 Dr. Larry Librach, Director of the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital in Toronto. (Sun Media/Jack Boland)
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Dr. Larry Librach is thinking about a dying man and now wondering if
he let him down in his darkest hour.
His patient, an accomplished middle-aged businessman, had end-stage
cancer and wanted the palliative care doctor to help him die.
“He asked me several times and said ‘You know, I’ve done everything
we talked about and I’ve accepted my dying and as hard as it is for
my family, I want to go now. Why won’t you help me?’” recalls the
director of the Temmy Latner Centre for Palliative Care at Toronto’s
Mount Sinai Hospital.
Librach knew he could control the symptoms of his patient’s disease,
but he knew his bowel could perforate, delivering the man to an
agonizing death.
The worst happened and his patient died in horrible pain.
Librach knows he gave the man “really good palliative care” but
wonders if he did enough.
“There’s a group of people who are very rational and very reasoned
and who are suffering immeasurably and still want that option (of
assisted suicide) and it’s becoming less clear to me that we can
refuse these people that option,” says Librach.
“We used to say palliative care would relieve all suffering, but
that, of course, was nonsense,” he says, adding after 30 years in
palliative care, he’s “seen too much suffering to be glib about it
anymore.”
Librach wonders if it’s time for Canadians to have the right to
what’s commonly called a “hastened death.” Opinion polls show more
than 70% of Canadians support assisted suicide, but Librach believes
that “as a society, we’re pretty conflicted over this.”
It’s part of the huge disconnect between how people picture the last
days of their lives — at home, surrounded by family — and the reality
of most Canadians dying in a hospital bed.
The Canadian Medical Association officially opposes euthanasia and
physician-assisted suicide and it would need a “fairly large shift”
in the medical community and society to revise that official
position, says Dr. Jeff Blackmer, executive director for the CMA’s
ethics office.
“There’s no question that there are a number of physicians in Canada
who feel very strongly that they would like to see physician-assisted
suicide made legal,” says Blackmer, but adds there isn’t a big push
for changing the law.
The Royal Dutch Medical Association is the only professional body of
physicians in the world that officially supports doctor-assisted suicide.
Since assisted suicide is illegal in Canada, there are no definitive
studies on how often it occurs although Blackmer says it’s “naive to
think that it’s not happening at all.”
“My own guess is that it’s fairly rare,” says Blackmer.
While Librach believes there are “very few” doctors who would support
euthanasia or physician-assisted suicide, he said “there’s more
confusion about the issues than there ever has been.”
Some observers say palliative sedation — when doctors sedate a
terminally ill patient and withdraw life support, allowing death to
happen without any interventions — is arguably a form of passive
assisted suicide.
“It’s assisted dying, but it’s not that active sort of pushing the
medication in or giving a quick overdose,” says Librach.
One Ontario doctor feels it’s time for Canadians to have “an open and
honest debate” on doctor-assisted suicide.
On any given day on his shift as an emergency room physician, Dr. Ken
Milne handles a host of life and death issues, including do-not-
resuscitate orders.
Milne, who works at South Huron Hospital in southwestern Ontario,
says ethical discussions haven’t kept pace with medical technology.
“If we assist people into this world through obstetrics and forcep
delivery and caesarean section and technology, do we also have an
obligation to look at the end of life and use the technology to
assist people?” says Milne, who authored a column on assisted suicide
in the Medical Post in 2005.
“I think it’s time to reflect on the latter part of life and say how
long do you persist with individuals with, for example, chronic
vegetative states or deteriorating neurological condition? At what
point do you say, enough is enough and it’s time to let go?
Sitting in his windowless fifth-floor office at the Ottawa Hospital’s
General campus, Dr. John Seely leans back in his chair and fiddles
with a paperclip on his desk.
The palliative care doctor is thinking about a patient he cared for
last year. She was a middle-aged woman with cancer. She suffered from
severe abdominal pain and asked Seely often about how he could help
her end her life.
“When someone asks that question — ‘Can’t you give me something to
hasten my death?’ — my antennae go up to find out what’s behind that
question. What’s driving that question and what can we do to
alleviate that degree of despair,” says Seely.
“It may be a persistent, well-thought-out and rational decision that
I no longer want to live, but more often, it’s a cry for help,” says
Seely.
Seely worries that adopting an assisted-suicide law in Canada would
lead physicians to “giving up prematurely” on patients.
“We’re uncomfortable in the presence of someone’s dying. We don’t
like to talk about it or acknowledge it and like to put it out of
sight and hastening someone’s death is another way of doing that,”
says Seely, a former dean of medicine at Univerisity of Ottawa.
Since moving into palliative care 12 years ago, Seely says he’s
observed how a person’s emotional, spiritual and psychological
suffering often dwarfs their physical pain.
“Fear of pain is there, but it doesn’t have the same potency as the
fears of being a burden or the fears of loss of control,” says Seely,
adding that losing control “breeds hopelessness and helplessness.”
Doctors often “hold the hope for patients,” says Seely.
“When a doctor takes active steps to hasten a death, we are
fundamentally changing the relationship between a doctor and a
patient and the nature of medicine as I perceive it, which is to do
good and do no harm.”
