Diane Kelsall is Deputy Editor at CMAJ, and Editor of CMAJ Open.
In June 1993 I attended my first international research meeting. WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) was having its annual meeting in The Hague and I had gotten funding from my fellowship program to attend.
It was all very exciting for someone new to the research world to see the hustle and bustle, and feel the energy, that accompanies such a large meeting. Even Queen Beatrix attended.
But that’s not what I remember most about the meeting.
One of the sessions put on by the local organizers focused on euthanasia (that was the term used at the conference). At the time, the Netherlands was the only jurisdiction in the world where this practice was legalized. Many attended out of curiosity—and the collective response was interesting. Numerous attendees filed out of the session in silence, clutching handouts that described euthanasia protocols:
Administer this. If the patient is still breathing, administer that. If the patient’s heart is still beating, do this.
We stood in small groups, hardly able to grasp what we were reading. This was so contrary to everything we had been taught and everything we believed. How could physicians have crossed this line? When did “above all do no harm” turn into an algorithm for death?
When I returned home, I put the protocols away in my desk. Every few years, I would stumble across them—and each time, I felt chilled as I read them.
Fast forward to February 2, 2016,,,
I received an email outlining interim guidance from the College of Physicians and Surgeons of Ontario on physician-assisted death. As I read through the guidance, I came across this statement: “College members may wish to consult resources on drug protocols used in other jurisdictions. Examples of such protocols are available in the Members’ section of the College’s website.”
More than twenty years after my trip to The Hague, I was again being given access to protocols to end patients’ lives.
Only, this time, it was in my own country. In my province. From my College.
I never thought this day would come. And I am still chilled.
Physician assisted suicide has been widely debated topic recently with its legalization in two states. There are many strong proponents on both sides of the issue. People who argue for physician assisted suicide state that it is the right of the person to decide if they want to die, and we should feel empathy to those who are suffering and are unable to end their suffering themselves, and want to die with dignity. People have a right to die, but are unable to due to a physical disability and should therefore be assisted (Andre and Velasquez, 2016). People should be able to die with dignity on their own terms (Hale, 2015). This will not lead to a slippery slope beyond terminally ill patients, or those who are mentally ill or incapable of making this decision (Breslow, 2012). Those in favor argue that people have a right die, and they are not encroaching on anyone else rights or freedoms by exercising this right.
Only in your wildest dreams do you think they are going to contain, just a “little bit of killing”…welcome to Belgium!
“The law says adolescents cannot make important decisions on economic or emotional issues, but suddenly they’ve become able to decide that someone should make them die,” Brussels Archbishop Andre-Joseph Leonard, head of the Catholic Church in Belgium, said at a prayer vigil last week.
Some paediatricians have warned vulnerable children could be put at risk and have questioned whether a child can really be expected to make such a difficult choice.
Last week 160 Belgian paediatricians signed an open letter against the law, claiming that there was no urgent need for it and that modern medicine is capable of alleviating pain.
So kids who are restricted from watching certain TV shows; are now rational enough as tender youth to decide they want to die?
Please explain why they defeated the National Socialists when they are casually reinventing the policies of 1937…drip by drip.
Naivety and stupidity, with an unhealthy dose of secular political correctness have run amok and you applaud? Absolutely PRICELESS!
John S. Mackay
Dear Dr. Kelsall:
I too never thought this day would come, but whereas you are “chilled”, I am delighted.
Since I presume as an editor you will not personally be asked to be involved as a physician, your concerns must be those of a potential patient. As such, I think everyone agrees you have the right to expect that your life will be prolonged to the last possible minute. I on the other hand, am much more “chilled” by the thought of being sent to a palliative care unit, deprived of all privacy, dignity or purpose: not as an alternative to death, but merely as a prolongation of dying.
Since there is no possibility that these two viewpoints can ever be reconciled, I ask only this: if you have the right to have your wishes respected, should not those of my persuasion have the same right?
Whose life is it?
If we are both to have our wish, then there must be two choices. Door A, to prolong life, or Door B to end it now.
The problem today, is the ambiguity of the medical mandate. For the common man, both Door A, and Door B lead to the same place, which is wherever the ambulance takes him. He is met by the same professional (that is whoever happens to be on duty at that place) and that doctor will be expected to give him the type of service he desires.
EXCEPT, that different professionals will have different bias. Some doctors will think that a given individual should logically die, EVEN IF, that individual thinks otherwise. And realizing that such differences exist between doctors it will be very difficult for patients to TRUST their doctors.
The only way, in my opinion, to resolve this problem, is to have an entirely different professional staff behind each door. Medical doctors behind door A for those who wish to prolong life, and something quite different behind Door B, something that remains to be named and defined.
In this way, we might each have our choice. But unfortunately, I cannot see how you can ever have your wish among medical doctors without fatally poisoning the well of confidence for all of us (and we are a great majority) who wish to prolong our lives.
Yes it is your life. And I fully support your right to die, including your right to militate for the creation of a new and separate professional service formed to provide you with that death.
Feel the Love
There are people who will take money to kill other people, it is known to mankind as:
THE ASSASSIN’S BUSINESS MODEL
Of course the National Socialists (Nazis) tried euthanasia out in 1937; apparently it didn’t work out too well.
Back in the period 1946-1948 the reward for euthanasia enthusiasts was a last meal, cigarette and blindfold before facing a firing squad.
But of course we have ‘advanced’ so much with budgetary considerations, that killing is now considered a kindness. Where have we heard this before…?
Welcome to the Brave New World, where the medical profession is once again being actively pimped out to corruption.
Dear Dr. Kelsall,
Thank you for this perspective on the creeping acceptability of convenient death. I also feel chilled and deeply saddened, for our profession and for all of us in this society, and especially for the next generation of physicians starting out. I certainly understand some of the respondents’ concerns about suffering, but surely that means we should be improving care – physically, emotionally, spiritually – rather than killing.
Doctors do not exist to serve the “wants” of citizens or vice versa. “Wants” is an interesting word choice, isn’t it?
Seems to me there are far worse things than death: Namely physician-assisted needless and prolonged suffering. Of course the official stance of the RCC is that such inconvenient suffering will get your patients extra kudos in Heaven – so lay it on thick, force that martyrdom down your patient’s screaming yaw. Good for you and to hell with compassion. I hope you get your full share and a bit extra.
Death can be a beautiful and timely transition, even something to look forward to – especially from the cold and heartless society.
Do doctors exist to serve the wants of citizens, or, do citizens exist to serve the wants of doctors?
No one, *no one*, should be ever be forced by their government to act against their conscience.
Dear Dr. Kelsall,
Thank you for writing what so many of us are experiencing. This will soon be law in the whole of Canada as it already is in Quebec where I practise. Why are we letting this happen? Why are Canadian physicians and medical organizations not up in arms, but rather passively aqcuiescing, and even collaborating, as political agendas and misinformed public opinion impose on our profession a practice that is the antithesis of compassionate medicine?