One doctor’s perspective on physician-assisted dying

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TORONTO – The Supreme Court, in a landmark decision that will have major repercussions not only for doctors, patients, and our medical system, but for society at large, said the ban on physician-assisted dying infringes on a person’s rights.

Most people agree with it; a new Forum Research poll suggests 78 per cent agree with the decision, while 22 per cent disagree.

And just like there are divided views in the public about this, there are divisions among doctors. Forty-five per cent of Canadian doctors supported legalizing assisted death in the latest Canadian Medical Association poll.

This dissension is not surprising given that, in my view, the issue boils down to a fundamental question which is intensely personal:  what makes a life worth living?   It appears that the courts believe it’s not up to society to decide what conditions make a life worth living. Rather it’s an individual choice.

Doctors’ personal views on this will naturally be influenced not only by their personal religious and moral stance, but also by experiences that they have had in the practice of medicine.

Personally, this issue really hit home when I took care of patients with ALS (amyotrophic lateral sclerosis), which is the scariest disease I have encountered.

When one ALS patient asked about physician-assisted death, the switch for me as a doctor went from thinking of myself in the traditional “treating” role as a physician, to actually contemplating what I would want if I were that patient.

There’s a migration from sympathy to empathy which can be very powerful.  That’s not to say that two patients in the same situation will want assisted death.  I’ve seen young people die of cystic fibrosis, which is basically like drowning in slow motion.  Yet one patient will fight for every last breath, and another patient will beg you to relieve their suffering.  For patients, as for doctors, views vary deeply and may change over time.

There have also been several concerns raised by opponents of physician-assisted dying over the years, which require consideration.

I think that the Supreme Court decision is partly a reflection of the knowledge we’ve gained in studying what’s happened where the policy has been adopted, and evaluating whether these concerns have been borne out.

One of the main concerns has been that vulnerable populations such as the elderly and disabled would feel pressure to seek physician-assisted death.  However, what we’ve seen in jurisdictions physician-assisted death is permitted, is that the people who are seeking this kind of death are not from physically or socially vulnerable populations.

People also worry about a slippery slope, whereby a large and increasing number of deaths will occur through physician assistance.  But this has accounted for a very small and stable percentage of deaths over time in permissive jurisdictions.

Finally, people worry that legalization of physician-assisted death will lead to a decline in palliative care services.  This is a major concern because palliative care is the cornerstone of relieving suffering at the end-of-life.

However, jurisdictions that have adopted assisted dying policies, such as the Netherlands, tend to have among the strongest palliative care programs in the world, and governments that have proposed physician-assisted death, as in Quebec, have often increased support for palliative care at the same time (which will be critical to any future Canadian legislation).  A majority of patients who request physician-assisted death are already in fact in palliative care – which highlights the fact that even palliative care cannot fully relieve suffering and restore function.