Sunday, March 6, 2016

Rage against the dying of...wait, now my doctor can do it? Screw rage, I'll take 10cc of Valium, 100mg of Morphine...

I'm in such a great mood, I thought I'd post about a really uplifting topic.

Okay, in truth I had a lively discussion with my wife the other night on the topic of physician assisted death (PAD), and the crux of the chat is worth sharing. My wife is an Oncologist (cancer specialist), so the issue is much more relevant to her practice than mine.

(Really, the only "physician-assisted death" I encounter these days is the accelerated clogging of my arteries from my own cooking--nothing beats bacon grease as a cooking fat.)

For those of you not up to speed on the latest non-money issue irking Canada's doctors, last year our Supreme Court declared the prohibition on PAD unconstitutional. The Court gave the government a year to put the legal framework in place, and suffice it to say it's caused a flurry of activity in the regulatory Colleges and professional associations. It's also led to immeasurable anxiety and umbrage in the medical community.

Personally, I find it ironic (and hilarious) that the #1 thing on doctors' minds these days is who should be responsible for killing their patients.

That aside, when you boil down differences in phrasing there are five objections a doctor can have to PAD:

It's against my religion. This isn't really an objection that can be debated, because doctrines are what they are. However, denying a patient their now-constitutional right on religious grounds is only fair game if you are sufficiently devout. If you're fine with eating un-kosher food so long as it's on a paper plate, you have no business playing the religion card.

Patients wouldn't ask for PAD if we had good, properly resourced palliative care. This argument doesn't hold water for a few reasons. The immediate issue is that we don't have anything close to properly resourced palliative care, so it's a moot point. Moreover, PAD is both legal and accessed in other countries, and the demand for it went all the way to the Supreme Court after years of lobbying. I'd say that's pretty conclusive evidence that PAD is something people want, not just something they think they want.  

The law is too vague. This will lead to a slippery slope--what's next, killing people with mental illness or intellectual disabilities? Setting aside the fact that a slippery slope is a fallacy in and of itself, if anything this is an argument in support of a properly crafted set of guidelines around PAD. That's precisely what the Colleges and associations have been doing. One of the main reasons the Court decided as it did was the confidence of ethicists and medical policymakers to put safeguards in place so such a slippery slope can't develop. And again, this is something that's been successfully in place elsewhere for decades.

This is a liability nightmare--families of patients will come back and sue us for killing their loved ones. My response is simply this: does this ever happen? It strikes me as pretty unlikely for someone to watch their family member suffer for years, only to turn around and sue the doctor for wrongful death. It also flies in the face of which doctors actually get's not the ones looking after people dying a slow, miserable death.

It's against my ethics. It's a violation of my professional autonomy. We now come to the substantive argument against PAD, although personally I don't see it as being much more persuasive than the other ones. On the surface it's hard to argue against someone's "personal conscience". But if you're using ethical obligations as an excuse to refuse performing or referring for PAD, I got news for ya: your professional College determines what those obligations are, in accordance with the law, not you.

If you ask me, I don't think doctors have a problem with PAD so much as they have a discomfort around the notion of being made to "pull the trigger". Really, the dialogue would be more productive if doctors would just come clean with their misgivings, rather than come up with weak excuses to go against their patients' wishes. There are other ways forward, like developing inter-professional teams to provide the service, staffed by nurses, doctors, and pharmacists that are wholly comfortable with PAD. But those proactive solutions can't happen if half-assed excuses take the place of open debate.

Personally, I don't have an opinion on PAD. I haven't encountered a patient asking for it, apart from an able-bodied twit in his 30s that needed a job and a girlfriend more than a hastened death. I've also (fortunately) not had to go through the pain of seeing a loved one suffer for a prolonged period of time. Since I can't speak from experience, I can only observe that PAD is now the law of the land.

And for all I know, I might end up being damn good at killing people...

1 comment:

  1. A physician at the CMA GC 2014 said something that has stuck with me ever since. Her mother dies of early-onset Alzheimer's and she knew that she had a fair chance at suffering the same fate. In response to the answer being that we simply need a properly-functioning palliative care program, she said (something to the effect) that "you can't palliate emotional turmoil, confusion and anguish".

    Good point, in my opinion, having seen countless elderly (and sometimes not-so-elderly) wandering the halls crying, perseverating, paranoid and scared. And many of them are physically healthy and will therefore continue like this for years.

    Not saying that I believe that PAD is the answer for these people, just something to think about.