Don't turn doctors into killers

36 Comments

 

 

I am a doctor. I work with homeless people, street sex workers, injecting drug users. The suffering many of my patients endure is beyond many of our worst nightmares. The idea of suicide is something many struggle with every day. The suffering involved in their living is far greater than the suffering they endure in dying.

Sad womanIt is my job to not just attempt to ease their suffering (which is often very difficult) but to assist them in finding within themselves ways of living with their suffering; finding courage to endure and find meaning in their lives. It is not my job to kill them or to assist them to take their own life because they 'suffer too much'. Nor ought it ever to be the job of any doctor.

I am working with a young woman who, 18 months ago, was was raped and set on fire by her boyfriend. The burns she sustained are disfiguring and give her a daily reminder of the trauma. She is suffering from major depression as well as post-traumatic stress disorder.

She awakes from nightmares in a cold sweat and relives the memories of the rape and attempted murder, where it is as if she is out of her body, watching it happen again, powerless to do anything to stop it. Her suffering is as severe as any I have seen and while there is much I can do to assist, I cannot eliminate her pain.

Another of my patients is an old lady with severe, intractable back pain. She is addicted to pain killers and they have stopped working. She has tried all the other alternative medications and therapies and they have failed. She has been to the chronic pain clinics, seen the surgeons — you name it, she has done it.

There is little that can be done. Her suffering is just as severe as any of my dying patients endured. From time to time she contemplates suicide. I cannot assist her to take her own life and it is important that I cannot.

My role, when all else fails, is to sit with her, to understand her powerlessness and mine in the face of her suffering, and help her find a way through.

 

"I am often struck by my patients' resilience and courage. Their darkest times do pass, as does the desire to end their lives."

 

The kind of suffering I see is extreme. However, all of us suffer, to a greater or lesser extent. One of life's great challenges is to accept this suffering.

So too, at the end of life, there is often suffering, loss and pain. We, as doctors, can assist with easing that pain, but we cannot eliminate it. This is no reason to assist patients to take their own lives, any more than it would be an argument for assisting my patients to suicide simply because they face what, on the face of it, appears to be intolerable suffering.

I am often struck by my patients' resilience and courage. Their darkest times do pass, as does the desire to end their lives. Both the patients mentioned above no longer want to die, though at times they would have willingly taken their own lives if they had had the means.

All of a doctors' work is based on the principle that patients' lives have value. It is absolutely essential that patients know that when they turn their doctor for help, we are there to help them live, not to help them die, no matter what their stage of life or how severe their pain.  

 

Josephine Samuel-KingJosephine Samuel-King is a Melbourne doctor.

Topic tags: Josephine Samuel-King, euthanasia


 

submit a comment

Existing comments

Admirable, but the article fails to persuade because there is no secular non-God argument for forcing someone to endure. There is only a religious edict to bear with pain and, for that reason, it cannot be persuasive with someone who has no religion. The only way a secular argument against euthanasia would work is if it could be empirically demonstrated that people always change their minds eventually about suicide and stay with the belief that they would rather live with the same level of pain. ‘Always’ never happens in reality because there’s bound to be one person who persistently wants to go but can’t because the doctor won’t let her. Claims about a slippery slope are contingent; pro-euthanasia advocates will say that the law will contain all the necessary safeguards. Whether that is so is an empirical question: the safeguards could well be sturdy. That life has an absolute value even against the wishes of its holder is unavoidably a religious premise. After all, there are many examples of lives which would serve the world better if they ceased. Societies which stop believing in God will find that the majesty of the human intellect is a dwarf in king's robes.
Roy Chen Yee | 13 October 2017


A timely article. I think your attitude to euthanasia depends on your attitude to life. The Judaeo-Christian-Islamic ('Abrahamic') tradition does not see life in a purely material or mechanistic sense. Life is something sacred and not something to be turned off at will by anyone, especially involuntarily by another. I am disturbed by the stories of voluntary euthanasia of young people with mental illnesses in the Netherlands and Belgium. Even more disturbing is the possibility of the coercion or involuntary suicide of older people. I am also concerned that some religious figures are seen as approving suicide. At a memorial service for a school colleague with a history of severe mental illness, the presiding cleric (an Anglican) used the phrase 'X chose to take his own life.'It was the 'chose'that worried me. Rather than blithely rubber stamping euthanasia legislation we need to be spending more on appropriate medical and social services. That would be a more appropriate sign of a caring, compassionate society than euthanasia legislation.
Edward Fido | 14 October 2017


When I ‘turn to my doctorr’ I’m seeking advice, and I want that advice to cover the range of options. It’s my health, and my decision about what course of treatment I choose. Sure, I want a competent doctor, one who can make a reliable diagnosis and explain the pros and cons of the various options from which I must choose. But in the end it’s my choice and my responsibility. The last thing I want is a doctor playing God and limiting my information and choices.
Ginger Meggs | 15 October 2017


There is a world of difference between the situation of the two cases used as examples here and that of the terminally ill. In the latter case, there is no hope for recovery, these ‘darkest times’, as you put it, do not pass. I watched my brother endure 4 years of horrific medical interventions and failures, culminating in a long and agonising journey to the end. If a doctor’s first duty is ‘to do no harm’ then actively easing a terminal patient toward that end is an obligation. Standing back and ‘letting nature take its course’ is cruel, pure and simple. We treat dogs better.
Withheld | 16 October 2017


At last! The nuanced argument this topic has been lacking - a clear and moral explanation of the issues at stake. Doctors are healers. For society to ask anything else of them is to change the very reason we trust them to help us in our vulnerability. To 'walk with' a patient in their suffering is a difficult but noble 'ask,' but one that we have always knowingly or unknowingly expected of our doctors. Our response should be one of deep gratitude, not to expect of them what they cannot and should not do.
Helga Jones | 16 October 2017


Josephine Samuel-King is not presenting arguments against euthanasia, but rather saying that doctors should not be asked to do it. I wonder how many other doctors have the same view?
Janet | 16 October 2017


I am frustrated by the way those opposing assisted dying legislation always, always ignore the views and wishes of the person suffering - they may as well not exist.
PHILIP JOHN NEWMAN | 16 October 2017


'... there is no secular non-God argument for forcing someone to endure'. Although it may be hard to articulate, Roy, I think that's demonstrably false. That can be demonstrated in many ways but consider the current push tho reduce suicide among young men. As a society we try to give them reasons to 'endure', don't we? And that desire is not limited to religious groups.
Tony | 16 October 2017


'One of life's great challenges is to accept this [extreme] suffering.' This is correct as the doctor cannot take over the suffering of the dying person. However, the doctor of any religion has a duty to alleviate suffering. They would not just accept suffering if they could offer relief. They would also not, in these post-paternalism days, override the patient's will. The difficulty seems to be where the doctor's world view conflicts with that of the patient - if the patient requests (legal) assisted dying, then the doctor who disagrees with the principle is both passive in the face of alleviation of suffering and overriding the patient's wishes. This is an ethical dilemma doctors must face, while also considering the alternative: that they stand by their principles and both add to suffering through their inaction and reduce the patient to 'thing' whose wishes must be submissive to those of the doctor.
Janine | 16 October 2017


I believe the Josephine is spot on: doctors of the Hypocratic tradition just should not be involve in deliberate killing of any kind, whether euthanasia or judicial execution, nor torture even if "legal". But lao the reality is that most doctors are rather poor at using the complex range of powerful pain-killers now available and may patients rain in pin which could be better controlled if more expertise were applied. We need better medical training in pain-care across the board, and guaranteed comprehensive access to specialist plain-relief services as a priority built-in characteristic of Australian health care; regrettably, that is not the case currently.
Eugene | 16 October 2017


I admire Josephine so dedication to her patients. But not all who wish to end their lives are suffering depression alone. Some have life-ending illnesses which will kill them anyway, with a ghastly period leading to their end. Unfortunately, palliative care can only go so far for some people, no matter how much money is poured into the system. So help them when it is practical, otherwise let them choose to have help to end their suffering.
John webb | 16 October 2017


I have been close to people dying peacefully whom I believe finally chose the time of their natural death. They appeared to die when they were ready to die and when they believed that those close to them were also ready for them to go. I have seen the most awful suffering of people who would not be eligible for assisted dying under the proposed Victorian legislation. Reflecting on my experience, I consider dying is far too complex a process to be covered, as yet, by legislation. Perhaps as we learn more of the science, legislation might be possible. The present debate respects the right of some people to a dying hastened by human interference but denies it to others. there is so much about living and dying that we do not yet understand.
Sheelah Egan | 16 October 2017


Dr Samuel-King made a clear statement that she did not wish to deliberately kill anyone and thus does not wish to be part of what may soon be the contemporary 'euthanasia scene' in Victoria. The beliefs held by doctors not wishing to perform abortions are based on similar grounds. They are in full accord with traditional Christian beliefs. To use terms such as "assisted dying" does nothing to change the facts. These days people are very keen on their rights, which, for many includes 'the right to die'. Traditionally taking your own life was considered Suicide which all churches have considered a serious sin. There is a very interesting article in the English 'Catholic Herald' of 12 October 2017 'Churches urged to toll their bells to mark 50 years since Abortion Act.' In it Anne Widdecombe, a former UK MP, was quoted as saying that the 1967 Act was not supposed to lead to abortion on demand and was supposedly hedged around with all sorts of safeguards, similar to the draft legislation to be put before the Victorian parliament. I fear the enactment of this legislation will lead to a similar situation to that in Belgium and Holland.
Edward Fido | 16 October 2017


As semi retired doctor and recovering Christian! I agree it is never a doctor's role to deliberately take life... yes it happens. Doctors don't play god GM but we are ethically trained and philosophically geared to care not kill. Maybe what is needed is a booking with an executioner not a medical practitioner .
Denis | 16 October 2017


Thanks for your honesty. I agree with your argument completely. Lack of trust in the real God and massive government subsidies to the profession mean medics may be encouraged to act like unaccountable secular deities complete with the tempting power of life and death.
Steve Etherington | 16 October 2017


Tony: “consider the current push to reduce suicide among young men. As a society we try to give them reasons to 'endure'….” You’re trying to convince them not to be hasty in making a decision that can’t be reversed. You might show them examples of young people like themselves who have chosen to keep their lives and have now lost any desire to die. You might even be a little sneaky and work in something about how family and friends will be made to feel by their death. Fair enough, but that’s not proving that it’s wrong to commit suicide, only that it most probably, given the years ahead of them, their relative health and all the opportunities they won’t be enjoying, won’t be a good idea. And they might traumatise a family member or friend. On the other hand when you’ve been old, sick and in serious pain forever, those arguments won’t work and plying the guilt trip would be churlish. You’ll either keep to life because you believe in the religious sacredness of your one life, or you’re a dogged person who’s going to exercise that last human right to show your body who’s boss, or both.
Roy Chen Yee | 16 October 2017


I would like to have a doctor at the end of my life who will respect my judgment that I know when enough is enough, that I and I alone will decide to call it quits.
Paul Laycock | 16 October 2017


Josephine, I have great respect for the work you are involved in with vulnerable people who experience many aspects of pain in their day to day lives. Your compassion is palpable. However, I support the assisted dying legislation as I want choice at end of life if I am terminally ill and no longer wish to suffer intolerable pain. I am a retired woman, a former nurse and social worker who has also worked in palliative care. I have been witness to suffering on both a professional and personal basis. It is a personal choice that should not be denied by others' religious beliefs or personal philosophy. If it is legal, voluntary and a consenting doctor assists, I believe it is my business. I am at odds to see how my chosen dying would effect you in any way
Robyn | 16 October 2017


Ginger Meggs, In euthanasia law reform, more is being asked of doctors than "advice", as Dr Samuel-King's article indicates. Do you imply that we have a right to take our own lives, and/or request of others that they do it for us. "Rights" are natural entitlements that conduce to life, not death. What is the basis for claiming death as a "right", and death by suicide, self-inflicted or assisted, at that?
John | 16 October 2017


This is a most moving and inspiring article. As a former chaplain in a palliative care hospital I strongly agree.
Brian | 17 October 2017


It appears, from reading the paper today, that they seem to have the numbers to pass the bill in the Lower House. The passage into Law is then a lot simpler. If 'assisted dying' becomes legal then the argument shifts as to how to best protect those doctors who don't wish to be involved in euthanasia and institutions such as Catholic or other hospitals which wish to opt out. It is not compulsory for a doctor to perform an abortion in Victoria nor do Catholic hospitals provide them. It would be hoped this prospective legislation protects the doctors and institutions who, on moral grounds, wish to opt out. I do not think it moral that a patient should be able to demand a certain doctor perform a service they consider immoral. That degrades the medical practitioner to a mere rubber stamp functionary. Life and death are serious matters. There has been talk in the pro-euthanasia lobby of some sort of recrimination in terms of funding or recognition being taken against hospitals which don't comply. That needs to be vigorously opposed.
Edward Fido | 17 October 2017


How much of the suffering of dying is in the eyes of the beholder I wonder rather than in the dying? It is painful to watch those we love suffer. Having recently experienced the pain of renal colic (said to be worst pain imaginable) none of the new expensive drugs touched my pain. Perhaps it's time to review the drugs we are using! Hastening death by easing suffering is completely different to active killing
Mary McKenzie | 17 October 2017


With 68 safeguards can't we give dying people, in extreme pain and suffering, a choice with Voluntary Assisted Dying. Kindness and Compassion always.
Giovan Gandolfo | 17 October 2017


Thank you Jo for your excellent article. I completely agree with your sentiments. If the euthanasia bill is passed it will also lead to many disputes and ongoing legal wrangles to the detriment of society. Human life is sacred and will always remain so.
Selina Quilty | 17 October 2017


There are a number of words that are commonly used to-Utah end to any rational debate: ‘sacred’ is one of them. If we put aside its religious meaning - which is irrelevant when we are talking about a civil law which will regulate the behaviour of the irreligious and non-religious as well as the religious, it means something like ‘worthy of or entitled to respect’. When looked at rationally, the proposed Victorian legislation — which Is what we are talking about, not the Belgian or Dutch or any unspecified future proposal - does not challenge that definition. If you still think it does, the you need to rethink your acceptance of ‘just war’ theories. Furthermore, the proposed legislation will not ‘make’ doctors anything. Those who don’t wish to be involved need not be involved. And yes John, I do claim the right to end my life when I choose and I challenge your ‘right’ to try to make that illegal on the basis of your religious beliefs. This is not a theocracy and the greatest threat to your freedom to practice your religion is the desire of religious persons and institutions to impose their beliefs and taboos on the rest of us.
Ginger Meggs | 17 October 2017


Ginger Meggs: “I do claim the right to end my life when I choose….” Actually, you’re claiming the right to end your life when you feel that your pain is unbearable, not because you’ve suddenly developed an insatiable curiosity about whether there is an after-life. But pain ceases when a patient slips into a coma or is put into one. If the State believed enough in the principle of life, the law could be amended to allow the Attorney-General to get a court order to put the patient into the peace of a coma. Since pain or sentient awareness of a degraded quality of life is no longer an issue, any claim of a right to end one’s life when one wishes would be based on ego rather than on practical necessity. And why should society cater to an individual puffed-up ego?
Roy Chen Yee | 17 October 2017


Ginger, How is he expression of one's point of view in a democratic process, regardless of one's motivation, an "imposition" on those who do not share that point of view?
John | 18 October 2017


We do not need the example of what happens in Belgium or the Netherlands, as, for a very long time, we had our own resident euthanasia advocate, Dr Philip Nitschke (now resident in the latter country). His approach to euthanasia/assisted suicide is certainly 'inclusive' to say the least. The pending Victorian legislation's scope could easily be extended at a later stage if it is passed as is. I think the reason that the Oregon legislation has not been extended is probably due to the presence of a strong Christian lobby in the US.
Edward Fido | 18 October 2017


I wonder if in the event of the legislation being passed, the government will appoint a roster of executioners, government employees similar to the hangmen of old. Presumably, as with the hangman, there will be no fees payable by the euthanised or his/her surviving relatives. Perhaps euthanasia will be a free service paid for by Medicare.
john frawley | 18 October 2017


In the year 2000 in an address to the International Congress on Organ Transplant Surgery, Pope John Paul II defined the death of a person "as a single event consisting in the disintegration of that unitary and integrated whole that is the personal self". Inadvertently perhaps, in so-doing, he also defined life as "the possession of that unitary and integrated whole that is the personal self". When that unitary and integrated whole is lost through brain death and the body can be maintained by artificial means, doctors, Catholic or not, have no moral obligation to maintain treatments which cannot restore that integrated whole. However, when that unitary and integrated whole has not been lost, no true doctor, Catholic or Hippocratic pagan, can ethically initiate that single event designed to produce the disintegration of that whole. It is also true that no other person can ethically initiate the process, Medicine possesses the means to relieve suffering very satisfactorily. Sadly, however, it does not possess the means to alleviate the fears of those who have seen suffering and are afraid that they too might suffer similarly.
john frawley | 18 October 2017


Bravo Dr John Frawley: another sane and civilised medic!
Edward Fido | 18 October 2017


John (F), I accept that your participation in ‘initiating that single event’ would be ethically abhorrent and I would never support any proposal to require you to do it. But not everyone shares that ethic and I am not persuaded that your genuine abhorrence should prevent that ‘initiation’ being available by another hand to anyone who requests it. John (not F), I don't challenge your ‘right to express one’s point of view regardless of motivation’. What I object to is any action that follows that would prohibit others who do not share that point of view from exercising their free will in a way that does no harm to anyone other than her/himself. Edward, we’re not talking about Dr Nitshke any more than Belgium of Holland. We’re talking about the proposals in Victoria and (perhaps) NSW. Do you really think that the scope of this legislation could ‘easily be extended’ at a later stage given the level of opposition that there has been to this stage? Roy, not for the first time, you have misrepresented what I wrote. I did not ‘actually claim’ all those words that you project on to me. And yes, I, like you, have an ego: it’s our sense of self-worth, and it’s what keeps most of us sane, civil and ethical.
Ginger Meggs | 18 October 2017


Ginger, I'd have thought a caring community would direct its energies and resources into discouraging self-harm in any form.
John | 19 October 2017


My simple answer to you GM is 'Yes'. I do believe the current euthanasia legislation to be put before the Victorian parliament could later be extended. That is the way politics works. Like abortion and SSM, euthanasia is not a 'simple choice' but has a number of serious ramifications as to what sort of society we are and what sort of society we might become. The fact that several Victorian parliamentarians are getting behind James Merlino's Amendment would seem to prove they, too, have serious long term considerations. Interesting that Dr John Zalcberg, Monash University's Head of Cancer Research, has this to say on the proposed legislation: 'Both sides need to come together and work on better access to end-of-life care; the alternative of offering to kill does not make us a more compassionate society.' I do not believe morality consists in simply ticking an appropriate box on very discrete issues with no thought as to the overall good of society. To attempt to limit the debate in that way, as I believe you are, cuts out the big picture. It is the big picture that is important. A society with no overall vision will fail.
Edward Fido | 19 October 2017


GM. As you are almost certainly aware perhaps the greatest achievement of ancient Greece is that it civilised its world and laid the foundations for that system we know as Western Civilisation. One of the great contributions it made was the abandonment of State-sponsored euthanasia practised on those deemed by others as having outlived their usefulness. Socrates was famously dispatched in this way amongst his friends and relations during a "living wake" celebrated with music and dancing. (A lethal dose of hemlock did the trick). The healer, Hippocrates, taught against this uncivilised practice and opposed it in his covenant with the sick, the Hippocratic Oath. This oath is still the basis of our system in the civilised world. I will give no deadly drug nor perform any operation for a criminal purpose even if solicited nor will I suggest any such counsel. With purity and holiness I will pass my life and practise my art. The true doctor in our society cannot in conscience deal the fatal blow. I sometimes wonder whether the proponents of euthanasia are prepared to offer their services as the executioners. I suspect they would back out if required to do so.
john frawley | 19 October 2017


Thank you John, Edward, and John Frawley for your clear, yet civil, responses. I suspect that we have much in common although on this issue we will agree to disagree. One of the strengths of ES is the civility of the intercourse between contributors and the principled position from which contributions are made. Again, thank you.
Ginger Meggs | 21 October 2017


Similar Articles

Raising boys amid Australia's 'masculinity of the frontier'

  • Fatima Measham
  • 19 October 2017

We may not have a daughter, over whom we would have worried about the countless ways the world can hurt her. Yet the work does not seem to be any less difficult, raising sons, especially in Australian context.

READ MORE

Creating a consent culture beyond 'no means no'

  • Neve Mahoney
  • 18 October 2017

The phrase 'no means no' has been bandied about for so long that is has become almost cliché. For many years, it was a great tool for explaining the basics of consent. If someone says no to something, don't do it. But 'no means no' is a tagline, not the start and end of the conversation, and there are obvious gaps in a 'no means no' framework.

READ MORE