Physician assisted death and euthanasia is not a new topic of discussion, but is creeping to a tipping point in Canada with recent legislative decisions (see Bill 52 in Quebec, and other bills tabled). Anyone who has had experience with end-of-life care, whether personally or otherwise, would understand the complexity of the issues involved. If you haven’t already, have a read through this article published on HealthyDebate which nicely summarizes some of the key issues in the debate.
What struck me most from the article are the following points:
Making physician-assisted death legal isn’t the same thing as making it mandatory. What would happen if a patient who really wants it, was under the care of a physician who refused to provide such “service” or “treatment”? Would it be practical and efficient to ask for another physician (who does not have the longstanding relationship nor the familiarity with the patient’s history, etc) to completely take over his/her care? And would it lead to conflicts akin to what we’re seeing with the abortion issue, or even the birth control issue (see here)? I can see how this may potentially lead to extreme (and unfair?) public judgements/opinions on individual physicians. It’s hyperbole, but at the extreme, will patients flock to “physician assisted death” clinics?
Support for it is much lower among physicians than the general public. This is unlike most other medical treatments in North America, where there usually is widespread support from the medical community and public adoption is driven by physicians. And it is not hard to see why. Most who embark on the long journey to becoming a doctor share one main core value: to save lives. Now we are asking physicians to be expert life-enders? Perhaps more thought and discussion should be focused on investing in education, training, and support for the medical community.
Inadvertently defining what are “good” reasons to actively kill…uh, die. By default, allowing physician assisted death means that as a society, we are drawing a line in choosing which reasons are ethically okay and which ones are not for a human being to actively and intentionally end the life of another. The problem is, that line is very, very unclear – and I’m not sure it ever will be. Who declares one disability eligible versus another? How much pain does one have to suffer; 9/10? 9.5/10? Is the elderly patient suffering from metastatic cancer who is depressed and wishes to die, different than the teenager suffering from severe mental illness who is depressed and wishes to die? Or rather, are we content to charge ahead with unclear definitions?
Most palliative care specialists are actually against it. This probably surprised me the most from that article. Isn’t the whole point of physician assisted death to help with palliative and end of life care? At least I’m pretty sure that’s what the general public believes. What’s truly troubling about this whole debate is that the average Canadian (patients and doctors alike) may actually know very little about what we are talking about here – and decisions are being made without a deeper understanding of the subtle nuances involved.
What do you think? As a physician, would you have a problem with actively ending a patient’s life? As a patient, should the option of physician assisted death be considered as standard of care? And as a policy maker, how do you propose to define which cases are ethically suitable and to police it?
Edmund Kwok
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