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

The Casket - - Page Two - DR. AMY HENDRICKS com­mu­ni­[email protected]­ald.ca

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.

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