Bonnie Larson is a Clinical Assistant Professor at the University of Calgary.
The past year has clearly demonstrated that doctors are willing and able to advocate. Television, news, and social media are all aflame with passionate, articulate MDs telling of injustice, difficult working conditions, and the latest in epidemiology, infectious disease, critical care and vaccine science. They do not hesitate to share expertise in writing, on camera, or by signing letters. If schools are open at our peril, the ICUs are bursting at the seams, or a rural emergency department is being shuttered for lack of physician coverage, the docs fight for it, and I’ve felt proud to see associates wielding their power and privilege for the greater good, influencing policy and practice and reassuring a public befuddled by pandemic bedlam that competent souls have their backs. We have witnessed unprecedented capacity and flexibility in our health care system as it makes room for everyone who needs care. We understand that there should not be excess deaths due to lack of space, staff, stuff, and systems. We are horrified at any contracture of health care capacity when so many are falling ill and are at risk for death.
And yet, this is exactly what is happening in Alberta for an entire group of patients, their families and caregivers. Excess deaths due to opioids – deaths that are preventable – abound in our communities. But where are all my colleagues’ voices raised in resistance to the recent closure of Calgary’s lone life-saving supervised consumption service?
Upon graduating from medical school, I took an oath to “practice medicine with conscience and in truth. The health and dignity of my patients will be my first concern.” As I consider the closure of Calgary’s supervised consumption service, I have to wonder what pledge was promised by my medical colleagues who have themselves witnessed the carnage of the opioid crisis since 2014. Did they take a different oath? There must be some other version of the Hippocratic oath. One that promises to put the health and dignity of patients at the forefront, but only if they don’t use drugs.
Obviously, I am breaking a code of professional silence by pointing out that medical professionals could, and should, do better. It is tempting to concede that everyone is exhausted, burned out, and struggling. Although I am sympathetic to this, it is becoming more and more difficult to sit politely by while thousands die and the crisis is only getting worse. Of course, a handful of doctors have been staunch in their allyship, but they are sparsely scattered across the nation.
Until I saw hundreds of colleagues join the political advocacy scene with the advent of Covid-19 and, in Alberta at least, provincial antagonism towards doctors, I was willing to give them the benefit of the doubt. Advocacy is maybe not everyone’s comfort zone, and in medicine it has traditionally been an area of debate. But if physicians are willing to advocate in some crises but not for the safe care of victims of the opioid crisis, the only logical explanation is that, though it might go too far to say they don’t care, many certainly can’t be bothered to resist the closure of an essential life-saving health service for people who use drugs. It pains me to say this, but I can no longer give them the benefit of the doubt. In my view my medical colleagues are willing to talk … but only if what (who) they are speaking up about is palatable to their own moral conscience.
Sonya M Regehr
Yes, a good wake-up call, and indeed, a health crisis in need of advocacy. In the area of health effects of climate change, I’ve found it helpful to belong to CAPE (Canadian Association of Physicians for the Environment) https://cape.ca/. Helps to inform and coordinate advocacy amongst busy physicians. I wonder if is something similar for the opioid crisis? As Dr. Chu has said above, “Let me know where the next rally is!” I did have the privilege to watch this excellent documentary on one courageous and empathetic physician’s response to opioid crisis: https://www.nfb.ca/film/kimmapiiyipitssini-the-meaning-of-empathy/
Thank you for the wake-up call, Dr. Larson. Addictions has a long politicized and racist history, which both confuses medical decision-making and contributes to physicians’ biases. I am hopeful that the now-familiar role of public health since the Covid pandemic and the growing demands for equity by various social movements (#metoo, BLM, BIPOC, Indigenous reconciliation, etc) will converge and bring us to our senses. When over seventeen Canadians and more than three Albertans die each day and all indices of the fentanyl poisoning crisis are worse than Covid — and the life-saving intervention is medical (medical supervision, naloxone, jaw thrust, oxygen) — there is no doubt that it is within our professional responsibility as physicians to advocate that this public health emergency be taken seriously. While there certainly a role for funding for long-term addictions programming, we need immediate life-saving interventions to stem the tide of deaths; five years into this crisis, Albertans are dying faster than ever.
As an anesthesiologist, it is heartbreaking that so many Canadians are dying for lack of a simple jaw thrust and some naloxone. It is heartbreaking that it is a political act to advocate for a nurse to watch over people to provide this care. Such a cheap and cost-saving intervention…. Where are the health economists?
Let me know where the next rally is!