This month we present the debate: “Should physicians be open to euthanasia?” Notice that the words that appear the most important in this discussion are “be open to.” Canadian Family Physician has no intention of taking a position on this issue; to argue for or against euthanasia in the context of a debate would be simplistic, inappropriate, and in bad taste.
We should recognize, however, that family physicians are without doubt among all health professionals the ones most frequently confronted with the demand for euthanasia. This is essentially because many practise in palliative and long-term care where they treat patients afflicted with terrible debilitating illnesses that extinguish hope and call into question the point of going on.
How can family physicians respond to sick people who ask them to hasten the end of their lives? That they cannot do it? That they will take care of them? That they will ease their pain? Aren’t these the expected responses?
Boisvert ( page 320) reminds us that more and more patients and physicians say they are in favour of euthanasia, and that, contrary to what we might expect, it is not because there is no palliative care or appropriate services or because pain is poorly managed.1 But according to Marcoux ( page 321), we need to put ourselves on guard against the risks associated with the practice of euthanasia and the possible abuses.2 However, among the arguments raised, one of the most troubling is that, paradoxically, being open to euthanasia prolongs survival!
This leads to an anecdote. One day, the wife of a patient I had treated in palliative care came to see me. “Doctor,” she said, “Among my husband’s belongings, I have found this letter addressed to you. My husband wrote it during the first days of his illness and included it in his living will.”
An evening’s reflection
Dear doctor,
When I am old and sick, will you help me to die with dignity? When I can no longer go on, will you help me to die gently? May Heaven preserve me from a long drawn-out death, bedridden, incontinent, demented, and ... blissed out.
Do not think that I make such a demand of you because I am depressed! Quite the opposite, I love life very much. Don‘t tell me that you will see to it that I do not suffer at all! That is not in question here. What I speak of is the anguish of a life that is fading away and will soon be gone; each day becoming feebler, thinner, and more fatigued—more dead in other words! Why are you so willing to alleviate physical suffering and so reluctant to understand the sufferings of the end of life?
Don’t tell me that our society condemns euthanasia. Where are all these people and all these judges who raise objections when their own loved ones are dying? Do you see many of these people taking care of their own family members when they are in agony? Scarcely 10% of our loved ones die at home. We’re too busy; we’re working; we have children. Better to condemn euthanasia and put our dying into institutions than to care for them ourselves. Death disturbs us, right?
Speaking of euthanasia, don’t you think the clever cocktails you might administer to me to alleviate my terminal symptoms could hasten the process? All the medicines for pain, for shortness of breath, for agitation, will surely render me yet more feeble, more apathetic, more prone to complications at the end of life.
Are you certain that you would not practise that which you so adamantly reject, a form of slow euthanasia? A little push toward the great beyond, perhaps? If this is true, why would you not give me this push when I ask you for it, or when I cannot go on? After all, they shoot horses, don’t they?
Will you do this for me if I ask you?
He never referred to the letter
Several months later, my patient was afflicted with a terminal disease. Strangely, from the moment he became ill, he never alluded to the letter. He paid close attention to the doses of medications I prescribed.
Is it possible that we see life differently according to whether we are in good health or are ill and at the end of life?
Footnotes
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Cet article se trouve aussi en français à la page 312.
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Competing interests
None declared
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