We need a moral compass

Downie’s commentary on physician-assisted suicide states that “as a profession we must ensure that there are physicians willing and able” to further this end once it is legal and regulated.1 Over two millennia ago, the Hippocratic Oath described how the push to end our patients’ lives was evident even back then: “I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.”2 Hippocratic medicine represented the dawn of principled practice, which is widely seen as the basis for Western medicine. Even then, they could see that just because they could do something didn’t mean they should.

Modern medicine has not stopped searching for a solution to this timeless challenge. Modern palliative and psychiatric care and novel symptom management are among such endeavours. Even when faced with severe physical symptoms, doctors have ethical approaches at their disposition such as the use of sedatives for refractory symptoms at the end of life. Patients should always be comforted and doctors should not feel obliged to medicalize suffering by making use of euthanasia, which corrupts end-of-life care3 and the treatment of hopelessness and mental illness.4

Many patients are searching for hope. This can be found in a therapeutic relationship that is genuinely caring and respects the value of a person’s life, not only at the end of life, but also in conditions like depression and dementia. How can we as a society and a medical profession prevent suicide on the one hand and promote it with the other?

Conscientious doctors who do not want to betray their moral obligation to first do no harm nor to kill should not be complicit with the act of euthanasia by referring for it. Jurisdictions where euthanasia and assisted suicide are legal have acknowledged and respected the rights of doctors to act according to their consciences. Patients may transfer their files to another physician whom they have designated to carry out their wishes. As evidenced by legislation in Oregon, Washington, Vermont, Luxembourg, Belgium and The Netherlands, however, no legal obligation exists for a physician to perform euthanasia or to refer the patient to another physician. Patients cannot demand euthanasia.

Faced with the spectre of forced participation in euthanasia and assisted suicide, Canada should enact similar legislation. Although this may result in travelling death clinics,5 the integrity of medicine could be preserved if we permit physicians the option to act ethically and first do no harm.