Dying with dignity can’t be forced on doctors — or hospitals: Cohn
Published in the Toronto Star on April 7, 2017. Click here to read the article on their site.
Coercion is a solution in search of a problem, a dead end when we have pathways to get people where they want to go.
Unsurprisingly in a matter of life and death, a war of words is at play: Medical suicide versus death with dignity.
Lowering the temperature, the authorities have settled on a more antiseptic acronym: MAID, or Medical Assistance in Dying.
There is no anodyne phrase, no easy right or wrong when both sides believe themselves to be on side of the angels. Or view the other side as being angels of death.
Let’s stick to the more clinical terminology of MAID for those who want to control their own destiny: the timing of an untimely death.
Someone contacted me last year seeking an outlet for his story about the obstacles to dying on his own terms. We corresponded for some time, and I gave him the journalistic referrals he sought.
As it turned out, he found what he was looking for. I do not know how it ended, only that 365 Ontarians have ended their lives with medical help since it became legal last June.
But I confess that even dealing with his request was not easy. And so one can only imagine the gravity of what a doctor faces in such circumstances — not just helping someone in articulating their thoughts, but acting on them.
Against that backdrop, I feel enormous empathy for physicians who entered the medical profession to save lives, not to take them, nor even facilitate the taking of them. Doctors must balance their ethical obligations to patients against matters of personal conscience.
No one can imagine coercing doctors to perform MAID, any more than one can fathom requiring them to perform an abortion if they believe it, rightly or wrongly, to be the taking of a human life. The more difficult question is whether a doctor should be required to refer a patient to another physician who will carry out the patient’s wish.
Beyond that, what about religious (yes, Catholic) hospitals or hospices for whom an assisted death would be anathema? A parliamentary committee last year conceded the conscience rights of individual physicians, but argued in effect that religious institutions don’t have them.
These are big questions of public policy and private morality. How can we force the province’s 21 publicly funded Catholic hospitals to do what we know they cannot? Cutting off government money would surely be a Pyrrhic victory and morality play, not to mention a false economy. For it is no accident that faith institutions are among the most motivated — and irreplaceable — providers of palliative care.
No one expects St. Michael’s Hospital to perform abortions in Toronto, from which it is already exempt. By that same logic, why would anyone realistically expect St. Mike’s to allow MAID on its premises?
Equally, some Ontario doctors are in a quandary because the College of Physicians and Surgeons, which regulates their practice, has ruled that if they refuse to act on a MAID request, they must provide a referral to another practitioner who will. This seems an abuse of authority.
It behooves doctors to help patients, notably young women, who seek contraceptives. If a physician cannot bring himself to distribute the pill, or refer to someone who will — knowing that this has always been among his duties — he should opt for pathology instead of family practice. But to abruptly demand that a doctor now do the precise opposite of what he believes he was trained to do crosses a line.
That doesn’t mean that patients, as a practical matter, cannot get what they want or need. It could mean additional steps, but where there is a will to die, there is now a way.
No right is absolute, and matters of conscience should not be arbitrarily circumscribed if reasonable compromise and accommodation is possible. Digital technology has made the matter of referrals less daunting than before: Belatedly, Ontario’s ministry of health is now promising a referral service to access willing doctors via telephone hotline or online, reducing the need to compel holdouts.
There is no perfect solution to the challenge of MAID, only the recognition that the perfect is the enemy of the good. There are, however, good and practical solutions that have been found.
Other provinces have found workarounds through online or hotline referrals, mobile teams of physicians and simple hospital transfers — a daily fact of life and death — without compelling doctors or institutions to do what they cannot or will not do.
Coercion is a solution in search of a problem, a dead end given that we have other pathways to get people where they want to go. To die.
It is possible to accept dying with dignity, while also embracing the principle of live and let live for doctors — and hospitals — of faith.