Thursday, July 30, 2020

Patients can no longer assume that doctors are committed to protecting life.

Gordon Friesen
By Gordon Friesen.

Throughout the long Canadian discussions, court cases, and legislative compromises, which eventually resulted in mandating physician “assisted” death, there has often been a comfortable tendency for people to think that euthanasia is merely another clinical procedure; that its influence could be restricted to certain unusual and well-defined circumstances; that it could be simply added to existing medical practice without changing the care and services which we have come to expect and rely upon; that no change in the relation of confidence between patient and physician would result. Or as some have made the case: that for those not personally requesting euthanasia, there would be no effect whatsoever.

Clearly, however, reason and experience have demonstrated that such is not the case.

Ideas have consequences

The practice of euthanasia is justified by a set of moral principles, medical and social, which are entirely at odds with those from which doctors have traditionally taken their inspiration in providing compassionate personal healthcare. In a medical sense: Philosophy translates to practice. Different philosophy means a different medicine -- and different doctors to provide it. For to be quite clear upon this point: those doctors who are now operating under alternative philosophical assumptions which permit the practice of euthanasia, can not, will not, and do not, provide the same sort of medical care as those, other doctors, who have chosen to continue, faithful, to earlier Hippocratic tradition.

Specifically, patients in this new environment, can no longer assume that doctors are unconditionally committed to protecting life.

The introduction of euthanasia, then, has illuminated a monumental shock of ideological principle within the medical industry. And although the details of that clash may still find many of us lacking in curiosity, or passion, I believe that this situation is about to change, as we become increasingly aware of the real-world consequences. It is not the case, for instance, that the nature of medical practice affects only the “vulnerable” among us. In a hospital bed, everyone is vulnerable. The nature of medical practice, therefore, affects us all.

The iconic case of Bill Peace 

Professor William Peace (center)
Many reading this article will be familiar with the career of William Peace (1961 – 2019), erstwhile executive member of Not Dead Yet, who unfortunately passed away last year, due to the complications of ongoing wound problems. I personally made contact with Bill some years ago, when his Bad Cripple blog first jumped out in my web browser. I now wish I had had more interactions with him. That is always the way of it. Last week, I looked him up for advice on some subject, and sadly, he was gone.

William Peace was a handicapped individual from childhood. In certain places and at certain times, there would have been significant opinion in favor of simply abandoning a child like Bill. But that did not happen. From his auto-biographical passages, we see that his family supported him and they found doctors willing to do whatever could be done, also, encouraging their young patient to persevere through very difficult courses of treatment, with very uncertain prognoses.

As a result of this severe upbringing, in support of his own natural talents, William Peace was able to function at a very high level of social performance, to gain an advanced education and to undertake an influential academic career. However, in 2010, he suffered a serious wound episode, of a sort which has precipitated the deaths of uncounted seated wheelchair users, including among others, Christopher Reeve (1952 – 2004) (more widely known to movie audiences as “Superman” (1978)).

The point of this story, is to highlight the attitude of the doctor who was assigned to the wound case of Bill Peace.

How the attending physician proposed to “treat” Bill Peace
 Visiting his patient in the dead of night (according to the author’s own account), this doctor immediately set in on trying to convince Bill that treatment would be useless. Better, he advised, to make him comfortable and “let nature take its course”.

Now there are those who would maintain that this advice reflects best Hippocratic practice (“do no harm”) and also, an admirably modern palliative approach where the terminal patient would be spared useless and invasive treatments. However, I think we can safely consign this episode to another medical strategy entirely, which is to say, “stealth euthanasia”. And the reason I make this charge is that this patient was by no means terminal!

As we know, Bill actually survived another 9 years, touching countless lives through his writing, his presentations, his videos, and his organizational presence in the disabled rights community. There would be, perhaps, a reasonable case for accepting, with regret, the self-motivated decision of some hypothetical individual (in a case similar to Bill’s) to withdraw themselves from active therapy. However, to attempt to persuade (and according to the account given : objectively to bully) a patient in such a case... for THAT behavior, there is no Hippocratic or Palliative rationale. And had the doctor actually succeeded in convincing Bill Peace to withdraw from active treatment, that doctor would effectively have killed the man, as certainly as if he had employed a poison-laden syringe to do so.

Two types of medicine, and two types of doctor

In the life of this one man, then, we see the influence of two VERY different sorts of medical professionals. For on the one hand, are doctors who give their patient the benefit of the doubt; who believe that the patient always deserves “a shot” at survival; and who, even in the grimmest of prognoses, are in no hurry to deliberately pull the plug. These are doctors for whom the question of shortening life never even arises because they are devoted to a medical model which excludes that possibility, and who are therefore free of the disabling doubts that always surround it. On the other, we have doctors who, when the outlook begins to look problematic (and resource intensive), are all for hastening death; not only in deferring to a (perhaps less than convincing) death wish; but in actively debating the patient regarding the value of his or her own clearly affirmed intent to survive.

And again, this was before the time of legal euthanasia as such. Because, as stated, euthanasia is not merely a procedure: it is the embodiment and validation of a pre-existing philosophical principle. However, whereas in the old days it was understood that killing patients was a “bad” thing (simply defined as murder, in fact), legal euthanasia today (that is to say for us in Canada: universally mandated, and institutionally normalized euthanasia), has made killing patients a positive virtue. And whereas the doctor in the Bill Peace case was still limited to surreptitiously attempting “euthanasia by stealth”, today’s professionals stand ready to propose, and to accomplish the act, in a completely open and (officially) ethical manner.

A new urgency for all

Such is the effect, then -- now entirely obvious -- of the general penetration of certain utilitarian ideas in our medical culture. It is true that these ideas were, as we have noticed, already long present among a minority of practitioners. The difference, however, is that with the universal implementation of euthanasia throughout our monopoly healthcare system, these ideas have become objectively dominant in Canada.

There is, therefore, no further excuse (and increasingly less appetite one would also hope), for politely ignoring these facts. We are all patients; and ever more frequently, these are our doctors.

In short, it has become high time for all of us to ask: What are the effects of these medical changes upon ME? And when I or a loved one is (inevitably) taken to hospital: WHICH SORT OF DOCTORS WILL I ENCOUNTER THERE?

Gordon Friesen, is a Euthanasia Prevention Coalition board member and Advisory Assistant Physicians’ Alliance Against Euthanasia Montreal, Quebec,


Post Scriptum : It seems quite extraordinary that William Peace does not have a Wikipedia page (where so many lesser lights are to be found). It would be most appropriate to remedy this situation.


cathie butler said...

Before treating a patient, all medical practitioners should be required to state their stand on life issues.

gordon friesen said...

HI Cathie,

That would indeed be an excellent principle. In Quebec, where I live, people get on a two hundred plus day public waiting list to meet a prospective family doctor, but this info is not provided up front. Your suggestion would help a lot in that context.



Ruth Enns said...

I agree with Gordon Friesen. After my doctor for over four decades retired I was shunted to an "Access Centre," the place I was told would accept "complicated patients" like me. In my first visit with a doctor there I was asked whether I have an advance healthcare directive. Such directives, the standard versions, assume that the person is designating the conditions under which they would no longer want to live. However, the doctor did not give her views on the subject and I hesitated to ask for fear of receiving a less-than-positive response and possibly a refusal of services. Physicians holding utilitarian views may believe that their motives are compassionate but they fail to recognize that such views lead to a loss of trust in their profession. I was placed in the care of a doctor who is part-time family medicine and part time palliative care. So far she has done her job (as I see it) but how do I know when she will want to switch to palliative care and nudge me to the nearest cemetery? How can I trust her or any other doctor these days?

Susan Enns said...

A family member of mine was euthanized at a hospice in Ontario last summer, but if I hadn't ordered the medical records and had them reviewed by a healthcare professional I would've never found out what happened. To make a long story short what the doctor said to me over the phone about the medications given and what the records revealed were two very different stories.

gordon friesen said...

The point that I am trying to make in this series of articles is that the supposed demand for death is a sham. It is not patients who desire death. It appears much more to be the "system" trying to "make the trains run on time".

gordon friesen said...

A loss of trust indeed...

The point I am trying to make in this series of articles, is that the supposed "demand" for death is a sham.

Patients do not (typically) want to die ! It would seem much more likely that administrators are pushing euthanasia because they simply wish to "make the trains run on time".