David Falk is a palliative care physician working in Calgary, Alberta
Recently the president of one of the Quebec medical federations published a request to the public to give the medical profession some time to accept physician assisted death (or medical assistance in dying - MAiD) “because they do not like change.” I agree and disagree with him about this. Yes, physicians are slow to change without measured assurance that the change would be beneficial to their patients, but, when it comes to the matters of the heart, these changes may not be beneficial nor become mainstream. Suppression of visceral responses does lessen with repeat exposure, just as shoplifting becomes less traumatic the more often you do it, but whether continued suppression of the heart language is good is questionable.
I'm interested to read articles where medical professionals describe their experiences with MAiD – either through their direct participation or through having in-depth discussions on the topic. Visceral responses seem to range from giddy euphoria to shared-experience intimacy to feeling emotionally drained to profound mistrust in one’s own medical judgments for a length of time after. Responses I've heard about but not seen published include profound nausea, uncontrollable shaking and cold detachment. It seems that the law of the heart does not express itself in “rational” intellectual words, which is the common acceptable mode of expression for medical professionals. There are acts for which our whole bodily DNA is wired to respond! It seems like this act is one of them from reports I have read in the literature.
To help me comprehend what is happening in these visceral responses, I find myself harking back to a framework I read from Dr. J. Budziszewski. 1 The law of the heart is transcribed through what the Great Wisdom Traditions, ancient & modern philosophers, and even Darwin would call the conscience and so Budziszewski uses that word. How we respond to the conscience determines how effective we will become in discerning heart language in our patients and their families. We can:
- acknowledge that our visceral response is the expression of a transgression and confess it
- acknowledge that our visceral response should be recognized for the outcome it will have in my heart if ignored
- rectify the misdeed performed if possible, which in this case is difficult as the patient could be dead
- acknowledge that continued ignoring of a visceral response is wrong for the integrity of person
We can suppress our conscience by:
- advocating for changes to the law of the heart by advocating for changes to society’s perception and society’s laws to soften the heart’s response
- denying that these visceral responses are of any importance as professionals must maintain a respectable distance/aloofness
- recruiting others to join our belief system so there becomes a sense of shared guilt/shared responsibility/blaming other
- rationalizing our actions so our intellect is comforted from the heart language and quiets the visceral response (mind over matter - “It’s their choice” is the standard line I hear in these discussions).
During the debate over legalizing MAiD, I noted all of the above suppression modalities were expressed at one time or another. Social media, repeat public polls over the past 4-5 years and different agencies all expressed advocacy. Not that all advocacy is wrong, but when it denies the visceral responses of the heart, it should be questioned.
Medical professionals have written or verbally expressed their visceral responses, but conclude that these were of no importance using denial and rationalization to continue suppressing their conscience.
I've seen professional associations’ leaders asking that all become involved, physicians asking that all physicians should be involved in enabling MAiD, administrators slowly searching for willing people/institutions near vulnerable patients, and people shaming those who are against MAiD by stating “you should not impose your morals on others.”
Of course, we are all very good at rationalization. That is the only way we can gain some control over our emotions and fears. Sometimes this is good; sometimes it is detrimental. Again, the statement, “It’s their choice,” ignores the impact it has on them personally thus shifting ultimate responsibility to the patient, and hopefully protecting the professional from their own visceral responses, and providing emotional distance from their patient.
Yet maintaining the ability to hear the language of a patient’s heart is necessary if we in the medical profession are to continue being healers as opposed to technicians. The physician’s heart needs to be clear to fully hear the heart of a patient in distress beyond the physical but repeated suppression of the laws of the heart desensitizes them . As a palliative care physician, I have been approached a few times by colleagues who either state they are unable to explore spiritual (heart) issues or they feel they need to learn how to do this. They sense the need to become more complete healers for their patients.
A clear conscience is important for a professional’s integrity, and for effective healing of existential suffering.