Category: Politics

Many physicians think that an ideal doctor should act like a philosophical zombie. They wouldn’t use those words, but popular descriptions of ideal physician behaviour sound less human, more zombie-like.

Philosophical zombies look and act like regular humans but do not have conscious experience or feeling; think more like I, Robot than World War Z.  We understand them entirely in physical terms. Like zombies, doctors should be objective; empathetic but psychologically un-phased, infinitely malleable to their patients’ worldviews.

Zombie doctors follow guidelines faultlessly. They never veer from standards of practice for unscientific things like patient individuality. If planners or legislation call for action, zombies obey without question. If a patient requests a legal treatment, they twirl and mechanically deliver referrals like vending machines serve candy bars.

Patients never have to worry about zombie doctors acting unprofessionally. Zombies only do what zombies do, without any variability. Zombie doctors learn ethical guidelines and apply them with computerized regularity. They do not have opinions, debate nuance or wrestle with inconvenient social dilemmas. Zombie doctors do what they’re told and always act in patients’ best interests as defined by the social collective.

The zombie defence might explain why Canadian doctors supported the Sexual Sterilization Act between 1928 and 1970. Patients unfit to reproduce – for example, people with low IQ, no money, alcoholics – were sterilized against their wishes, sometimes without their knowledge during an unrelated procedure. Zombie doctors explains how the head of the Toronto Psychiatric Hospital served in the Eugenics Society of Canada during that period and received the Order of Canada.

But do patients really want zombie doctors? Or do we want doctors to act on strongly held personal morals?

Doctors denounce, and refuse requests for, female genital cutting even though most jurisdictions don’t prosecute parents who take their young girls out of country for the procedure. Most doctors denounce sex selection even though there are no laws against it in Canada (Globe and Mail, CTV News). If sex selection and female genital manipulation became legal, we hope most physicians would refuse to have anything to do with either of them.

 As Dr. Margaret Somerville, the founding director of the Centre for Medicine, Ethics and Law at McGill University said recently, “Do you really want to be treated by a doctor who doesn’t care if he thinks that he’s doing something unconscionable or unethical or immoral?”

There will always be some tension between the moral convictions of an individual medical professional who adheres to his or her own worldview and the different procedures that are legally available in a pluralistic society. (National Post)

Clear laws can help. But Martin Luther King Jr. reminded us to, “Never forget that everything Hitler did in Germany was legal.” Just ‘following the law‘ is known as the Nuremberg defence.

Life is great when other people do what we want them to.  But utopian dreams blur imperceptibly into nightmares.  A civilized society should not force anyone, including doctors, to do what they find morally reprehensible, even if it is legal.

Physician assisted suicide (PAS) is fundamentally confused. Other societies throughout history have supported physician assisted suicide, euthanasia, abortion, infanticide and much more. That does not mean Canada should. We might consider the following irreconcilable issues:

1. Doctors spend massive amounts of time and energy convincing patients to not kill themselves. It is materially impossible to differentiate nihilism from depression from hopelessness. The Dying-With-Dignity crowd promotes a false image of the typical patient requesting PAS: idealistic, articulate, and simply looking for relief when faced with the prospect of death.

2. Physicians take the Hippocratic Oath. They do it for two reasons. First, they want patients to know what they stand for, to offer patients a standard of accountability. But more importantly, the oath rests on the presupposition that moral neutrality does not exist. No one can pretend to stand as an objective oracle of medical wisdom devoid of cultural interpretation and nuance.

3. Assisted suicide can fail or not go far enough. Assisted suicide necessitates laws to support euthanasia so physicians can intervene to complete the suicide for patients left near dead from their attempt. Is that what society wants?

4. The rhetoric supporting PAS sounds exactly like abortion. Initially, abortion required special outstanding circumstances, second opinions and was supposed to happen rarely. Now, abortion is routine, uncomplicated and no reason seems slight enough to get one. The Netherlands experienced the same change in frequency, approach and reasoning over the years since PAS became legal.

5. Most patients do not want suicide. By orders of magnitude, the majority wants great end of life care. Those who pretend that frail elderly patients will not feel pressured to pursue PAS in the face of huge burdens placed on their families for elder care mislead to the point of cruelty.

6. What do patients want? Do they want physicians who hold to strong moral values and will share those views graciously? Do patients want physicians who will remain a source of strength, support and encouragement when their own resources run out? Or do patients want physicians who pretend to be objective, morally neutral and blind to the issue? Do patients want a physician who can care for them even when the physician sees the world differently?

7. After the media about forcing physicians to provide or refer for any and all publicly funded services, what protection do we expect for physicians’ own human rights? The College of Physicians and Surgeons has already taken direction from the Toronto Star to consider forcing physicians to act against their moral judgment.

As the libertarians, individualists and death-with-dignity celebrations die down, I hope Canadians will consider the consequences of legalizing physician assisted suicide. Let your MPP know what you think.

For most doctors, physician assisted suicide will not change almost anything in day-to-day practice. It will happen away from the mainstream of care, available but not obvious. Doctors will want reassurance that neither patients nor doctors get coerced. But beyond that, most physicians will not get passionate either way.

Doctors usually avoid social activism. As a group, they support social movements but rarely create movements of their own.

Doctors agree on one moral absolute: Thou shalt not express a moral opinion about the behaviours, beliefs or decisions of thy patient. Everyone is a potential patient. Ergo, doctors should not express opinions about anyone’s choice. Society expects this – demands this – of their doctors. Modern medical trainees learn objectivity before all else.

People used to expect doctors to toddle the streets offering wisdom for healthy living and good character like the sheriff on the Any Griffith show. Those days are gone. Post war individualism promoted maximal freedom in personal morality.

Doctors focus on medical problems, not emotions or ethics. Doctors learn to separate morals from medical tasks. I’m often surprised when my wife takes the opposite approach on a medical issue. Doctors can separate medical problems from their social context. Physicians often turn a scientific lens onto social problems to see how social issues impact human organisms. But doctors do not care about social issues in the same way they care about surgery and pap smears.

Physician assisted suicide will probably develop like abortions. Doctors usually hear about abortions after the fact. Patients decide with their families then go to a clinic. Physicians rarely have to agonize over termination. MDs help before and after the event but do not discuss it much in between.

Doctors live as a tiny part of the social fabric just like everyone else. We work hard and try to help people where possible. We enjoy our family and buy lots of stuff. We don’t want to die with unfulfilled dreams. Counter-cultural revolutionaries are rare.

Politicians will probably set up physician assisted suicide like abortion. It will happen in discrete clinics with staff that want to be there. No provider will be forced to participate. Family doctors won’t write referrals.  Doctors will carry on looking after all the other medical problems relieved that the courts took care of things.

Physician assisted suicide will be a non-issue for most doctors. That’s what society wants. Or does it?

Please share a comment or read “Bad Idea – Physician Assisted Suicide” (next post).