Patients often describe little or no pain in major trauma. Their bodies go numb. Feeling returns as they wake to realize what has happened.
Possums play dead. Hedgehogs roll up. Doctors learn how to go numb. They become experts at not feeling. They have to. Doctors turn off a switch in order to stab a newborn’s chest with a large trocar to fix a pneumothorax. The same switch can be turned off to do anything rationalized as good, or compassionate.
Many doctors could end life, perhaps most. If socially accepted and freed of moral qualms, doctors could act with dispassionate precision. Detached reason can do terrible wonderful things.
eu·phe·mism
ˈyo͞ofəˌmizəm/
noun
1. a mild or indirect word or expression substituted for one considered to be too harsh or blunt when referring to something unpleasant or embarrassing.
Call it euthanasia, physician assisted suicide, medical aid in dying or physician assisted death. Just don’t say kill, such an inflammatory word. It biases discussion. It crushes dialogue. Say anything else. Pick any euphemism.
Impassioned Reason
The College of Physicians and Surgeons of Ontario believes physicians should be forced to act against their conscience. Forced to act according to reason and the laws of the land. No discretion allowed.
The Toronto Star agrees. They published a jeremiad: Doctors who play God can be pastors, not physicians. Doctors must not hold an opinion, at least not act on it.
We look at history and wonder,
- “How could anyone, especially doctors, support forced sterilization in Canada?”
- “Did anyone actually believe in Eugenics?” (Tommy Douglas wrote his Master’s Thesis supporting eugenics.)
- “How could physicians perform medical exams in Nazi work camps?” See: Doctors From Hell: The Horrific Account of Nazi Experiments on Humans
Did physicians feel numb then, too? Were they free to decide?
Assisted Suicide
The Wall Street Journal reports that the Assisted Suicide movement seems to be going on life support.
” Cases in Oregon have surfaced showing that the Oregon Health Plan refused to pay for more expensive potentially life-extending cancer treatments, but offered to pay instead for the $50 assisted-suicide pills.”
The last year of life consumes 18% of healthcare spending. Could debt strapped provinces, like Ontario, resist saving billions with assisted suicide instead of ‘wasting’ it at the end of life?
In Canada this summer, assisted suicide gains momentum. Doctors gather in Halifax next month to debate policy on how best to operationalize “Medical Aid in Dying”.
How do we dodge Quebec forcing doctors to participate beyond conscience, the CPSO prescribing ‘effective referral’ against conscience and mockery from media that spin this as patients’ rights versus doctors’ beliefs? After all, doctors have privilege bestowed upon them by the state, like birthright, don’t they?
The Supreme Court’s assisted suicide ruling has forced physicians to face something incomprehensible to reason alone. Death is existential, not just biological. Will physicians feel comfortably numb as they shape policy this summer? Let’s hope not.
Sobering questions, well posed.
As I get frustrated with the many months wait for patients to get time-sensitive procedures done, such as tumor removal, I cannot avoid the thought that at some level it is a cost-saving strategy by MOHLTC to limit providers and facilities even if it means the premature death of active people, fully enjoying productive lives. Like any other insurer, except with a state-enforced monopoly, OHIP must view sick people as liabilities rather than the reason they exist. If someone dies waiting for treatment, the system saves money, especially if the patient is past the peak of their tax-paying years. It is bizarre that we are swinging from grotesquely keeping someone alive, who could just be given comfort care as they passed away from natural causes, to the other extreme of actively hastening death in those who we deem as not having quality of life.
Stumbled into this via Linkedin, some thoughts…
-Agree w/ Phil”bizarre” & “grotesque” are fitting terms to describe the swing from human care to barbaric resource management.
-Actively transitioning an individual from this life into what’s next is of course “killing”. I’d argue we know this intuitively & innately from a strictly common-sense perspective, which is why the active & passive definitions of euthanasia are integral to the conversation. Euphemisms are merely clever linguistic devices we use to masquerade, to fool. “Death” isn’t mild, it’s final. Actively hastening is killing, uncomfortable as the thought is.
-What’s interesting to me is how Shawn’s thoughts on “detached reason” every so subtly echo Vogelin’s discussion of human reason conceived as solely possessing an instrumental use vs. reason understood as possessing a metaphysical capacity. The first view constricts reason, in a certain sense ossifies & so dehumanizes; the second absorbs the first view, while pointing to our ability to transcend our condition as finite beings & participate in events & processes beyond the here & now.
-In care, a cold, calculative application of reason ignores the human person subject to the care & the individual subject to himself/herself as the author of those caring acts. The outcome seems to me a devaluing of the activity, of caring period, with not only ethico-moral effects on the suffering individual & physician. “Dispassionate” = “inhuman”, insofar as we analyze the term from the perspective of health care.
-Seems to me end-of-life care applied via reason in its full breadth of power is open to possibility, open to the physicians’ impassioned application of his/her medical knowledge & skills aligned w/the resources at hand. We may not be able to save the life, return the person to his/her previous levels of health, if at all, but we need not actively pursue the inevitable existential outcome…it comes regardless, so from the standpoint of passion, rather compassion, with the suffering, managing that transition as painlessly as possible becomes primary.
Wow. What a thoughtful comment, Kian! Thank you for taking time to share your thoughts. I doubt I can respond as well as your ideas deserve…
I appreciated you picking up on ‘reason’ qua reason. I think I envisioned a logical positivists’ definition of it, or perhaps that of the strong rationalist where reason is that cognitive capacity separate from all nonphysical – certainly all metaphysical – thinking. Of course, the notion defeats itself because both the strong rationalist and logical positivist have no basis for their position using the criteria they use to measure other people’s ideas. I must confess to not having read any of Vogelin’s original writing and have only read secondary sources. I must put him on my reading list!
I entirely agree that “dispassionate” = “inhuman”, but many would challenge us on that. Many still cling to romantic notions about physicians being able to function as calm, detached, purely objective, rational beings in the clinical care.
Again, I sure appreciate you taking time to comment! Readers’ comments make any post far better than it would have been otherwise.
Kind regards,
Shawn
Brilliant reflection, Phil!
I wonder how students will discuss this time period in history classes of the future – such bizarre contradictions. In the face of significant – massive, horrendous, egregious – barriers to care, we choose to spend thousands of hours discussing how to fix an access problem for a tiny handful of, usually elite, well-educated, patients who want absolute control on the exact timing of their death. The whole healthcare system turns to address this one issue while study after study shows patients coming to harm from waits. I’m not saying we shouldn’t discuss it; just that the loss of perspective is glaring.
Thanks so much for taking time to read, reflect and comment! As always, your comments make the post so much better!
Best regards,
Shawn
I am so conflicted about this topic. I have long felt that if a person suffering from a terrible illness for which there is no hope of recovery wishes to die, then it should be allowed. But I also fear that it is such a slippery slope. Could it eventually mean that others could make that decision and not the patient? Or as you have stated in your blog post, could governments decide it is economically more feasible to end a life rather than try to preserve it – regardless of the patient’s wishes or those of the family? And I strongly believe that under no circumstances should a doctor be forced to assist a suicide if they do not wish to. As far as I know doctors are not required to perform abortions (but I could be wrong on that). Nor should they be. So why should they be required by law to assist in suicide? The government already has too much negative influence on healthcare and this is yet another area where they need to butt out. Thanks once again for an excellent blog post!
Thanks for writing, Valerie!
I think many of us are conflicted on this, too. We don’t want to prevent others from doing things, but we worry about how the change will impact the weak and vulnerable.
Just to clarify, the Supreme Court stated that MDs must not be forced to participate. The trouble is that the College of Physicians and Surgeons of Ontario believes that an ‘effective referral’ to another doctor who will do what the first doctor finds abhorrent is just fine. Many physicians believe this makes them complicit in the act. Sort of like, “No, I won’t do that, but I will send you to someone who will.” I don’t think that reasoning would fly with any other action.
Thanks again for reading and commenting! I agree, government is WAY too involved in running medicine.
Best regards,
Shawn
You do not need a physician to kill people … yes k-i-l-l people. The bureaucrats can come up with the instructions very quickly. The CPSO, God Bless them, they need it badly, the usual henchpersons of government or any member of ‘the public’ who wants to promote his personal desires, will insist that it is the ‘standard of practice’ that they ‘maintain’ (show me where). It will then be de facto ‘malpractice’ if you do not do it. If you do not cave under this indictment but your refusal is ‘persistent’, then you have become ‘incompetent’ and will have your licence revoked unless you agree to ‘re-training’ in the Lubyanka at 80 College Street. This is not just a euphemism to sanitize words, this is an attempt to sanitize an action as a ‘medical procedure’. If our profession agrees to this, even on a ‘limited’ basis. we have given up ‘public trust’ forever.. “Thou shalt not kill” is not just a religious or Hippocratic dogma, it is the law of this land. Doctors sometimes kill inadvertently. It is the intention that counts. Just call the State executioner instead, as long as it is not a required ‘effective referral’.
“Nor shalt thou strive too officiously to keep alive”. That is the grey area where underhanded euthanasia is sometimes perpetrated or large sums of money are spent that do nothing to relieve the suffering of the patient or the family. Compassionate public education on end of life CARE, including advanced decision making, and more funding of research, education and enhanced true palliative care should be the ‘medical’ solution.
The final judgments will be made by the College ICRC. The CMPA and the CPSO have asked Justice Stephen Goudge to look into the ‘efficiency’ of the ICRC, but apparently nothing about justice. Well that worked well for Auschwitz didn’t it? The Nazi war criminals expressed difficulty judging the morality of what they did and explained that it was not their decision, but they WERE proud of their ‘efficiency’.
Thanks for you comment, Roger!
You’ve packed so much into it, I find it hard to add anything pithy. You make an excellent point about language, an almost PC cleansing of the topic. On the one hand, I understand the desire to avoid loaded words, but it feels more like equivocation than politeness.
Again, thanks so much for taking the time to read and share such thoughtful comments!
Best
Shawn
Yes, it is a very slippery slope, my Mom was euthanized without anyone’s permission in 1965 and my Mother-in-law was accidentaly euthanized in 1974 , it ( the shot) was meaned for another lady!! This happened in The Netherlands, and my Dad told me that seniors are afraid to go to the hospital, it happens regularly!
Thank you for sharing this shocking story, Theresa. Very disturbing. It seems that a few well-connected, articulate people can push their agenda on everyone else.
Thanks so much for taking time to read and comment.
Best,
Shawn