Hissan Butt is a medical student at Queen’s University in Kingston, Ontario
I recently learned that two Canadian medical students died in the past three weeks. Little is known about the circumstances surrounding these deaths.
However, this has not stopped worried Canadian medical students from speculating about the causes of death. The speculation arises not because of a desire to gossip. Rather, I think, it stems partly from a lack of information and partly because of fear. At the time of writing, most believe that the students died by suicide. One university has acknowledged the death of one of the students, although the cause is not identified.
The silence is justified – we are told through unofficial sources – by a request from the families to respect their right to privacy. We are also told that talk might spark copying. Indeed, any decent person should want to respect the wishes of the bereaved families, to help them grieve and lighten their burden in this difficult time. There is no need for naming, but there is a need to talk.
Maintaining silence about suicide comes at a cost, the consequences of which may not have been considered.
First, silence breeds fear and isolation. It perpetuates and is emblematic of the stigma attached to mental illness that we health-care professionals are supposed to combat. At a time when leadership is most desired, the lack of a clear official statement alienates and confuses students. These deaths demand a collective acknowledgment of the loss and its cause, despite the excellent supports available in universities. Moreover, students have already begun responding to the news as if they were suicides. In this context, the silence sends a chilling message: In times of distress during your medical training you must suffer individually because we, as a collective, will not address systemic problems that affect you. The alienation puts vulnerable students further at risk and demoralizes student bodies across campuses.
Second, the silence continues a trend towards a lack of data on suicides in Canadian medical schools (and more broadly Canadian universities). Statistics are gathered by age group not occupation. Suicide is complex and stressful careers are thought to contribute. Reports suggest that doctors have a higher suicide rate than the public; however, little research has been done on suicide rates in Canadian medical students. If in fact these recent deaths were unacknowledged suicides, we will be choosing to remain ignorant, perpetuating unscientific claims and myth, and impeding efforts to make meaningful progress in improving medical training.
Third, in light of recent medical assistance in dying (MAID) legislation, the silence appears inconsistent with our professional roles. Future medical trainees will be expected to respect and accommodate patients’ wishes to die. Yet the unwillingness to address similar sentiments that arise in members of our profession devalues the suffering felt by our colleagues and casts doubts on our professional capacity to provide medical assistance in dying for the general population.
Remaining silent is a choice. However, we should understand its price before we make that choice.
Acknowledgement: The author would like to express his gratitude to Dr. Jacalyn Duffin for her editorial comments
Jane Keeler, Counsellor, MSW
Thank you for raising the crucial concern of silence on the part of students who are generally under high pressure to both perform academically and to provide help to others– while often handling their own stresses alone. We should not expect medical practitioners or learners to be able to handle the exposure to vicarious trauma, intellectual challenge, financial debt, and personal life events without a great deal of support.
If you are a student, please remember that there are willing counsellors available in every university who can help you and provide confidential listening..
Thank You Hissan Butt for taking the time to address the issues of death and dying openly in your blog post.
I believe we can still respect family wishes while addressing these issues in our medical training and profession. Understanding and processing grief are essential skills for physicians. you are correct, that if we cannot talk openly about grief amongst us, how will we learn to be comfortable addressing this with our patients seeking compassionate end of life care?
We also need to speak openly about and address issues of stress and burnout in medical training and profession. The way in which we train and work is hurting us, and it compromises the care we provide. we have the science and knowledge to do better. do we have the will?
How apt that your blog was posted on Let’s Talk day. Once again, thank you for starting this conversation and bringing awareness to this issue.
This is a very helpful text. You identify the problem. And you identify the extraordinary situation of the doctor who is both abnormally a risk, and at least potentially, the agent of the suicides of others.
First of all, then, let us agree on one point : Faced with the reality of suicide there is no “us” or “them”. “There but for fortune go you or I” as Phil Ochs sang in 1963, (or “There but for the grace of God go I” –John Bradford 1555). Suicide, and suicide prevention are a continuum. As you quite rightly pose the question : If the patient is justified in refusing further suffering, what about the overstressed Med student ? And if not, why not ?
In 1972 suicide was decriminalized in Canada. From that point there was no further attempt to promote a monolithic moral judgement ; and thus, each person was henceforth obliged to decide the matter for him or her self. This does not mean that there is no such thing as right or wrong ; it simply means that there is no agreement on what those might be.
My own thinking on the question runs as follows :
I will not kill myself, because other people depend on me, not only materially, but morally. And even in the very most isolated social condition, even for that person who believes no one cares about his life or death, the example is still believed to make suicide more acceptable in the minds of others. Suicidal thought and action have even been proposed as a contagious condition. Therefore, for me, suicide would be a socially immoral act.
However, others will maintain that from the height of my privileged perspective I have no knowledge of true suffering. So be it. My life story is of no interest here and I will not quibble on this point. I am willing, then, to reserve judgement on the suicides of others.
But now we come to “assisted suicide”. And on this point, once again, I am adamant. If I am unqualified to decide that another person’s suicide is unjustified, then I am certainly no better able to conclude that it is, or more concisely put : I have no way of deciding whether a given suicide be justified or not. And in light of this knowledge I have decided that I will not “help” anybody to die. period.
But then I am not a doctor, and it is easy for me to choose. I don’t have to worry about shirking an implied duty, now that suicide has become a right guaranteed to the patient.
This is the unenviable lot of the modern doctor. No normal human being could be comfortable with the judgements required by such a vague duty to kill. Eight hundred years ago a famous soldier asked his commander how he should differentiate between the good townsmen and the bad. “Kill them all” was the reply, “God will know his own.”
Of course when asked by others, later, it is easy to avoid responsibility : “I was doing my duty” or “I acted within the law”. But that will not suffice, for any thoughtful person, alone, in the night, tortured by the demons of guilt and of doubt. (And this also is the doctors lot, with or without assisted suicide.) Again, as you so rightfully point out, physicians are way out of the common suicide curve. Approximately twice the incidence for men and as much as four times for women, on statistics averaged across the developed world.
Before such numbers, and recognizing the limited and precious human capital upon which we must draw to form competent doctors, it would appear, at first sight, to be the height of folly, to add this mortal stress of PTSD onto their already loaded psychological plates. There must, indeed, be some terrific emergency, some undeniable urgency — some catastrophic need — to provide immediate death for that tiny percentage of patients who demand it !
Unfortunately, though, beyond the notion that this service MUST be provided — everywhere and at all times — there has been precious little thought about the most elementary precautions to be taken : Individual assessment and licencing of volunteer professionals ; constant monitoring of practice and affective state ; provision of serious intervention and counselling services for those involved ; and above all –restriction of the number affected to the smallest practical dimensions.
But again, these things have not been thought through, and they have not yet had the time to jump up and smack us, figuratively, like a two-by-four, between the eyes. For the time being, individual doctors, and medical students must make their own assessment. And this is where we find the good news : There is no reason any individual doctor should feel obliged to participate in voluntary euthanasia. The right to refuse is built into the law. Nor is there a need for any particular doctor to participate. Because, contrary to the notion that has been created, this is a very, very small market. No normal person wants to die any more than any normal person wants to kill.
In the Belgian-Flanders region where euthanasia has been legal and aggressively promoted for over 12 years, only 13 % of cancer patients have recourse to MAID. Fully 87% refuse, that is … knowing and informed refusal.
Therefore, normal medical practice need in no way involve the practice of euthanasia. There are clearly enough euthanasia enthusiasts to go around.
Let us recognize, then, and perhaps with gratitude, that the existence of this small minority among doctors, in perfect symmetry with the small minority of suicidal patients, will enable us to ensure that at least this new and extraordinary level of stress need not be added to the lot of the ordinary doctor.
Feel the Love,
Gordon from Montreal
I appreciate your courage in bringing this issue to the attention of Physicians. Universities and Medical schools have been silent for far too long. Hopefully, someone in the “Ivory Tower” will read your blog and a process will be started to identify problems and solutions.
When I went to U of Med.school in the 60’s all students had access to a personal student advisor who was very helpful in assisting students with emotional needs.