Saturday, December 5, 2020

Assisted death - the path of least resistance

The following article was published in the London Free on Dec 6, 2020

Dr Ramona Coelho MD, CCFP, Family Physician, London, ON

Dr. Sohail Gandhi, MD, CCFP, Immediate Past-President and Board Director, Ontario Medical Association

Dr. Leonie Herx MD PhD CCFP (PC), Division Chair & Associate Professor of Palliative Medicine, Queen’s University, Past-President Canadian Society of Palliative Care Physicians

Day af​ter day, we par​tic​i​pate in a health-care system and a so​cial sup​port sys​tem that does not come close to meet​ing the ba​sic needs of our most vul​ner​a​ble patients. How​ever, our role as physicians should al​ways be to first ad​vo​cate that our pa​tients ac​cess all rea​son​able sup​ports for mean​ing​ful life without suf​fer​ing.

As the COVID-19 pan​demic dom​i​nates the political agenda and strains the country's health-care systems, the fed​eral Lib​er​als are in​tent on pass​ing Bill C-7, which pro​poses to ex​pand med​i​cal assistance in dy​ing (MAID) to those who are not dy​ing.

Pro​po​nents say the bill al​lows choice and dig​nity for those with chronic ill​ness and dis​abil​ity. How​ever, the bill fails to pro​vide them with the dig​nity and hu​man​ity that comes with good care and ac​cess to sup​ports.

We are doc​tors who wit​ness the strug​gles that con​front our pa​tients and their loved ones every day. Those liv​ing on the mar​gins and with dis​abil​i​ties face sig​nif​i​cant barri​ers to care though sys​temic discrim​i​na​tion (ableism) that can make it harder to live a healthy, ful​fill​ing life in com​mu​nity.

As doc​tors we should be in​still​ing hope, sup​port​ing re​silience and us​ing our expertise to find cre​ative so​lu​tions to ad​dress health and well-be​ing. In​stead, we would be re​quired to sug​gest as​sisted sui​cide as an op​tion if this bill be​comes law.

Spring Hawes, a woman who has had a spinal cord in​jury for 15 years, said:
“As dis​abled peo​ple, we are con​di​tioned to view our​selves as bur​den​some. We are taught to apol​o​gize for our ex​is​tence, and to be grate​ful for the toler​ance of those around us. We are of​ten shown that our lives are worth less than non-dis​abled lives. Our lives and our sur​vival de​pend on our agree​able​ness.”
A choice to die isn't a free choice when life de​pends on good be​hav​iours and compliance to so​ci​etal norms. Sadly, the med​i​cal com​mu​nity can be com​plicit in this mes​sag​ing.

Gabrielle Peters, a bril​liant writer who has strug​gled with poverty since her disability, has shared that a health-care pro​fes​sional sat at her bed​side and urged her to con​sider death. This was just af​ter Peters' part​ner an​nounced he was leav​ing her be​cause she was too much of a bur​den and she no longer fit into the life he wanted.

Doc​tors can pres​sure some​one to die as in Peters' sit​u​a​tion but also more sub​tly can con​firm a pa​tient's fears that her life is not worth liv​ing and MAID would in​deed be a good med​i​cal choice.

Day af​ter day, we par​tic​i​pate in a health-care sys​tem and a so​cial sup​port sys​tem that does not come close to meet​ing the ba​sic needs of our most vul​ner​a​ble patients. How​ever, our role as physi​cians should al​ways be to first ad​vo​cate that our pa​tients ac​cess all rea​son​able sup​ports for mean​ing​ful life with no suf​fer​ing.

But alas, Canada does not seem to pri​or​i​tize health care and sup​ports for all, and soon, that lack of support will be pit​ted against an op​tion to ac​cess death in 90 days.

Pa​tients en​trust doc​tors to make eth​i​cal de​ci​sions every day re​gard​ing their care and to make recommenda​tions that are al​ways aimed at pro​mot​ing health and heal​ing. The core role of medicine is to be restora​tive, not de​struc​tive. Ad​vo​cat​ing for our patients' health and well-be​ing is solemn oath we took.

As physi​cians we help our pa​tients do many things in the con​text of a trust​ing, shared de​ci​sion-mak​ing process. Doc​tors en​cour​age healthy habits. We refuse to prescribe an​tibi​otics when pa​tients have a vi​ral in​fec​tion, or opi​oids on de​mand. We pull a driver's li​cence when we have con​cerns for pa​tient safety and the public good. We refuse to write mask ex​emp​tions with​out good rea​son. We serve both patient and the com​mon good.

All of this re​quires courage to not be​tray the trust so​ci​ety and the pa​tient have be​stowed on our profession. So​ci​ety's be​lief in the in​her​ent virtue and ethics of the profes​sion has been the nec​es​sary basis of the physi​cian-pa​tient trust. Would you trust your doc​tor if you thought they didn't care about your safety and well-be​ing?

While we rec​og​nize pa​tients have the right to ask for MAID, physi​cians must not be forced to sug​gest or forced to fa​cil​i​tate this, when rea​son​able op​tions for liv​ing with dig​nity ex​ist. We must con​tinue to offer our pa​tients what is good and prac​tise medicine with in​tegrity.

As Thomas Fung, physi​cian lead for Sik​sika Na​tion, a south​ern Al​berta First Nation, said:
“As​sisted death should be an op​tion of last re​sort, and not the path of least re​sis​tance for the vul​ner​a​ble and dis​ad​van​taged. Con​science protection is needed in this bill, as no one should be forced to participate in the in​ten​tional death of an​other per​son against their good​will.”
One of the most im​por​tant foun​da​tions of our Cana​dian iden​tity is that we are a caring, com​pas​sion​ate coun​try. We are proud of our universal health-care man​date, and we place a high pre​mium on be​ing inclu​sive and tol​er​ant while work​ing hard toward the ac​com​mo​da​tion and in​te​gra​tion of marginal​ized and vul​ner​a​ble members of our com​mu​nity. And yet, if Bill C-7 is al​lowed to stand with​out amendments, we will be in se​ri​ous dan​ger of los​ing this fun​da​men​tal el​e​ment of our Cana​dian iden​tity.

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