OPINION: As a doctor, I’m not here to facilitate death

I read with interest Jocelyn Downie’s argument for urgent access to medical assistance in dying (MAID) within the walls of St. Martha’s Hospital (Dec. 17 opinion piece). Perhaps a physician’s perspective will clarify why the hospital may not be keen to bend to her will.

Three years ago, I left a position as a general internist in northern Canada, where I served a far-flung population of predominantly Indigenous patients.

For 14 years, I brought specialty care to remote health centres and into patients’ homes, often with a pacemaker interrogator or ultrasound machine in tow.

My patients did not have easy lives, and there was a general acceptance, particularly among the elders, that the timing and means of one’s death was as controllable as the caribou migration.

Suicide was a terrible scourge, with effects on every generation, regardless of the circumstances or age of the victim.

Rather than focusing on control, which increasingly seemed to me an odd obsession of my own culture, the focus was on healing connection: connection to people, to the land, to the Creator.

My recruitment to St. Martha’s was influenced by the changing legal climate around euthanasia.

I began medical school in 1994, and the social contract that I entered into did not include facilitating death. I have withdrawn care that was burdensome to patients more times than I can count, and although this may seem like a close cousin to MAID for the casual observer, there is a vast difference (for almost any nurse or doctor) between accepting death and intentionally producing it. A professor of medicine where I trained and the founder of palliative care in Canada, Dr. Balfour Mount, has remained a staunch opponent of MAID. We’d do well to hear his compelling testimony, from the trenches of caring for dying patients.

What I have found at St. Martha’s is a unique medical culture that values individuals — whether staff, patients, or families — not because it is a policy of the NSHA, but because this is who we are.

The heritage that the Sisters cultivated for over 100 years — of service, excellence and particular love for vulnerable people — is perhaps one reason why so many family physicians still come to see their patients in the ICU, why we don’t have patients on stretchers lining the ER hallways, why my department has the safest signover practice I’ve seen.

I don’t believe that forcing euthanasia within St. Martha’s, by severing our staff from our heritage and mission, could have any beneficial effect on the patients we serve.

As the former senior medical director for acute medicine services within the NSHA, I visited over 30 hospitals and witnessed many disparities.

Patients suffer daily in our province due to lack of inpatient physician services, dire shortages of specialists in regional sites, and inadequate EHS capacity.

Their stories do not enter Ms. Downie’s narrative because they do not fit into her euthanasiaactivist agenda. But these patients’ suffering is what the NSHA must address, in partnership with the health department, Doctors Nova Scotia, Dalhousie University, the College of Physicians, and our communities.

If the NSHA chooses to use its administrative authority to mandate euthanasia at my site, there will be unintended consequences. Changing the social contract is not what I signed up for. If I am forced to facilitate the deliberate ending of a patient’s life, I may have no choice but to leave the province, the country, or the practice of medicine.

I do not consider myself a social conservative, nor am I Roman Catholic. But I have found a hospital where my conscience is protected as I care for underserved rural Nova Scotians.

Within three years, deliberately ending a person’s life has gone from being a crime to being a legislated obligation for many hospitals.

However, my practice will continue to be grounded in the principles and heritage that are captured by the St. Martha’s mission. I would encourage Ms. Downie to look beyond her personal political agenda, and advocate for true equity in access to all kinds of medical care, if she wishes to improve the lives of people in Nova Scotia.