When My Doctor Offered to Help Me Take My Life
January 24, 2023
When my throat cancer returned, I met with my surgeon, expecting him to outline a plan to cut the tumour out of my throat. It’s a risky procedure, but I felt brave. The universe laughed:
“You thought: ‘I am prepared for the worst.’ Such self-flattery.”
Here is the gist of my conversation with the surgeon:
Surgeon: “I’ll review your options. First, there is palliative care.”
Me, silently: <What? Palliative care is intended to comfort the patient but not to cure her. Why are we talking about this?>
Surgeon: “Second, there is medical assistance in dying.” (The acronym is MAID.)
I was derailed until I grasped that he had offered to help me take my own life. Then,
Me: “That’s not an option for religious reasons.”
Surgeon, kindly: “I understand. I mentioned these options first because we do not have much to offer regarding treatment.” He added that I had “months, not years” to live.
Eighteen months later, I’ve outlived this prognosis. But I still have cancer, and I am still thinking about why my doctor offered to help me take my own life.
I’m a medical school professor; I knew that the Canadian Supreme Court had legalized physician-assisted suicide. I’d thought through arguments for and against this. The universe laughed again,
“You thought that was an academic question, didn’t you?”
It’s no surprise that many cancer patients want to die. Suicide is twice as frequent among cancer patients than among the general population and three times as common for throat cancer patients. I wake each morning stunned by the pain, knowing that pain might end only when I do. Knowing that my health may only get worse and that my physical world may, in time, be just a hospital bed. Two of my friends developed cancer but died by suicide. I get it.
In Evangelium vitae (The Gospel of Life, 1995), John Paul II criticized medical euthanasia as part of a secular “culture of death.” There’s something to this, but the problem is not that my surgeon had a disordered character or motivations.
What were his intentions? I can’t know. And when we don’t know, we should charitably attribute good intentions to others. I think my surgeon believed that my health would irreversibly decline. He knew far better than I how much suffering I might go through in my last months. And he wanted me to know that I could check out if I did not want to endure that. He offered this without pressure.
My doctor did not harm me by offering to help me die by suicide: he treated me respectfully. We had previously decided together whether my first round of treatment should be radiation or radiation and chemotherapy. He gave me the options and facts; I made the choice that fit my values. Now, looking at the end of life, he wanted to provide me with the best advice he could, leaving it to me to determine which course of events I preferred.
As if he were helping me decide whether to put my savings in stocks or bonds.
That’s what troubles me about my surgeon’s offer of MAID. I don’t think that suicide ought to be normalized as a standard treatment option for the end of life. It shouldn’t be offered as something you can choose because you think it would be best for you given your grievous and irremediable illness. Here are two of several reasons.
First, Canadian law doesn’t allow this. The law requires three things. I must have a severe illness, disease, or disability. Check. I must be on a decline that cannot be reversed. Well, the surgeon and I believed that at the time. Finally, I must be experiencing unbearable suffering that cannot be relieved in a manner I consider acceptable. The last criterion excludes me from MAID: my suffering is bearable, and I never said it wasn’t. And notice that this criterion sets MAID apart from other medical choices. It’s – ha ha – a last resort. Moreover, the law doesn’t permit it just because it’s what you think is best for you. It says that you can have it because your situation is unbearable and there are, by your lights, no alternatives.
Second, there is a slippery slope here toward normalizing suicide at the end of life. MAID now accounts for 3.5% of Canadian deaths, and the proportion is growing. When Canada legalized MAID, we were assured that no one would get MAID because they could not get mental health or palliative care. This promise was empty then and remains so today. MAID is a drug treatment, inexpensive and easy to deliver. Effective palliative and mental health treatments require skill, time, and resources. Healthcare systems move, over time, towards what’s efficient. Left to itself, the system will, as if pulled by gravity, move toward suicide instead of healing.
I don’t want to relitigate the Supreme Court’s decision. I don’t have that competence, and I want to live in a society where people of good will can hold different views. But the increase in MAID in Canada is a crisis. It has revealed an ocean of despair among those at the end of life. Our first concern should be better care for those marginalized by illness, age, and social isolation. Compassion and justice require that we work to provide universal access to good palliative and mental health care. Resisting a culture of death will not build a culture of life.
I could not disagree with you more viscerally on ANY of the points you make. I too, teach physicians and in my view, self-determined end of life is the most comforting, compassionate thing a physician can offer.
Offering this option BEFORE someone is in extremis gives them time to think. It offers people a parachute in the event their suffering becomes overwhelming. Indeed, it gives them the COURAGE to live whatever days they have left, without cowering in fear of what is yet to come. And, NO cleric should weigh in on such matters until he/she themself is terminally ill and in pain. Then and only then, they may speak.
How many suffering patients/friends/family members have you watched BEG to be relieved of life so that their suffering will stop? How many? Self-determined end of suffering is NOT ‘a culture of death’? This is a culture of compassion!
“I will walk by your side until you can not continue. Then, I will carry you." We’ve all heard that trope, but it has manifestations other than the "footprints in the sand image". Relief of unremitting suffering is one of them. For some, it is the ultimate gift of compassion.
Hi Bill! I am grateful for your thought-provoking and well-presented piece around MAID and appreciate the way you explored the issues from both a personal and professional perspective.
I currently work as part of a Palliative Care team for Alberta Health Services serving the north zone of Alberta. I was the first mental health therapist to be added to the team which is comprised of physicians, nurse practitioners (some of whom are MAID assessors), nurses, clinical nurse educators, social work, occupational and recreational therapy, and spiritual health consulting. We have also recently hired a second mental health therapist. I shared your article and presented on it in our teams rounds today and a lively discussion ensued. Many people expressed their gratitude for your piece, and I wanted to pass that along to you! Additionally, I hoped it might be of some encouragement or nice for you to hear that in our small rural part of the country our team is doing what we can to care for our patients (and their families) mental and spiritual health alongside efforts to care for their physical comfort and provide quality of life as they face life-limiting illness.
One final thought I felt was worth noting, our team has seen many clients who have reversed their decision to move forward with MAID and passed away peacefully on their own (both in home and hospital) when we have been able to adequately address their physical symptoms and pain, alongside providing meaningful activity and legacy work, supporting their physical functioning to be able to carry out (often in modified ways) activities that are important to them, practical and financial concerns, as well as mental and spiritual health issues. For us, these things combine to form the basis of effective palliative care, something which should be available to all.
I pray God will bless you richly in the coming days as you continue to endeavour to find hope and joy in your current circumstances as well as continue your research and professional work!