I am a retired kidney specialist. I have witnessed the deaths of hundreds of patients throughout my career. Fortunately, the vast majority of these deaths were peaceful, painless and occurred a few days after dialysis therapy was discontinued.
Alas, this is very different than in many other areas of medicine, such as cancer care and neurology. These dying patients often have a horrible exit from this world. For some, current palliation practices do not address their needs, leading to their intolerable suffering. They seek an obvious alternative, namely death. This is one of the situations in medicine where the patient decides that death is preferable to life.
Because of current Canadian law, such patients have no choice but to suffer two indignities. First, the indignity of the worsening of their condition. Second, the indignity of having their wish to decide upon the timing of their own deaths rejected by their physician.
There are several versions of the Hippocratic Oath that physicians are expected to adhere to, but there is one overriding principle: The physician must act in accordance with the “patient’s best interest.” In the case of a fully competent patient, the final judge of what is best is the actual patient. If a dying patient, who can no longer accept the overwhelming burden of terminal illness, clearly and unambiguously asks the physician to help terminate the suffering and the physician refuses, then that physician can no longer be considered to be acting in that patient’s best interest.
In Canada, people without a terminal illness have the legal right to commit suicide. And yet, in the throes of a terminal illness, where the patient no longer has the physical capacity to take his or her own life, physicians cannot assist. I know of no other area of medicine in which a physician refuses to give adequate relief to a patient. If a law precludes them acting in accordance with their patients’ needs, then they should openly protest that unjust law.
One of the major reasons that physicians have difficulty in accepting assisted suicide is the dictum that a physician should “do no harm.” The logic of this principle is self-evident. A patient goes to a physician to be cured or for relief of symptoms. Patients do not want a therapy that has a high risk-to-benefit ratio. In these cases, the ultimate risk of therapy is death. Inherent in these scenarios is that the patient has the autonomy to chose what is best for him. The physician can only act in accordance with the patient’s wishes. To do otherwise is both breaching medical ethics and against Canadian law.
And yet, when the disease is untreatable and terminal and the needs of a patient are at their most profound, physicians (and many medical ethicists) hide behind this “do no harm” edict. They deny their patients the only and ultimate relief they request because, perversely, death is considered a harm.
My response to my colleagues is: How on earth can a peaceful, dignified death, requested by the terminally ill patient, be considered to be harm? I would submit that allowing continuation of unbearable suffering, expressly against the patient’s wishes, is truly doing harm to that patient.
Those on the other side of this debate often stress two other concerns. First, the “slippery slope” argument. But data from countries and U.S. states that allow assisted suicide show that this fear is unfounded.
Second, the belief that only God can give and take life. But surely that religious credo cannot be forced onto others who do not share that belief. As in the abortion debate, I say: “Mind your own religious business.”
There is a further benefit to the option of assisted suicide. A terminally ill patient may well be comforted by knowing that should the degree of suffering become unbearable, there is a way out. Having the autonomy and control to choose that option allows the patient to preserve their dignity.
In my opinion, it is time for my medical colleagues to re-examine their code of ethics, taking into account current individual human rights. Those terminally ill patients who seek the timing of their inevitable demise should be given their dying wish.
Sue Rodriguez told us that 20 years ago. Here in Victoria, her home, Choices in Dying, First Unitarian Church of Victoria (choices [email protected]) continues her crusade.
Dr. Adrian Fine is a retired professor of medicine from the University of Manitoba. He lives in Victoria.
