In mid-May, my son Andrew Helt graduated as a medical doctor in Canada. He is moving on now, with the goal of becoming a critical-care physician, working with the sickest patients in the most crucial minutes of their lives. Many of his patients will die. Many will also live. Some may wish they had died.
The keynote speaker at Andrew’s graduation ceremony was a seasoned physician who spoke on the topic of assisted dying. He spoke of a colleague who was faced with the choice to assist in a death, and agreed, thinking he was prepared for the emotional/spiritual/intellectual fallout. He was, we heard, until the final moment. And, while he went through with his patient’s wish, he has struggled ever since. The ethical and sometimes spiritual dilemma of assisted dying is the ultimate question for physicians – is killing my patient actually helping my patient? Does “do no harm” mean “preserve life,” or can it mean end life?
Let’s look deeper. The covenant to which all doctors are ethically bound is the Hippocratic Oath. Almost every doctor takes the Oath – a most ancient text that can be traced to the late Fifth Century BC. There is one line within the modernized Hippocratic Oath that might specifically address assisted dying: it states that a doctor “must tread carefully in matters of life and death” and must, “above all . . . not play at God.” By itself, this tenet seems to make it clear enough. A doctor’s responsibility should stop short of ending a patient’s life, if life is considered God-given. And, in the original Greek text, there is a line: “I will abstain from all intentional wrong-doing and harm.”
There is, also, however, a contextual understanding of the Oath that might help physicians manage their thoughts around assisted-dying legislation.
One of the tenets of the Oath states that “warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” In another, the doctor is reminded she treats a human being whose sickness may include related problems: “My responsibility includes these related problems, if I am to care adequately for the sick,” the Oath states. “Related problems” might certainly include quality of life, which is often the precipitating factor in a patient’s decision to request assistance in dying.
Apart from that, there is the question of whether assisted dying is, indeed, “doing harm” at all.
The speaker at my son’s graduation went even further. He said that the modern physician is trained – and therefore expected – to alleviate suffering. All treatment and, indeed, the tenets of the Hippocratic Oath, in context, are encompassed by the over-reaching goal to alleviate suffering, he said. If this is so, perhaps then, assisted dying becomes possible.
Either way, it is clear the the ethical dilemmas faced by today’s doctors run deep. With the legislation waiting in the wings, there is little option but for physicians to consider these new realities carefully, to be prepared for their eventuality, and to consider the ramifications of them on their own personal beliefs and values.
And, if all else fails, perhaps the medical profession – or perhaps another profession altogether without the ethical ties to “do no harm” – will designate an auxiliary health care professional as one to whom patients may look for assistance in dying.