A Letter to MP Rick Dykstra: In response to Steven Fletcher's News Conference

-Dr. Wes Reimer

Rick,

I happened to catch Mr. Fletcher's news conference today and what I want to pick up on most is his comment that we, as physicians, are basically practicing covert, physician-assisted suicide (PAS) via his "wink wink..." statement.  As a practicing physician in this country and one who deals daily with late stage disease and palliative care, I find Mr. Fletcher's comments misleading of the public, and offensive.

Hearing him speak to this issue today, one would almost think it's flatly illegal to die in Canada!!  It's neither unlawful to live nor to die.  And myself and countless colleagues have the remarkable duty and privilege to care for the dying in a manner that respects their wishes and acknowledges their condition.  

Credits: REUTERS/Chris Wattie

In just the same way that a patient (or their representative) can, at any time, elect to decline any procedure or intervention - even if potentially life saving - the patient also currently has the right to decline any degree of 'medical' management.  At the obvious end stage of illness, many many patients and families decide, in concert w caring physicians, to withdraw all active treatments (eg. feeding tubes, IVs, countless maintenance meds., oxygen etc).  This is not now, nor should it ever be illegal. Some remain in hospital at that point while others prefer a Hospice setting.  The point is, nobody is killing anyone in these everyday scenarios.  Invariably, late stage diseases of all etiologies lead to anorexia and minimal nutrient intake - no winks, no nudges - just the natural, anticipatable sunset of life.  The universal consequence of kidneys and other vital systems shutting down.  "Starvation" would be denying the hungry/thirsty patient proper nutrition when they in fact want it.  That is NOT what we do!  

Now to the use of morphine and related medicines in palliative care.  For centuries, narcotics have been an essential part of compassionate, respectful palliative care.  I thank God for morphine and it's many modern 'cousins' in the realm of controlled substances used appropriately across this country for excellent palliative care every day.  Any increase in rate of such a drug is done because of the often profound escalation of pain in the final days of cancer and other diseases.  Again, no nudging, no winking, and definitely no suicide.  Just good, professional palliative care.  While treating the pain, might the needed dose ever hasten one's passing?  It's certainly possible, but not intentional.  In cases where that has been true, it doesn't change the fact that treating the pain appropriately was the right and compassionate thing to do, in precisely the same way that one may die during necessary heart or limb surgery.  In each case, appropriate, patient-centred care is the intentional act while anticipatable death not infrequently occurs.

Death is an unavoidable, inevitable and entirely natural part of life, and one where physicians, nurses and care givers of all sorts can play a crucial, compassionate role in guiding patients through the process.  Please advocate for the truth on this issue.  That there is no clandestine death club among physicians.   For my part, one of the best things that could arise from the recent resurgence of interest in PAS, is that more funding and emphasis be directed to excellence in palliative care in this country.  As we support and empower caregivers in this art (and it is that), I believe we'll find that the perceived need for and volume of cases relevant to PAS will diminish.

As a conscientious professional in the life science of medicine, I don't ever want to see the day when I and my colleagues are forced by the state to take the life of any patient.  Thank you for receiving this and I trust you can advocate to that end.

Sincerely,
Dr. Wes Reimer
MSc, MD, FCFP