Assisted Suicide in Canada (Part III): Despair and dying
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
As a medical student, I read the arguments about physician assisted-suicide and euthanasia with an additional question on my mind: When I become a doctor, will there be circumstances in which would I actively provide my patients with a means through which they could end their lives? Would I refer my patient to one of my colleagues who would do so?
Looking to the foreign experience is important in considering the legalization of these practices in Canada, not only because it describes the institutional and societal risks of euthanasia and physician-assisted suicide, but because we now have research that examines the factors that motivate patient requests for aid in dying. Depression, hopelessness, and psychological distress have been consistently associated with patient interest in physician-assisted suicide and euthanasia. Patients with depressive symptoms are up to four times more likely to make a request (and also more likely to change their minds about such a request).
Furthermore, public health data from Oregon has shown that 40 per cent of patients who choose physician-assisted suicide are concerned with being a burden to their friends and family, and that 50 per cent of patients who choose physician-assisted suicide are afraid of losing control of bodily functions. The “death with dignity” movement would use this latter statistic to support its claims, but the notion that loss of control of bodily function is equivalent to a loss of dignity is inherently problematic. As bioethicist Felicia Ackermann has argued, the death with dignity movement suggests implicitly: “human dignity reside[s] in the bladder and the rectum.”
Ultimately, what is clear from this research is that requests for physician-assisted suicide and euthanasia are driven not so much by physical suffering, but by existential suffering. Doctors should address this kind of suffering in conjunction with the physical aspects of suffering—medicine is an art as well as a science. When seriously ill patients feel their lives are no longer worth living, doctors should compassionately address the patient’s social, spiritual, psychological, and emotional sources of pain, in addition to providing the patient with access to the full range of modern palliative care medications and treatments for their physical symptoms.
Doctors, and the health-care system as a whole, have much to improve upon. Currently only 16-30 per cent of dying Canadians have access to palliative care, and discussions regarding advance-care directives too often happen too late or not at all. As a result, Canadians may receive invasive medical interventions that do not support their autonomy or allow natural death. However, legalizing physician-assisted suicide and euthanasia would create a separate stream of care that has the proven risk of compromising the vulnerable it supposed to protect. When medicine came into existence thousands of years ago, doctors had little to provide to the suffering apart from their words and their touch, and physicians must remember that when all else seems hopeless, they still can offer these two small, but endlessly powerful things.
Sophie Palmer, BAH is a medical student at Queen’s University Faculty of Medicine. She would like to thank Dr. Chris Frank for his guidance and input. Sophie is a guest contributor to Juris Diction.
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To read Jonathan Nehmetallah’s introduction piece, visit Part I by clicking here . For Katherine Deakon’s opinion piece, visit Part II here. Dr. Udo Schuklenk’s article can be found here. For Dr. Kaplan’s opinion piece, visit Part V here.