Sunday, January 24, 2016

Opinion: Doctors should not Kill.

There are ethical reasons why physicians are instructed to do no harm to their patients.

This opinion column was published in the Toronto Sun on Jan 23, 2016.

Opinion: Dr Irvin Wolkoff

As a doctor, I have a question about assisted suicide that has not been clearly answered: Who will perform the procedures resulting in someone else’s death?

To look at the news, you would think it will automatically be doctors.

The media refer to this voluntary ending of life as “physician assisted suicide”, or “doctor assisted death” and — this phrase makes me cringe — “medical death”.

The Canadian Medical Association has engaged in the public dialogue about assisted death, but I’m not aware that it, federal or provincial governments, doctors’ licensing and regulating bodies, or anyone else has already decreed the people who will help very sick patients to die will be doctors.

It’s just assumed doctors will do it. Why?

There are practical obstacles to engaging doctors to carry out assisted suicides. For example, where would we find the doctors we’d need?

Canada’s physician population isn’t large enough to care for our growing and aging population as it is and governments are constantly cutting back funding to the facilities, procedures, treatments, medications and working conditions we need to do our jobs properly.

Will Canadians be happy to see scarce medical resources shifted from medical services to assisted suicide?

Canadian physicians have no training in assisting suicide or complying with whatever legal regime is set up to permit it. How will this be organized and paid for in an age of huge cuts to medicare budgets?

More important is the moral impact on the medical profession of making doctors the designated death providers of their patients.

In Greece, in the fifth century BCE, my medical colleague, Hippocrates, established ethical guidelines for physicians which ethical doctors follow to this day, including this crucial one:

“With regard to healing the sick … I will take care that they suffer no hurt or damage. Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.”
In short, ethical doctors aren’t supposed to kill their patients or help them kill themselves, even in the service of supposedly noble goals.

I understand many Canadians accept that physicians who help their very sick patients die in accordance with their wishes are not murderers.

But putting doctors in charge of killing their patients assumes there will be no corrosive effect on medical ethics over time, as the practice becomes more common and accepted.

Why? Most doctors are professionals but medical skills alone do not guarantee doctors are immune from corruption.

Once we start doctors down the slippery slope of inducing death, how far is to Dr. Jack Kevorkian, who felt he was above the law when it came to helping people commit suicide, just as some doctors will ignore the law’s restrictions when it comes to legally assisted suicide?

How much further to Dr. Guy Turcotte, who fatally stabbed his five-year-old son and three-year-old daughter a total of 46 times, and was recently found guilty of second-degree murder?

How much further to Dr. Ayman al Zawahiri, the pediatric surgeon currently running al-Qaida, or Dr. Basher al-Assad, the ophthalmologist and citizen-slaughtering president of Syria?

Or to history’s most notorious killing physician, Josef Mengele, the “angel of death” at Hitler’s Auschwitz death camp?

Inevitably, I believe, the public’s association of doctors with killing, even for the supposedly benign purpose of euthanasia, will negatively impact on how the public perceives the medical profession.

The assumption by our courts and politicians that doctors are immune from corruption when it comes to killing their patients is naive and dangerous.

A year ago, the Supreme Court of Canada unanimously struck down the Criminal Code ban on assisted death, giving Parliament 12 months to create a new law to regulate the process.

Recently, the court extended this ban by four months to give Parliament more time, but added it will allow applications for assisted deaths in the interim, suggesting a sense of urgency in the matter.

What is being ignored is that a doctor’s legitimate role in assisted suicide should be strictly confined to conducting careful clinical assessments, to identify those who satisfy the criteria for a legal, voluntary death.

But it should be someone else, not doctors, who pushes the plunger.

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