"The Vocation of Medicine: Considering History, Theology, and Sociology"

From Lester Liao at the CMAJ Student Humanities Blog,

When we enter medicine solely for personal fulfillment, everything becomes a means to that end. Patients are welcome insofar as we can bill for them or insofar as they present us with cases that can further our academic careers. But when we are not paid more for dealing carefully with patients’ concerns, they become a nuisance. We usher them out because their questions do not benefit us. Unless some prestigious publication is attached to our caregiving, these patients are not worth our time. It upsets me to consider friends who have been poorly treated by the “best” or “most prestigious” physicians in a field. We do not see them as people in need of help, nor do we see ourselves as public servants. We see patients as secondary, or even as obstacles to our primary goals. If we think like this, we will be uncaring doctors. 

(Read the full article here: http://cmajblogs.com/the-vocation-of-medicine-considering-history-theology-and-sociology/)

Upcoming Event: May 23, 2014

23rd of May

Student Lunch with Larry Worthen CMDS Executive Director
Western University

On Friday, May 24th Larry Worthen, CMDS Executive Director will be having lunch with students and Munjula Saito, CMDS Associate Staff at the Wave (2nd floor UCC building) at Western University. (11:30 - 11:45 start) After lunch all are welcome to come and hear Larry's talk at Brescia College at 13:30
"Is there a role for Christianity in the Euthanasia Debate?"

Dr. Bryan Dias who is the President of the Canadian Federation of Catholic Physicians Societies (CFCPS) has offered a warm welcome to any students who would like to come hear Larry's talk.

Larry is in town to give his talk and participate in the 6th annual national conference for the CFCPS.

Everyone is welcome!

The #CMDS2014 National Conference Experience

-by Lester Liao

This weekend I attended the National Conference for CMDS.  It was amazing.

Despite the low attendance of students/residents (less than 10), the experience was incredible.  What a wonderful opportunity it was to meet other physicians that have been in the practice of serving Christ in medicine for decades!  What wisdom there was to be distilled from brilliant minds!  What fun it was to praise Jesus and learn together!

I must say this was one of the best, if not best, conference I have ever attended. A large part of this is likely because it was my first real exposure to the CMDS community at large. Our student CMDS chapter in Windsor is small, and there is only one full-fledged CMDS physician actively involved with us.  Yet at this conference there were so many people to meet.  My vision for the work and influence of Christian physicians in CMDS grew exponentially.  It was massively encouraging.  For the first time I met Dr. John Patrick, who blew my mind away (and my fellow Windsor student’s) after just a few minutes of conversation with his sharp insights and apologetic method.  I attended seminars that were both educational and spiritually enriching, addressing issues that have never been brought up in medical school.  The PAS/euthanasia presentation was poignant and eye-opening, and has compelled me to share this message with local churches and colleagues.  I had numerous extended conversations (some over two hours!) wise people that really challenged my thinking and simultaneously built me up – all outside of the formal schedule. And the list continues.  I quite distinctly recall the feeling of my head swelling over the weekend because of everything I was taking in. I have never been at a conference like this one.

What I learned also encouraged me in practical engagement in my setting. Just the day after the conference ended I was able to talk to one of my preceptors about euthanasia/PAS with some of what I had learned, only to find out he is an influential policy maker at the hospital!  This very morning I spoke with colleagues in small group about the need for us to consider why we do medicine and not simply how we do it – and some very good discussion ensued.  By the end of the conversation one colleague even admitted to the fear of what her own thoughts would lead to practically, and she then desired to change her stance.

What a blessing it is to be part of this organization. It is my prayer that more students would become involved at a level beyond the student level. The mutual encouragement of different generations kindles fire for Christ in our souls. CMDS is a wonderful place where we can help one another in our respective fields and spur one another on to love and good works. Let’s hope that more students and residents can get connected with the community at large so that we can learn from one another, come together, and magnify Christ in healthcare.  

"My thoughts on Euthanasia"

-by DENNIS W. BOETTGER MD

My thoughts on Euthanasia, (aka end of life care)

The Governmental regulation of trust-based institutions (banks, credit unions etc.) creates an environment that engenders trust in the institution. We deposit monies and expect accurate accounting, access and protection of the assets we grant to the bank in safekeeping.

Medical care is based on trust.  A patient engages a physician to provide expert opinion, and upon the patient’s authorization in trust, the physician is allowed the authority to provide ongoing advice and recommended management of the life entrusted to the physician.

The physician is accountable to administer best practices, and failure to do that is considered a breech of trust, and if harm can be proven, then the practitioner is held accountable.

This principle is one of the most foundational principles of the practice of medicine.

Life itself, is entrusted to us. It is granted to the infant. Passed on from the parent, this life is life that was received from the grand-parents.

We are taught to steward our life well, because it is granted to us for a season, and then we must release it.

I contend that DNA is an elegant accounting system of the stewardship of life. In DNA is traceable the lineage, and is a stewardship record of the life granted in the transfer of DNA.

Do we “own” the life that we individually carry for a season? We certainly have authority to direct our own life, to a limited extent. If we direct our life in such a way as that it brings harm to others, our freedom to direct our life may be removed from us. This is what happens when prison accommodation is imposed upon a person for a punishable breach of trust.

Ownership implies entitlement to recall the asset. Life is not like that. When it is released, life cannot be recalled.

When money is withdrawn by recall from the bank, the bank is no longer responsible for the accounting of it.

If by a change of laws, the physician becomes authorized to remove, rather than to protect, treasure and support life, even at the request of the patient, then a fundamental change has occurred in the relationship of the patient to the physician and vice versa.

The erosion of trust would have as profound an impact on the environment of medicine, as deforestation is in the physical world.  It would be like the effect on the financial world of passing a law prohibiting locks on banks.

Legally giving physicians the right to terminate life , no— also imparting the obligation to consider the request of the patient to end his life, (and if in moral disagreement—the obligation to refer the patient to an assessment committee who would determine the appropriateness and the capability of the patient to make “informed consent”) would completely destroy trust.  It could save the government a lot of money.

Such a committee could not be populated other than by persons who agreed that it is acceptable to consider the termination of life as a therapeutic act. Committee members would insist on immunity from responsibility if endorsing the patient’s ‘right” to termination.

Given a change of law, this will become argued as an issue to be determined between the patient and the doctor. Where have we heard that before?

Will this be an unpaid committee? So . . .  someone will be paid to decide whether and when to end another person’s life?  Is this the direction we want to go?

Perhaps we should ask the public,  ‘what would you think, if you saw a sign in a physicians office, declaring something like this:

We endorse choice of the patient,

and we endorse the practice of compassionate

euthanasia with proper documentation.

We can assist you with everything.

This is a government approved

and licensed medical practice.

This is a non-insured service,

the cost is $ _______   plus

(Your life with no recall).

No money? No problem.

We will do it for free but

We will charge your estate.

Your children will pay. . .”

For more information, just ask. . .

Fast-forward—to Circa 2099; “Do you recall a time when it was a felony for a child to pay for someone to terminate a parent so they could get the inheritance?”  

That which we sow, we will reap.

D. Boettger MD

Will physicians be left out of the debate?

-Jennifer Derwey

An article in the Canadian Medical Association Journal warns that physicians "could soon be left in the legal vacuum" with regard to the practice of euthanasia. CMDS is dedicate to giving doctors and dentists a voice in this debate. 

Find out more on how you can be a leading voice on this topic by visiting our educational project website for the CMDS film, The Gift: Living Fully, Dying Naturally, here. 

More from the Ottawa Citizen,

...physicians could soon be left in a legal vacuum if the Supreme Court of Canada rules later this year that laws banning doctor-assisted suicide violate the Canadian Charter of Rights and Freedoms, experts argue in the Canadian Medical Association Journal (CMAJ).

Polls show that support for assisted death is high and growing, said Dr. James Downar, an assistant professor in the division of critical care and palliative care medicine at the University of Toronto.

“The ‘yes-no’ debate is about to become obsolete,” Downar said.

“Physician-assisted death (which covers both physician-assisted suicide involving giving patients a lethal prescription they take themselves, and euthanasia involving administering a lethal injection to the patient) is going to become legal in Canada in the very near future by one means or another” and crucial questions need to be answered, he said, including when does suffering become “intolerable” and how long must it last before doctor-assisted death could be granted? Would psychological or “existential” angst be grounds for seeking a lethal injection?

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.