Physician-Assisted Death: Facing the Challenges of a New Reality in Canadian Healthcare

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By: Amir Safavi

A physician should be in the service of the patient, treating not only disease but also the totality of a person. The physician is an integral component of a complex system of individuals, communities, and social structures that facilitate patient-centered care. Every decision that a physician takes with regards to a patient must be personalized by the patient’s unique medical and personal needs.

It is ironic that Canadian medical professionals advocate for personalized medicine on a biological level but exhibits selective reluctance for it on a social level. Countless Canadians must concurrently struggle with a merciless, incurable medical condition and a lack of support given by the healthcare system when they wish to die on their own terms.

The official policy of the Canadian Medical Association (CMA) states that physicians should not participate in assisted suicide [1]. On August 19th, the general council of the CMA voted to “support the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether to provide medical aid in dying.” [2] While this position provides more flexibility than the official policy, it remains insufficient because it would allow physicians to withhold the option of physician-assisted death from a patient and refuse to transfer the care of a patient asking for physician-assisted death, even if assisted suicide were decriminalized.

The late Dr. Donald Low, head of microbiology at Mount Sinai Hospital and the Department of Laboratory Medicine and Pathobiology at the University of Toronto, was one physician who believed that Canadians should have the option to pursue physician-assisted suicide. Eight days before succumbing to a terminal brain cancer, Dr. Low shared his feelings in a video produced by the Canadian Partnership Against Cancer: “I’m just frustrated not to be able to have control of my own life. Not being able to have the decision for myself when enough is enough.” [3] Dr. Low addressed the reluctance of physicians to support assisted suicide: “A lot of physicians have opposition to dying with dignity. I wish they could live in my body for 24 hours and I think they would change that opinion.” [3] Perhaps some of these physicians would willingly choose to endure unimaginable suffering and relinquish agency over their lives, even if they were in Dr. Low’s condition. Ultimately, that choice, informed by a lifetime of values and experiences, must be made by individuals for themselves.

In an article recently published in the Canadian Medical Association Journal, Dr. James Downar and colleagues raise important questions that must be addressed to prepare the healthcare system for the Supreme Court of Canada’s seemingly-inevitable ruling against the law banning assisted suicide. What criteria must patients meet to be eligible for physician-assisted death?  How will we ensure that vulnerable and incapable patients are protected from involuntary physician-assisted death? How can we ensure that legalizing physician-assisted death will not detract from efforts to improve palliative care? [4]

Answers to these questions must be elucidated sooner rather than later; the chapter on whether physician-assisted suicide should be allowed is nearing its end. A large proportion of physicians may have strong reservations about physician-assisted death, but the reality is that physician assisted suicide will likely become legal in the immediate future. Failure to proactively engage the critical issues involved in practicing physician-assisted suicide will endanger both physicians and the public. Physicians, medical ethicists, legal scholars and ordinary citizens must engage in discourse to clarify a fair set of standards so that all Canadians may receive care that is truly patient-centered and exercise their right of self-determination in the face of terminal illness.

References

  1. Canadian Medical Association. Euthanasia and assisted suicide (updated 2007). [homepage on the Internet]. 2007 [cited 2014 Aug 22]. Available from: http://policybase.cma.ca/dbtw-wpd/Policypdf/PD07-01.pdf
  2. Picard A. Canadian Medical Association softens stand on assisted suicide. [homepage on the Internet]. 2014 [cited 2014 Aug 22]. Available from: http://www.theglobeandmail.com/news/national/canadian-medical-association-softens-stance-on-assisted-suicide/article20129000/
  3. CBC News. SARS doctor Donald Low’s posthumous plea for assisted suicide. [homepage on the Internet]. 2013 [cited 2014 Aug 22]. Available from: http://www.cbc.ca/news/canada/toronto/sars-doctor-donald-low-s-posthumous-plea-for-assisted-suicide-1.1866332
  4. Downar J, Bailey TM, Kagan J, Librach Sl. Physician-assisted death: time to move beyond yes or no. CMAJ 2014; 186(8):567-68.