One day this week, I had a bad day. Much of what happened can really not be spoken about at all. Actually because of psychiatric terminology, some of it would be incomprehensible to anyone but other psychiatrists. That was one worry. The other worry was more ethical and moral. Because of that, it may only have been a worry to me, because we all have different morals and ethics.

Every doctor does have bad days with just such dilemmas. In fact, every professional group has these same dilemmas, dilemmas that cannot be discussed easily with our usual confidantes because of technical complexity or confidentiality.

The issue of physician assisted dying is the kind of dilemma that can cause bad days, exactly because it poses questions that have different correct answers depending on your perspective. So many people are wrestling with the consideration of physician assisted dying at present – patients and their advocates, doctors, nurses, politicians, journalists, faith groups – both for and against, jurists – the interest is great.

When all is said and done, however, the final decisions and actions regarding physician assisted dying are going to be down to the patient and the doctor.

A number of physicians are going to be morally and ethically opposed to assisting in a patient’s death. They will have to face the dilemma that the law will require them to refer that patient to a physician with very different values than their own – not better, not worse, just different. A number of them will break the law. Another group will not, again for reasons that are too difficult to dissect.

Other physicians’ values will put patients’ needs at all times above their own concerns. They will fully support their patient in seeking physician-assisted death, although they may not ever consider performing that act themselves.

Some patients, in great pain, with a terminal illness will never consider physician assisted death, even though they might wish to die, because their values prohibit such action. Others might, but know their families could not bear this decision. Other patients with a terminal condition, realizing that their families are under undue financial stress because of their illness, might seek physician-assisted death as a solution to that dilemma. These are personal choices. None of them is necessarily wrong to the person making the decision.

The variations of this dilemma that I have described are not the only variations that are going to arise. I raise these to demonstrate the complexity of the issue and the variety of issues that patients and their doctors will have to face. They will have a hard enough time working together without the commentary and judgment of all the other interests around them.

Medicine today espouses a team-based model but there are many situations just like physician assisted death in which the team fades into the background. The decisions are now left to two principals: patient and doctor. Google “Medical Team Assisted Death” or “Nurse assisted death”. When you google the latter, you get to “The Nurse’s Role in Physician Assisted Death”. That seems to be as close as the team gets, and, of course, the nurse is the only other health professional to enter the scenario, in a supporting role. Who else comes to a patient’s or a doctor’s aid other than a nurse?

My goal in writing this has been to show that, as much as families, politicians, journalists and faith groups may have opinions about these medical decisions, in the end, the final decisions will be left to patients and their doctors, with nurses providing support. Society has decided on physician assisted death. This will mean that some days, a doctor will be making a choice that someone will disagree with. They may even disagree with the decision themselves to provide their patient with the care they require. These choices cause bad days.

“Who has choices need not choose, we must who have none…” Peter S. Beagle

3 thoughts on “A Bad Day

  1. Gail…. most of us have not yet grappled with the reality of what we will do when we are faced with this decision for the first time. We have to work through our own issues case by case by case and then come to a conclusion every time. This will happen over and over again because every situation will be different. The only way through the learning and decision making process, in my mind, is with a place to share. We (physicians) need a place or space to talk to each other about the details of individual cases, to help guide us through the process of making a decision, and in some cases where these patients have been our friends for many, many years, even grieving. How do we make this happen??
    Thanks for the thought provoking post!

    1. drgailbeck says:

      On twitter, Dr. Brasch, a Psychiatrist from Hamilton, mentioned that she is giving a talk on April 6 on what we can learn about Physician Assisted Death from suicide prevention. It’s being broadcast on OTN – it sounds like an unusual way to help us think about this.

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