‘I’m just trying to live by my conscience’
This spring, a patient told Dr. Ramona Coelho she was thinking about physician-assisted death.
Coelho gently probed to find out what was at the heart of the woman’s fear, anxiety and depression. The patient felt her life was diminished and no longer meaningful. Coelho says she steered the patient away from assisted death to finding ways to make every day seem worthwhile.
“My patients’ death wishes go away when their issues are dealt with,” says Coelho, who has practised medicine since 2007 and did palliative-care work in Montreal before moving to London, Ont., in 2012. She believes time, careful listening, affection and respect are key to a good relationship with patients.
“We have a rushed, overworked health-care system. Patients feel neglected. It can create an overwhelming anxiety. What is driving a lot of death wishes is anxiety. It’s not overwhelming pain.”
Coelho was interested in social justice long before she went to medical school. And yet she is surprised to be considered a “conscientious objector” to assisted death.
“I’m just trying to live by my conscience and with integrity,” she says.
A College of Physicians and Surgeons of Ontario policy acknowledges that physicians who object to providing medical assistance in dying for reasons of conscience or religion are not required to provide that assistance or assess whether a patient is eligible. However, these conscientious objectors must provide “an effective referral” to a patient in a timely manner. That means a referral made in good faith, to a non-objecting, available and accessible physician, nurse practitioner or agency.
This “active” referral is the sticking point for physicians like Coelho, who believe the province should set up a self-referral phone line for patients and not require physicians to act against their conscience.
“Patients want to know, ‘What would you do if you were me?’ So why would I offer them something if I feel it would be bad for them?” she says.
If a patient insisted on seeking access to assisting dying, Coelho says, she would respectfully ask that patient to find other means.
“They could still see me for emotional support. I truly have affection for people I disagree with. I wouldn’t terminate the relationship. The important thing is that we don’t abandon a patient. But you don’t have to do something that’s against your conscience.”
Coelho doesn’t want to bring religion into it. Assisted death has been a polarizing issue, and neither side is open to debate. Talking about religion creates a bias about the person making an argument, she says.
“If I brought religion into it, people would try to put me in a box and explain me away.”
The College of Physicians and Surgeons of Ontario has had no discipline cases for access to medically assisted dying, a spokeswoman says.
“In the event that we receive a complaint from the public relating to the provision of medical assistance in dying, we will investigate just as we would when a concern is raised about any other area of medical practice.”
Coelho recognizes speaking to a reporter about referring patients puts her viewpoint “out there.” But at the end of the day, a patient is free to see another doctor, she says.
“I respect free will. I can’t control people. I’m passively objecting. This law stands, unfortunately. But I shouldn’t be forced to do it. There’s a thousand other medical acts I can do. And I do them well.”