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Doctors don’t know

02 May 2019 11:09 AM | Philip Patston (Administrator)

Jim Vause | 24 April 2019 | NZ Doctor


It seems our ethics on this matter are plagued by opinion, beliefs, awed interpretation of evidence and biases of individual professional realms

There is something very paternalistic about the “Doctors say no” letter opposing medically assisted euthanasia (i).

The letter’s rationale that, “to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect” is akier than lo.

For a terminally ill patient to ask their doctor to cease their suffering by assisting them to advance their death usually reflects a deep trust often built up over years of a GP-patient relationship. Any GP worth their salt will know this. I do not buy the letter’s argument.

Similarly, the NZMA using the argument that “the proper provision of such (pain) relief, even when it may hasten the death of the patient, is not unethical” to justify opposing doctor-assisted suicide fails when the patient’s desire for death is due to suffering, but not of pain.

Rationality is further eroded by their statement: “We are of the view that permitting individuals to end their lives with the assistance of a doctor — even when that assistance is limited to assessment, verification or prescribing — is contrary to the ethics.”

Standing on the top of a seven-strand fence or dancing on a pin? This seems a common circumstance when it comes to the NZMA arguments, a situation probably resulting from the clinical experience of those realms of medicine opposed to medically assisted euthanasia and one in which palliative care features very strongly.

Causes of suicide

Consider: What is the underlying reason for most persons committing suicide? It is due to mental illness. Depression, anxiety and a few other mental states.

If doctor-assisted suicide was available, how many persons contemplating suicide would seek help rather than killing themselves? Don’t know.

Does palliative care treat these persons? No. Are the mental states leading to suicide treatable or do they attenuate with time? Yo.

In some persons, it is irreversible and they continue to suffer until they die, irrespective of medical intervention. Underlying is a neurological disease, usually degenerative, often difficult to detect, if at all.

It is hard to refute the rationale that ending such a life when suffering is unbearable is better than continued futile medical interventions that don’t work, lead to a loss of dignity (see the NZMA Code of ethics) and cause suffering in their own right.

To end such suffering in a manner that preserves that person’s dignity and is painless, is vastly better and humane than the terror, physically and emotionally, of an ill-planned gruesome suicide with all the concomitant distress and social angst it causes family and friends.

Does allowing the latter through doing nothing meet the NZMA’s Code of Ethics that “requires doctors to always bear in mind the obligation to preserve life wherever possible and justiable, while allowing death to occur with dignity and comfort when it appears inevitable”?

Stench of paternalism


Ultimately, I feel that taking this absolute position, one of medical control, has the malodour of a paternalistic profession that comes from a position of believing that it knows everything about the human condition and can treat all its malfunctioning, when in reality it knows so little about how the brain works, and what it does, and is thus so limited.

Terminal patients want to maintain control, especially for dignity.(ii) We advocate for advanced directives while patient rights are articulated explicitly in our H&DC code, yet we seem to nd it too hard to do the difcult thing, exemplified by the NZMA statement that, “It seems that doctors are somewhat reluctant to take on the weight of the burden that we are asked to assume by legalising active euthanasia.”

It seems our ethics on this matter are plagued by opinion, beliefs, awed interpretation of evidence and biases of individual professional realms. A change in our ethics is only a matter of time.

References

[i] http://doctorssayno.nz/

[ii] J Med Ethics. 2006 Dec; 32(12): 706–710.

doi: 10.1136/jme.2006.015883

PMCID: PMC2563356

PMID: 17145910

What people close to death say about euthanasia and assisted suicide: a qualitative study

A Chapple, S Ziebland, A McPherson, and A Herxheimer


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