As a physician, and a surgeon in particular, I have made many decisions in my career, that have been difficult, and caused me immense stress. I have lain awake at night, wondering if I missed anything, with regards to a patient’s care. But most of the stress has come from decisions that have nothing to do with the actual practise of surgery. Many years ago, I operated on a man, who came in with a bowel obstruction. On opening the abdomen, I was faced with an inoperable cancer, which had spread beyond what had been visible on the CT scan. I had to simply close the abdomen, and later, tell the patient, that he had advanced disease. A couple of days later, when I went to see him, he was alone, and he asked me if I would shut the door, so he could speak to me alone. I sent the nurse out, and shut the door. He told me that he wanted to end it, and could I help him? I was taken aback, and totally lost. I did not know what to say. He saw me hesitate, and reassured me that he was not asking me to do anything. He was asking my advice, as to what would be most sure-fire way for him to end it himself. I managed to tell him, that it was not ethical for me to give such advice. I also tried to be clinical, and told him that no matter what he does, there is no guarantee, and he could end up worse than he was then! (“Thank God, for the gift of the gab, and some quick thinking,” I thought.) The man was a very smart, intelligent man, and perhaps did not really mean to end it himself. But he did give up all hope, and died within a few days. That incident shook me up, and I never told anyone about it, but it stayed with me. I think about it often.
Physician Assisted Suicide is being legalized in Canada, and with it, comes another source of immense stress to the poor physician, who has to deal with the various aspects of this issue. It is not as if we don’t see people who to choose to die – who are very sick, and old, and have very few chances of recovery from a terminal illness, who ask to be left alone (surgically speaking, not literally!), people with irreversible brain damage, on a ventilator, and so on.
When it comes to helping a person make the choice to commit suicide, however, there arise so many questions, dilemmas.
If that patient had asked me this question today, I don’t know if I can really say that I will not help him, given the new legislation that is coming. However, in his case, he was fully cognizant of what he was saying, and why. And yet, I would find it very difficult to be there to ‘assist’ him.
In my discussions with many people, both in the medical profession, and outside, what I see is a severe blurring of the lines between ‘Advanced Directives’, and ‘Physician Assisted Suicide’
In the first case, a person, when he/she is fully capable, makes it known that in the event of an illness in its terminal stages, the person would rather die than be hooked up to monitors and ventilators, which unnecessarily prolong his life. This decision is put down in writing, as a DNR (Do Not Resuscitate) request, and the next of kin are made aware of it.
As far as Physician Assisted Suicide is concerned, I would think that a person who is suffering immensely from an incurable medical condition, which is not immediately (or in the short term) life-threatening, decides that life is not worth living anymore, makes a decision to end it. I believe that this decision is not one that anybody else in the family makes for the person, and the actual act of suicide is carried out by the patient themselves. For this, the person has to be of sound mind.
I know that no matter what legislation is brought about, and no matter what safety checks are in place, there will always be some elements who will abuse the system. This scares me no end.
On the other hand, I myself am quite averse to doing something that is as irreversible, as far as human life is concerned. This has nothing to do with religion or any other belief system. It is just that death is so final – and who knows what really is right? And of course, it is not my decision, but the patient’s to end it. In all fairness, they have the right to decide when enough is enough.
I have no idea how I will tackle this issue if it ever comes up in my practise!
Yet another source of stress in our already stressful lives!
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