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Comment: Doctors should be prolonging life, not dying

Nov 17 2012

Anumber of letters and articles have been written recently on euthanasia and the right to die for the terminally ill.

Because all of us are mortal, we will at some point in our lives face "the crossing of the bar" of someone near and dear and eventually our own homeward passage. I thought the following experience might provide some guidance and comfort to those facing this difficult time.

In 1967, I was 21 and visiting my father who was a patient at Vancouver General Hospital. He had been flown from Edmonton, where he was dean of medicine at the University of Alberta, for emergency repair of a detached retina. His eyes were bandaged, and the possibility loomed that he might emerge from the procedure permanently blind. We made small talk about university and anything else other than the issue in the room.

Our conversation was interrupted by a young man in a white lab coat. He had been a student of my father a few years before and had a question of life and death to put before his mentor.

An elderly man had been brought in suffering from a heart attack. The young doctor had stabilized him, but feared another heart attack was imminent and wanted to know what to do. In the emerging age of medical marvels, people were coming to believe that science could forestall the inevitable, and the families were clamouring for every available procedure to be done to prolong the lives of their loved ones.

My father asked a few simple questions: How old was the patient, what was his general health, what was his prognosis for recovery, did he have family or other social support to care for him and, lastly, what would his quality of life be if extraordinary measures were taken to save his life?

The answers were not hopeful. Besides his age, the man had lived a hard life and had chronic health problems besides his heart. He lived alone with no family, and would probably die alone.

My father's advice was that if the man had another heart attack, the staff should let him slip away. In the meantime, everything should be done to keep him comfortable and out of pain.

After our visitor left, my father asked me what I was thinking. Did I find his advice too harsh?

I said I had never been confronted with the question, and at my age was not much acquainted with death, so I really didn't know how to react.

My father then gave me a most valuable lesson on his philosophy of life and death and the role of medicine. In a nutshell:

First, all people are born with dignity and should be allowed to die with dignity.

Second, the duty of the physician was to cure the sick and relieve suffering.

Third, the duty of the physician was to prolong life, not to prolong death.

Too often, he said, young doctors get caught up in the mechanics of medicine and lose sight of its human ends. Some even saw a dying patient as being in some way a failure of the medical profession, rather than part of the natural ebb and flow of life, and that this fear of failure would sometimes cause them to abandon a patient in their hour of greatest need.

We had reason to return to this subject on several subsequent occasions as close friends and family came to the ends of their lives. Dad would talk of the differences between "ordinary" and "extraordinary" procedures, and what, when, and why each was appropriate based on his first principles.

As dean of medicine (Alberta Health Services' Walter C. Mackenzie Health Sciences Centre was later named in his honour), Dad at times was asked to speak publicly about his views on government-sanctioned "euthanasia" and his opposition to it. So when he lay dying of cancer some years later, I knew that there would be no heroics and that he would not die in pain. Near the end, he was put on a morphine drip and slowly drifted into a coma and death.

In ethics, this seeming act of euthanasia is referred to as the "principle of double effect." The physician has at the end of life the duty to relieve suffering and not prolong death. The doctor knows that the morphine will accomplish the first. The doctor also knows that the patient will in all probability die of morphine poisoning rather than from the disease or injury. However, since the primary goal was to relieve suffering, and death collateral to the treatment but not the intent, the doctor has remained true to his or her Hippocratic oath to "do no harm."

Richard Mackenzie is a Saanich resident.

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