The caricature of the conscientiously objecting physician

Objecting doctors are the bad guys, obstructing care.

How will disciplining conscientious doctors or driving them from the profession improve health care?

Physicians' Alliance Against Euthanasia | Collectif des Médecins Contre l' Euthanasie

14 May, 2019

Reproduced with permission

Catherine Ferrier*

Canadian doctors who object to directly causing the death of their patients, once the near-totality of the profession, have, since the enactment of laws permitting "medical assistance in dying" suddenly become outliers.  

Polling data is unclear, polls are often biased, and there is no doubt that the euthanasia lobby had the ear of media, opinion leaders and politicians long before we knew what they were up to.

Be that as it may, we are now told that euthanasia/MAiD is an accepted 'medical treatment' that must be provided to those who request it. Many provincial medical colleges, though not requiring doctors to euthanize patients themselves, do expect, to different degrees, that we facilitate their being euthanized by someone else.

Aware of the fear of complaints and lawsuits that many objecting doctors are now feeling, the Physicians' Alliance against Euthanasia asked the Canadian Medical Protective Association (CMPA) to speak at our recent Improving Care conference, held in Montreal on April 6, 2019, a request that they graciously accepted. The talk was entitled MAiD and conscientious objection: the medico-legal perspective, and included an excellent overview of the various provincial requirements regarding referral, transfer of care and/or providing information to patients who ask for MAiD.

Unsurprisingly, the advice we were given on how to prevent medico-legal woes was: "Inform your patients. Don't be judgmental or impose your beliefs. Don't abandon your patients."

Willingly or unwillingly on the speaker's part, the implication was the same we hear everywhere in this discussion: You, the objecting doctors, are the bad guys. You are the ones trying to protect your own rights at the expense of patients' rights. You are the ones obstructing care.

One by one, members of the audience began speaking of their deep concern for their patients and of how hard we are trying to give them the care they need, in the presence of a law that offers a quick fix, to get rid not only of the symptoms but also of the patient. The speaker's response was more or less: "If that's who you are… there is no problem! Keep treating patients as you do!"

That is who we are.

Consider this story told by a family physician member of the Alliance:

My first MAiD "request" after its legalization was from a fiery lady with a history of depression. She had recently learned her diagnosis of metastatic breast cancer and her poor prognosis. I was extremely overwhelmed by her request, and started the conversation by fully disclosing that I would never be able to journey that road with her as I didn't think it was good for her, for anyone else or for society. I said we had mutual affection and I found this to be a difficult moment. I then stumbled through what felt like hollow reasons in the face of her request and determination. She had answers to everything. She was very angry at her family, who she felt treated her badly because of her increased irritability. She also expressed feelings of hatred for people she saw on the street, living, while she was being robbed of life. 

I was not really offering her any care, as she had a palliative care doctor and an oncologist, and I thought I would never see her again.  But she kept coming back to talk. I would book her at the end of the day and give her my time, so I thought, but the gift I received from her during those visits was of far greater value. She spoke freely and showed me photos of value to her. We talked about making voice memos for those she would leave behind. I decreased her steroids, and this decreased her irritability and anger. I suggested moving them to the morning, and that improved her sleep and quality of life.  We switched her antidepressant. In the end, my patient decided to die at home, naturally, and did not choose MAiD.

Why did the patient change her mind? She could have asked another doctor for MAiD, but she chose to keep visiting the one who refused it. Maybe because that doctor saw value in her life and helped her see it too. Maybe because she helped her, using medical and other means, to heal her relationship with her family. Maybe because she listened and journeyed with her.

Here you see the conscientiously objecting physician.

Not in the caricature of the doctor in her ivory tower, jealously protecting her ideology and her rights, judging and lecturing to patients, and abandoning them when they need her the most. I have never met such a doctor. But that is who the licensing bodies have in mind when we are told we should all retrain in sports medicine, plastic surgery or pathology.

The hard-core MAiD zealots, would (and do) say: "This patient was denied her rights. She asked for death and was refused it. This doctor should be disciplined."

In what way would a quick technical fix have improved this patient's last days?

Which approach is the truly compassionate one?

Which is the more dignified death?

Which will ease the grief of those left behind?

Why are the conscientious objectors under the microscope of the licensing bodies, while those zealots are not?

The legalization of "medical assistance in dying" has created a surreal situation. It is the only act in the realm of health care that is considered a patient's "right". Every Canadian has the right to health care, but not to any particular procedure. We are trained to make diagnoses and recommend treatments that are appropriate to the presenting problem.

Another part of our discussion in the session was about whether the speaker, a surgeon, would perform any procedure a patient asked for. Of course not, he said. Would he refer to someone else who would do it? Say, for extensive surgery that was useless because the cancer had already metastasized? Not so clear… for the record, yes, but in real life?

In family practice, a patient with a viral respiratory infection will not be offered antibiotics. There are myriad other examples. This is professionalism, not paternalism. This is good, evidence-based medicine: choosing wisely. There is no evidence supporting euthanasia as treatment for any illness, but patients have a right to it. They can say, "I don't care what you can do to relieve my suffering; I want to die now", and we must comply. How does this improve the lives of our patients?

How will disciplining conscientious doctors or driving them from the profession improve health care?