming to an end. Intelligence can be thoughtful after all.

It doesn't hurt that Rémy's estranged son Sébastien has returned from Europe under the pretense of easing his mother's burden (though she's Rémy's ex) to leap at the role of prodigal son, using his self-made wealth and inherited smarts to secure his ailing dad the kind of care ordinary Quebecers could never dream of. Rémy's death is touchingly self-prescribed (a series of heroin doses) and delivered by the junkie-with-a-heart-of-gold-turning-the-corner estranged daughter (another!) of Rémy's friend (who also serves as a near foil to Sébastien's perfect fiancée, though fils has not inherited dad's lust for just any woman).

Though Arcand overdoes the chaos that is public health care in Quebec, perhaps to underscore the meaning of Sébastien's act of love, the real thing isn't that much better. At best, when the stars line up and loved ones are capable of making the right kind of effort, Québécois medicare can be reasonably quick and comprehensive. At worst, patients who shouldn't die are left to perish for no good reason. Generally, the rest of us find ourselves in the middle. If Rémy's death - painless, loving and on his own terms - is the best we can hope for, and Terri Schiavo's is of a kind so dreadful we are urged to plan for it in great detail, what must be done?

Canadians are hesitant to accept "two-tier" medical care (while Americans, if only due to incomplete coverage, inadequate insurance options and the unneeded burden on small businesses, are moving toward a single-payer system - surely there must be some middle ground). Arcand makes it quite clear that, by traveling to the U.S. to get a PET scan or greasing the right pockets to open up a long-shutdown wing of a crumbling hospital, accept it or not, we're already there. (Interestingly, Quebec - where we're all supposedly in it together - is home to the most private-pay health care options in Canada.)

Meanwhile, public spending on health care continues to grow, eating up badly-needed funds for education and infrastructure (and if schools are unfunded, the tax base of tomorrow will be unable to sustain the quality of health care aging Baby Boomers will demand). The future, it seems, is pretty grim. Our options are limited: to accept a private-public system and install it across the board (and fast) or continue to invest in our aging system and hope things come out alright. Somehow I don't think this is what Tommy Douglass had in mind.

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John Paul II, whose brave stance against Communism helped usher in real live freedom to Eastern Europe (and whose rigid opposition to liberalism inside the Church is tough to accept), chose to eschew the route of feeding tubes, unproductive surgeries and life-by-machine. Much like Rémy, he set the broad terms of his life's ending, and in so doing weighed in on the ugly Schiavo nonsense in the U.S. Deuteronomy tells us that there is a choice we must make between life and death - and that we must choose life. In the end, though, life does not always choose us back. Much like Rémy, the Pope knew when the choice could no longer be made; the opportunists who used Terri Schiavo so viciously did not. Each story, though, imparts a similar, powerful lesson. Life, life that is lived, is precious, and it isn't permanent. In guiding our way through the challenges that await a nation that will be demaning more and more from a system that can no longer sustain itself, we must bear that in mind. Through care and comfort do we honour the living and sanctify the dying. The devil is in the details, so remember Rabbi Akiva: the rest is commentary, now go and study.