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Med student 'distressed' by assisted suicide decisions

By  Alexandra Majerski, Guest Columnist
  • March 22, 2018

I am a second-year medical student at the University of Toronto. Next year, my peers and I will embark on a series of rigorous and demanding clinical rotations, shortly after which we will decide which area of medicine we will pursue in our professional lives. Conversations about the future abound. 

However, recent court rulings involving doctors’ conscience rights have thrown a new light on these conversations. And it has left me feeling distressed and bitter. 

Job satisfaction, length of training, residency program competitiveness and work-life balance are concerns central to conversations with some of my peers. With others, though, the question when trying to choose a medical speciality for post-graduate training becomes: is it safe? 

This question has taken on greater significance following the recent ruling of the Superior Court of Ontario that compels physicians to provide an effective referral for physician-assisted suicide. The court made this ruling despite acknowledging that it infringes the religious freedom of physicians. 

We’ve been warned by the College of Physicians and Surgeons of Ontario (CPSO) and others that conscientiously objecting physicians should leave family medicine, palliative care and other specialties, and move to a small number of specialties such as pathology or cosmetic medicine. This is not a warning easily overlooked by those at the very beginning of their medical careers. 

To add insult to injury, the possibility of expanding the current physician-assisted suicide legislation is currently being investigated. The legislation could grow, as it has in other jurisdictions, to include individuals suffering strictly from mental illness and mature minors, and to allow advance requests for physician-assisted suicide. Specialties such as paediatrics and psychiatry appear vulnerable as well. 

My expectations for what a career in medicine would entail were formed as I was pursuing my undergraduate degree at the University of Toronto in cell and systems biology, physiology and immunology. Although my core studies provided a solid foundation in the science of medicine, I sought an introduction to the art of medicine by taking additional courses that explore the history of the profession. I came to understand that the role of the physician was consistent with an ethical framework deeply rooted in Hippocratic tradition. 

But in the time since our class recited a modified and  watered-down version of the Hippocratic Oath during our orientation activities, I have come to wonder if we have broken away from this tradition. And in breaking away, what instead have we latched on to, if anything? 

Those of us who wish to practise medicine in a way that is consistent with the Hippocratic tradition find that the moral philosophy that guided our decision to pursue medicine is being uprooted from under us. I continue to believe that starting a patient on the journey towards his or her own suicide constitutes a grave harm. I felt exactly this way when I had my first clinical encounter with a suicidal individual earlier this year. 

In two 45-minute interviews, we spoke at length about this patient’s challenging home life, unstable work, social life, difficult relationship and how these factors led him to attempt suicide twice within a month. All I could do was listen attentively, speak occasionally and be truly present with this vulnerable, thoughtful and sensitive young man. 

Upon reflection, I simply cannot imagine how this conversation would have gone were I legally obligated to take his suicidal intent as not a cry for help, but as a legitimate request for help to end his life. 

Clearly, the moral tide in medicine has turned. Regulatory bodies are instigating changes that have already forced and will continue to force dissenting physicians to re-locate their practice or retire early. What sort of message does this send to young physicians and medical trainees who share similar moral convictions? 

As I continue my own process of discernment, I am reminded of the words in Deuteronomy 3:16: “Be strong and courageous. Do not be afraid or terrified because of them, for the Lord your God goes with you; He will never leave you nor forsake you.” 

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