Special to The B.C. Catholic
When doctor-assisted suicide became legal in Canada in 2016 many physicians found themselves forced to decide how they felt. For Doctor Nicola Walton-Knight it was not the first time she had to reflect on the issue, but it was the first time she had to make a decision that would affect her medical practice.
After taking part in a panel discussion about physician-assisted suicide hosted by the Jewish Christian Dialogue of Vancouver April 10, Dr. Walton-Knight told The B.C. Catholic, “When I was going through medical school in the U.K. it was an ethical question we debated due to the legalization of it in European countries.”
Only when doctor-assisted suicide became legal
in Canada did she have to decide, “will I agree to become part of this, or will
For Dr. Walton-Knight that meant looking at the issue through the eyes of her Christian faith – she is Presbyterian and serves as a leader in her church.
“I believe that God gives life and that he desires his people here on earth to give life to each other as they live, and that they do that by following God’s commandments and by being selfless in thought, word and deed. Therefore, when I consider MAID (medical assistance in dying) I consider it in light of my Christian belief,” she said.
In examining doctor-assisted suicide this way she came up against several aspects that caused her concern.
The struggle for Dr. Walton-Knight was that, to her mind, physician-assisted suicide did not seem to fit neatly into either the category of murder or manslaughter.
She said, “The Ten Commandments state that we shall not murder, and Jesus in the New Testament elaborates that murder is not just the physical act of taking life, but also an attitude of the heart ... to selfishly consider my life of greater value than someone else’s such that their life no longer deserves to exist.”
She said doctor-assisted suicide, “is not requested or carried out from ill intent – unless we perceive a request for suicide to be because someone abhors their own life …” At the same time, it could not fall into the category of manslaughter because there is explicit intent to end life.
Dr. Walton-Knight found herself asking what would make someone hate their life so much they want to end it. “Is it simply because of intractable pain, or because they genuinely hate themselves? If you ask someone a few weeks earlier if they want to die, or to commit suicide, would they say no?” she wondered.
Also attending the panel at Hillel UBC, the Jewish centre at UBC, was Dr. Jyothi Jayaraman, a family physician who sits on the Residential and Frail Elder Care Committee of the Vancouver Division of Family Practice. She assesses patients who request a doctor’s assistance ending their lives and carries out the process.
She noted that society increasingly defines a person’s value by their ability to be productive and give something to others. As a result, when a person needs help and care from others they can find it impossible to accept.
Based on her experience, she said society seems to feel the need to legalize doctor-assisted suicide because of the high value now placed on autonomy. That emphasis on autonomy leads people to feel they must end their lives if their autonomy is taken away.
When Dr. Walton-Knight considered that someone might request physician-assisted suicide out of a desire to be in control she concluded that, “If I believe, as I do, that I am not in control of my life, but rather a loving, heavenly Father is, (my wanting) to be in control of my last days would seem to go against my trust in a loving, steadfast God.”
Advocates of doctor-assisted suicide often use the term “death with dignity,” a phrase that led Dr. Walton-Knight to reflect on the nature of dignity.
She reasoned that while everyone has moments in life in which they might be undignified, they do not lose their dignity. “I believe that God is the giver of life and that he affirms what he has made with dignity – ‘it is good’ – stems from his view of me and not my own view or society’s view,” she said.
Her careful assessment of the issue in light of her Christian faith led Dr. Walton-Knight to decide that she would conscientiously object to physician-assisted suicide, following guidelines established by the College of Physicians and Surgeons of British Columbia.
If a patient indicates they would consider physician-assisted suicide, she notes it in their chart and explores their motivation. “I see it as imperative that I hear from my patients and non-judgmentally help them to navigate what is best for them based on their religious, cultural, and personal beliefs,” she said.
When a patient decides to explore the option further, Dr. Walton-Knight gives them a phone number to call where another health-care professional takes over the process.
Knowing that guidelines get updated and adapted with time and experience, she is concerned the scope of physician-assisted suicide may change in the future to include people currently not eligible, and her right to conscientiously object may change.
“If I find myself the only doctor available, will my choice to not be involved be overruled by the patient’s right to have MAID?” she wondered. As well she wondered “How do we reconcile the dilemma for institutions that are established under religious charters but are now funded publicly?”
Dr. Jayaraman also said to her mind the issue of conscientious participation needed to be discussed. “I have had personal conversations with nurses and physicians who are being forced to stand by while patients under their care are being transferred out for MAID assessments and provision. As you can imagine these are very frail people with loved ones who are already going through a lot stress. So, there is considerable moral distress when you cannot protect your patient. So, while individuals can conscientiously object, can institutions do so?” she said.
Both doctors agreed the issues surrounding physician-assisted suicide and the balancing of rights are complex and need to be discussed deeply. They also indicated that having conversations with one’s family physician as early as possible about what options one does and does not want in a critical care situation is important. The family physician can then advocate for their patient, minimizing stress for everyone involved in an end-of-life situation.
“Jesus walked beside people in all circumstances. He didn’t shy away from tough topics nor abandon the dialogue. We need to do the same ... We need to dialogue with those holding different views on MAiD to work together within the legal framework we have been given,” said Dr. Walton-Knight.