My Personal Angst Around Physician Assisted Death

Canadians, outside of Quebec, are in a no man’s land around Assisted Dying.  In Quebec the law and regulations seem clear.  In fact earlier this month at least one Assisted Death took place.

The rest of us are scrambling to keep up.

In Ontario the College of Physicians and Surgeons are busy making policy around this issue. Thank God someone is.

I believe that the Provincial Government is also looking at this. The Parliament of Canada has until June 6 to make law.

I have a quirky sense of humour. I find the June 6 deadline to be fitting.  It’s the anniversary of the invasion of Normandy in 1944. D-Day takes on a whole new meaning.

Soon this will stop being an interesting political mess and will start to be a real issue for me and my practice in Stoney Creek.

I support the principle of assisted death. I have some concerns and questions as I’m sure everyone does.

Physician Assisted suicide occurs when a physician provides the knowledge, means and support for a person to end their own life. In other jurisdictions a prescription is handed to a person who goes home and takes it from there.

Euthanasia requires someone, not necessarily a physician, to actively end someone’s life. A number of drugs are usually administered intravenously and the person dies.  Does this require the presence of a physician?  Not really, but that seems to be the accepted reality in Canada.  People talk about physician assisted death, but why couldn’t it be a nurse or other health professional?

I’m also concerned about the need for a competent adult to make a decision. This seems to make it impossible for people to give advance direction about assisted death.  This means that people who acquire certain disabilities that render them incompetent will be forced to live in intractable pain while the rest of us have other options.  Not only is this unfair but it seems inconsistent with the notions of equity that the Supreme Court has championed over the years.  Look for more court cases to sort out that mess.

Which brings me down to my own tiny practice in Stoney Creek. Sooner or later it all boils down to ‘all politics is local’.

I do support assisted dying. The question for me is how I will participate.  How will I help my patients who request this service?

I strongly support a woman’s right to decide her own destiny and that includes her right to have access to abortion services. I don’t do abortions, but I make an effective referral.  What about assisted death?  At this point I don’t have enough information.

If a patient wants to die at home and wants to have an injection, what will be my role? I can tell you right now that I have not started an iv in almost 3 decades.  It’s not that hard a thing to do on a young healthy person but on someone who has been ill for months and who may be dehydrated it can be difficult.   I have no confidence in my current skills.  And that is surely one of the things that can go wrong in euthanasia.  Loss of iv access may make the death experience unnecessarily painful-the very thing that a person is hoping to avoid.

I’ve read all the horror stories about executions in US prisons that have gone wrong. What if something like that happens to one of my patients?  What backup can I expect?

Clearly I need a skills update if I am going to participate actively in my own patients’ homes.

But I live near a city with teaching hospitals, a medical school and fantastic community services. I may not have to get personally involved.  I may have the ability to make an effective referral.

As always, my colleagues who practice in the north or in rural or remote settings will face a bigger challenge. For them, they are the not part of the thin line of health providers.  They are often the only  providers.  Options for referral or other help which may be available to me, might not be available to them.

The usual fall back of a referral to another city would be meaningless for people who want to die in their own homes. I worry about my colleagues and their patients.

I have a lot of questions and very few answers about assisted dying. I’m glad we are having the conversation now.  But in five months we need answers.

Personally I want to do what I can to make things better. Right now I don’t know how.

Scott D Wooder, MD

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2 thoughts on “My Personal Angst Around Physician Assisted Death”

  1. Hi Scott,

    Another excellent read. We publish the next issue of DocToc first week of Feb. This is of high interest. May I have permission to reprint it in our publication please? I will email you the issue when it is published.

    Many thanks,

    Dawna

    Dawna Ramsay

    Executive Director

    Academy of Medicine Ottawa

    1867 Alta Vista Drive

    Ottawa, ON K1G 5W8 Tel 613-733-2604

    Fax 613-733-9083

    Email dawna@amodocs.ca

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    *From:* drscottwooder [mailto:comment-reply@wordpress.com] *Sent:* January-21-16 12:21 PM *To:* dawna@amodocs.ca *Subject:* [New post] My Personal Angst Around Physician Assisted Death

    drscottwooder posted: “Canadians, outside of Quebec, are in a no man’s land around Assisted Dying. In Quebec the law and regulations seem clear. In fact earlier this month at least one Assisted Death took place. The rest of us are scrambling to keep up. In Ontario the Colle”

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