Considering Death by Doctor
Comments. Considerations. Questions.
by Kenneth Bagnell
It’s one thing, arguably morally acceptable, to favor doctor assisted death for patients who are near death and in great pain. But it’s rather dubious policy if doctors don’t want to do it. Most don’t. Moreover, the makeup of Canada’s population suggests the public doesn’t favor it. For example, we have a huge number of Roman Catholic citizens, virtually fifty percent of our population, and you’d have to look forever to find a faithful Catholic doctor who would do the deed or be at the beside to help out. (If it all passes, the Prime Minister himself, despite being a Catholic, will theoretically at least have to abide by a policy his Church and its people strongly oppose.) As for Protestants, its evangelical ranks (Pentecostal, Salvation Army and so on) oppose the idea and are swelling rapidly. Sadly the liberal ranks (United, Anglican etc.) who might support it in significant numbers, are facing steady and increasing decline. As for our ever growing Muslim population, it will not support euthanasia. Given this reality, I’m bothered by media reports that a majority of Canadians actually favor death-by-doctor. (Secularism is both a growing and an influential erosion on once treasured moral and religious practice.)
It may sound comforting, but, whatever your inclination, there just aren’t enough Kevorkian style physicians with the killing inclination to treat a population of roughly 35 million people. (The late Dr. Kevorkian of Michigan was a champion of physician-assisted suicide, claiming to have given assisted suicide to 130 patients and for that he served eight years in prison.) As one Canadian doctor put it with a slightly chilly smile: “There is not one shred of evidence to prove you are better off dead.” So remember as we used to say: “the doctor knows best.” That being so, I take seriously the CMA survey of a few months ago which revealed that of just over 1,400 responses sixty-three percent said no to helping patients die; eight percent said they were uncertain. “I feel strongly that hastening death is not part of medicine,” says Dr. Sheila Harding of Saskatoon. “I think it eviscerates what medicine is intended to be. I think asking physicians to be killers is contrary to the very core of medicine.” A strong opinion.
I know, I know – from many previous responses on this subject – that values change and attitudes change. Friends who visit aged veterans – men and women in their nineties – tell me that many are simply tired of their time on earth and hope for an early passing, and thereby are open to assisted deaths. Who am I to lobby for a policy that will disallow a ninety eight year old veteran who has seen enough and suffered more than enough to receive at her own request a peaceful passing from a life of pain and loneliness. I recognize that.
At the same time, there are many questions that rise out of the practice of doctor assisted suicide, a number of them outlined a month or so by the country’s highly regarded medical journalist Andre Picard of The Globe & Mail: what will the policy be for a person’s life insurance if he/she opts for assisted death; what will be the cause of death on the death certificate; if a patient insists on assisted death and no doctors at the small town hospital will perform it, whom does he refer the patient to; will there be a billing code for administering the lethal drug; is it acceptable, within the proposed act for a patient to exercise his/her right to administer the drug at home; does the patient’s doctor, who will not perform the lethal act, be duty bound to make a referral for an injection he himself finds morally repugnant? In fact, is the patient mentally competent to make a clear headed decision to die at the hands of somebody else? (There are still more questions in Andre’s disconcerting list which can be retrieved on line from the Globe & Mail, August, 2015.)
While I am torn by the issue, one aspect I will not yield on: it’s been reported that some people in influential positions take the view that the physician be virtually directed by superiors to perform the suicidal death the patient requests. This is appalling. Think about it. And don’t forget to think about what has been the ethical foundation, taken by virtually all physicians for over 2,400 years. It’s the Hippocratic Oath. Maybe from time to time, we all might read it or reread it, recognizing its ancient style, but reflecting on its moral content and relevance to today’s uncertain but rapidly changing culture:
“I swear by Apollo the physician and Aesculapius and all the gods and goddesses, that according to my ability and judgement, I will keep this Oath and this stipulation – to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art if they shall wish to learn it, without fee or stipulation; and that by precept, lecture and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art… While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art respected by all men in all times. But should I trespass and violate this Oath, may the reverse be my lot…” (Hippocratic Oath 400 BC.)
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All past blogs are archived on my website: your comments are welcome there: www.kennethbagnell.com.
With this very touchy topic of euthanasia, you’ve brought up many issues here for which there are simply no answers at the present time.
In terms of support for doctor-assisted suicide, surveys show that Quebecers are, by a large margin, more in favour than the rest of Canadians. So how do you create a national framework — with a not-withstanding clause to appease Quebec, as we did with our Canadian Charter of Rights and Freedoms?
When it comes to the thorny issue of culture and religion, we’ve already run into doctors across the country who wouldn’t change the direction of their moral compass by treating gays and lesbians, recommending an abortion or prescribing birth-control or morning-after pills. The result of that has been basically an edict from the federal and provincial governments that this won’t be tolerated and is grounds for dismissal.
Will a similar push come to shove in the matter of death by doctor?
To me, the biggest issue is this: physicians train to preserve life, not to end it. Veterinarians are probably more skilled when it comes to euthanasia than our doctors. In the United States, we’ve seen botched executions of prisoners when their death medications were either applied incorrectly or didn’t have the desired and intended effect. One man was put through two hours of terrible pain, a heart attack and other conditions before death set in. How would a Canadian doctor feel if this happened to one of his or her patients?
Whatever law is passed surrounding physician-assisted suicide should allow medical practitioners to make up their own minds whether or not to take a life. No government bureaucrat should ever make the decision for them.
Trust you, ever the journalist, to use the catchy phrase “Death by Doctor” to underscore your point! I prefer other language, though I recognize that this is probably the real bottom line. “Physician-assisted” sounds gentler somehow, which may be part of the problem from your point of view.
You make some valid points, and raise some important issues. The only one that I would add is the need for some kind of checks and balances. It would be harder to find two corrupt MDs than one, so to speak. I wonder about the risk of finding an MD who agrees to dispose of a wealthy person on behalf of impatient relatives! Or is that too cynical. There need to be very careful checks and balances if the procedure is ever to win favour. If memory serves me correctly, they have tried to accommodate that concern in the Netherlands and elsewhere, but I’m a bit fuzzy on that.
In any case, I will file your article and make us of it, I’m sure, in future discussion of the topic.
Keep up the good work,
With respect, I disagree. It’s not complicated: the principle should be that assisted death be allowed when it’s asked for, when it’s physician-delivered, and when it’s treatment. That way it will always be patient-centred. Let those who want to say ‘no’, do so on their own behalf, but let no one – including doctors – say ‘no’ for others when they are really only speaking for themselves.
Thank you for printing out the Hippocratic Oath, noting its cultural source (not Christian) and the date. The sacredness of human life isn’t an idea invented by right wing evangelicals and Catholics from the US.
A note from the Evangelical Fellowship of Canada, whose materials I read (along with other more liberal sources, of course): If the submission to the federal health and justice ministers from the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying is accepted by the government as written, this will be the case: Eligibility will be based on competence rather than age and a “grievous and irremediable medical condition” will be defined as one that cannot be alleviated by any means acceptable to the patient. So, consider an 18 year old who has just been diagnosed with life-long diabetes – a condition that is sometimes associated with depression. If proposed treatments are “unacceptable” to him, this 18 year old’s wishes for assisted suicide must be granted. (We may not discriminate by age in Canada.) Yes, it’s a Pandora’s Box that the Supreme Court has opened.
Thanks, Ken, for reminding us of the underbelly of this new “freedom” and “right”.
This is a thorny issue indeed. Making a law precise would be difficult; and I wouldn’t want to be the physician agreeing to assist. On the other hand, if I were dying of bone cancer, if I were ravished with pain, if I were living out my last days in that way, I wouldn’t be worrying about a Hippocratic oath. I would be looking for a potion.