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

Our Impetus in the Euthanasia Debate

-Lester Liao

Over the past few weeks I have been thinking a lot about the discussion on euthanasia and physician assisted suicide (PAS/E). The topic is so controversial in our society because of the many things that are misunderstood. People have a poor appreciation for what palliative medicine is actually able to do throughout the late-stage disease process, people are swayed by the use of emotionally charged language that paints euthanasia/PAS in a positive light (not unlike using the term “therapeutic” abortion), people misunderstand the whole notion of what a “right” is, and people fundamentally have a flawed grasp on what human life is, both ontologically and practically. This is of course, just a brief sketch of issues I have encountered with colleagues. I am sure that many of us have heard so many other reasons. So what should we do? 

This morning in my daily reading I was reminded of God’s Word through Micah as he addressed Israel, saying, “He has told you, O man, what is good; and what does the LORD require of you but to do justice, and to love kindness, and to walk humbly with your God?” (Micah 6:8). The Israelites were living arrogantly in a time of wealth during the reigns of the Judean kings Jotham, Ahaz, and Hezekiah (1:1). They oppressed the poor (2:1-2), they sought preaching that would only suit their ears (2:6; 3:11), and they offered meaningless sacrifices to God that were empty rituals in light of their wider actions (6:6-7). In response to all these things, God reminded them what His desire for them had truly been – to do justice and love kindness and walk with Him. 

And yet before God calls them to these actions, He reminds them of their identity and what He had done for them. In 6:3 God rhetorically asks the Israelites, “O my people, what have I done to you? How have I wearied you? Answer me!” In contrast to harming them, He had actually brought them out of Egypt and redeemed them from slavery and saved them from oppressors (6:4-5). He called them to remember who they were as God’s covenantal people and reminded them of what He had done for them. It was only after they recognized this that they would have had the heart to go out and do justice and love kindness. And so it is with us. 

CMDS has been making many efforts to be vocal against euthanasia/PAS. This is a great thing. It is great because it is in the heart of God that we stand for those who are unable to protect themselves and who are being oppressed. God’s call to the Israelites is something we must remember. We must remember who we are as the adopted children of God (consider the National Conference this year from May 1-4!) and remember all that Christ has accomplished for us. For if we forget who we are, we will act without a foundation, forget why we even strive, and grow weary and discouraged. It is when we recognize our identity that we can then begin to organically act out of our nature, namely to love and care for others. 

This is what we should do. Engage colleagues and be vocal. Voice your stance on CMA forums. Do not let this debate go by without standing for justice and kindness to those who are in need of advocacy. For Christ took the initiative to save us in our helpless condition. 

If we find ourselves with little desire to engage in this wider discussion, let us consider our identities and remember who we are in Christ. For we are in a unique position to make contributions to this topic. And while I do not want to confound the fundamentals of being a Christian with being vocal about opposition to euthanasia/PAS, I do believe that when we recognize that God has appointed us to be physicians in Canada, our hearts will begin to stir. As we return to the awesome truth that is the Gospel, let’s pray that we’ll be empowered by the Holy Spirit to let our actions flow from our identity so that we may be light in this world. 

CMDS Executive Director on CBC Radio

-Jennifer Derwey

Listen to CMDS Executive Director, Larry Worthen, point out the risks of legalizing euthanasia in Canada here on CBC's Information Morning, Nova Scotia.

Don't forget to email your comments and questions on this debate during tomorrow's public forum to saintandrews@eastlink.ca.

Upcoming Event: Public Forum on Euthanasia

-Jennifer Derwey

Values and Vision: Is Doctor Assisted Suicide a Right?
MARCH 21 @ 7:00 PM, Halifax, NS

Values and Vision: Is Doctor Assisted Suicide a Right? – A public forum on end of life issues, co-sponsored by the Halifax Shambhala Centre, The Universalist Unitarian Church of Halifax, St. John’s United Church and St. Andrew’s United Church, will be held at St. Andrew’s United Church (Corner of Robie St. and Coburg Rd.) on Friday March 21st at 7pm. Halifax, NS. 

Wanda Morris, Executive Director of Dying with Dignity Canada will be joined by academics, advocates and religious leaders (representing a variety of points of view) for a panel discussion. 

The Christian Medical and Dental Society of Canada's Executive Director, Larry Worthen, will be participating in this event. He will also be interviewed on this topic on Thursday, March 20th on CBC's Information Morning Nova Scotia. You can listen live to that event here on Thursday morning.  

We urge all supporters of the dignity of life to attend. If you cannot attend in person, potential questions for the panelists can be emailed in advance to saintandrews@eastlink.ca

Medicine as Vocation

Medicine as Vocation: Q&A with Daniel Sulmasy

BY JOHN SHORB

How do you view vocation? 

Vocation, simply described, is a calling. It is God who calls us and calls us to be the person we have been created to be, to fulfill God’s plan for us. It is what we in our deepest most central part of ourselves, actually most desire. The match of those two is our vocation, one and the same when our will and God’s will are one for what we should do in life. Everybody in that sense has a vocation. 

There are particular kinds of occupations that are more particularly viewed as ministry. Those are the kinds of traditional ministries of being in the clergy, or being part of the liturgy, being in the choir, being a deacon within a church. But then there are also, at least within the Roman Catholic tradition, particular kinds of works that are classified officially as ministries and those works are what we call the “corporal works of mercy” which come from the list of Christ’s own discourse about where we find him. We find him, we’re told, when we visit the sick, when we clothe the naked, when we feed the hungry. Healthcare is one of those particular kinds of “corporal works of mercy” that is ministerial. When your call in life is to be a minister and your total work is doing that particular work, it is one of those special vocations–vocation with a capital “V”—that is every bit as equivalent to the vocation of being a minister.
From the beginning of recorded history, the roles of priest and doctor were unified, right? The shaman was the healer and certainly it has been significant in the history of Christianity that this work of being a healer has been seen as spiritual kind of work. There is something special about illness and death and those who minister to it and those who are able to heal. It is central to the Christian message, and it is part of the good news. It is part of what Christ announced, and it is part of what he sent the apostles out to do – to heal the sick and preach the good news.

(Full article available here: http://chreader.org/contentPage.aspx?resource_id=551)

URGENT: CMA to Begin Major Consultation on End of Life Care

-Larry Worthen, Executive Director CMDS

The CMA has started a major consultation with CMA members and the general public on end of life care. This includes euthanasia, advanced directives and palliative care. 

This is a signal that we are now in an all Canada debate over whether or not euthanasia should be legalized. The time has come to make our voices heard to protect human life. If we miss this chance it may be too late.  

We strongly recommend that all CMDS members participate in this process by:

If you are a member of the CMA: 

- logging in to https://cmadialogue.ca and registering to be part of the discussion - right away 
- continuing to participate in the discussion to make your views known throughout 
- attending the town halls and breakfast meetings scheduled by the CMA throughout the country for your input 

If you are not a member of the CMA:

- attending the town halls scheduled by the CMA throughout the country for your input 
- making your opinions known to the CMA via correspondence 

All of this input will be taken to the August 2014 meeting of the CMA. It is important that CMDS members get involved with the provincial associations in a formal capacity because only delegates will be able to speak and vote at the August meeting. 

Public meetings and breakfasts are scheduled throughout the country. 

Vancouver (March 24)
Whitehorse (April 16)
Regina (May 7)
Mississauga, Ont. (May 27)
Members in those areas should start now advising their church contacts, friends and family about the need to come out to these sessions. 

IT IS CRITICALLY IMPORTANT THAT WE ALL GET INVOLVED.  The experience of being in Quebec two weeks ago at Mc Gill was very disturbing. The proposed legislation requires that all physicians be involved by participating in referrals, and no institutions - hospitals, nursing homes or even hospices are exempt. Our members are concerned that it will be very difficult to practice in Quebec as a Christian physician. The can spread throughout Canada unless we act now to respond. 

Let's all pray together that this will NOT become legal in our country. 

God bless you 
Larry

Pulse Conference Feedback

-Lester Liao

Last week I attended the Pulse Conference for Christian medical professionals in Toronto.  While it was a short conference spanning Friday evening to Saturday evening, it was certainly an informative one.  The conference was focused on providing spiritual care to patients, considering briefly its merits on the health of patients both in the conventional medical sense and spiritually, and also how it is practically done.  A number of sessions were dedicated to considering what spiritual care is including how to share the Gospel, the ethical implications of such care, the biblical impetus behind such care, and also the effects that such care has on patients.  Following these an afternoon was then set aside to practically engage the community in an effort to practice at least broaching the topic of spiritual care. This was finally followed by a wrap-up session discussing the conference and practicum.

This was only the second time it has ever been run, and a few speakers came up from the United States to share their expertise on the subject.  That being said, the conference is still in its infant stages.  From what I could gather there were some thirty to forty people in attendance at the conference, and they were from various backgrounds including nurses, social workers, physiotherapists, and of course physicians/medical students.  This multidisciplinary involvement was a highlight for me personally, as I was sitting beside a physiotherapist for the conference and found it particularly gratifying to meet a Christian in another medical field seeking to faithfully minister in his setting.  

The conference was certainly an interesting one.  The best way I can characterize it is that it was a primer to spiritual care for Christians.  Given the limited duration of the conference and its young nature, it was difficult to delve very deeply into the subject and the teaching portions were somewhat limited in scope.  Personally I would have liked to see a deeper exploration of the Bible's direction on such matters.  What the conference did provide much of, on the other hand, was testimonials on the impact of spiritual care on patients.  There was also a very heavy emphasis on being practical with what we were learning both during the conference and immediately in the workplace.  These being said I think the conference is a great place for people to begin considering the true merits of spiritual care and to receive guidance on how to do it.  It is also a wonderful place to be encouraged by other believers and to gain an appreciation for the Christian medical community seeking to serve Him in the workplace at large.  It should be noted that things will likely change not insignificantly for the conference in the years ahead, but I would wholeheartedly recommend doctors and medical students to partake in the conference to improve their ability to holistically care for patients and to see Christ glorified in medicine.  May God continue to raise up workers in healthcare that love patients and care for their souls.