It is hard to believe, but it has been 50 years since I graduated from medical school.
In the intervening half century of looking after patients, I have encountered every imaginable end-of-life issue.
From one end of the spectrum, where people refused to accept that they were going to die, and not only expected but demanded that either the Creator or the medical profession prevent that.
To the other, where people demanded that I put them out of their suffering.
Now that the courts are asked once again to determine if a helpless, terminally ill patient can commit suicide with the help of another person without incriminating the assistant, it is a point of renewed, vigorous discussion among many colleagues, lawyers, religious leaders and the general public.
There is really nothing new about the controversy or the practice of euthanasia or suicide, assisted or not. The only new aspect is the question of when to stop treatment on account of our newly developed abilities to prolong the dying process for a very long time.
In the ancient Greek and Roman classical period, euthanasia was generally equated with suicide when “a worthy and good life” was no longer possible due to illness or extensive physical decline. Suicide was only criticized if it was irrational or without cause.
That changed in the second and third centuries AD under the influence of Christianity, where suicide was seen as a direct defiance of God’s will. People were made to believe that “life and its sufferings are divinely ordained by God and must be borne accordingly” (St. Augustine).
In the 13th Century, St. Thomas Aquinas was of the opinion that suicide violated the biblical commandment against killing and was the most dangerous of sins, because it precluded an opportunity for repentance.
Scientific and medical discoveries in more recent times have upset the religious teachings of divinely ordained suffering. Physicians can treat and extend life to a degree unimaginable a century ago and the current discourse is once again focused on the quality of life and on the right of the individual to determine when this quality had deteriorated to the point where it is acceptable to cease living, just like the Greeks and Romans discussed some 2,000 years ago.
Most older and experienced doctors can reflect on the understanding gained from the many occasions that we had to deal with patients who were going to die from very different causes and under very different circumstances, and these physicians, therefore, are in a better position to have a more valid and reasoned opinion of what is appropriate than someone who is guided by purely legal theory, religious dogma or raw emotion.
With current medical technology, we can prolong life, independent of considerations about the quality of that life. Questions like when to turn off the respirator, or when to withhold potentially life-sustaining interventions or medications when the patient can no longer consent or refuse treatment are difficult to answer when the law and, specifically, the criminal code are threatening to put us in jail for 14 years if we do not adhere correctly to the many conflicting guidelines.
The courts have struggled to interpret the existing, antiquated laws in such a way that if a person is charged and convicted, most of the time citizens and, specifically, physicians receive judgments and sentences that take into consideration the vastly changed societal capabilities and expectations.
Sadly, too much is left in the hands of the personal views of the judges and juries to always render a fair and just outcome. Time and again, there has been a plea for Parliament to review and change the laws in keeping with the wishes of the majority of Canadians who want to give active consideration to the limits they will place on their own medical treatment and that of their loved ones.
So far, any attempts to do that have died on the order paper.
Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.
