Medical assistance in dying

PFSP Perspectives

July 15, 2017

Terrie E. Brandon, MD, CCFP | Clinical Director, PFSP

Caring for ourselves and our colleagues in changing times

Contributed by: Terrie E. Brandon, MD, CCFP | Clinical Director, PFSP

Dying is a difficult process to witness. Death and dying should not be trivialized. Every death, even the most expected, is unsettling.
It is an event that defines us as humans.1

As I write this, 97 Albertans have been granted medical assistance in dying and another 48 who requested the service were found not to have met the criteria. Given the number of physicians involved in the care of a seriously ill patient, it’s safe to say that the issue of medical assistance in dying (MAiD) has personally touched hundreds of Alberta physicians.

The passing of Bill C-14 initiated a sea change in the practice of medicine. In our training, we prepared to relieve suffering and preserve life. That we are now expected to participate in ending life is unsettling to many physicians, even to some who support the concept.

Issues with MAiD

What about MAiD is distressing us? The types of stories we’re hearing reveal a variety of stressors within this issue.

  • A physician opposed to MAiD on moral and religious grounds feels silenced by his peers who support the practice.
  • A family doctor experiences unexpectedly severe grief after losing a long-time patient while dealing with the emotional impact of having participated in ending his life.
  • A medical practice is divided when one physician decides to provide MAiD while the others are opposed.
  • A physician calls the assistance line from her car while on the way to provide MAiD. She believes she is doing the right thing for her patient, but she needs to sort out her thoughts and emotions.
  • A physician fears the legal consequences of providing MAiD to a patient whose family is opposed.
  • Having promised a patient assistance in dying, a physician is distressed that he was unable to complete the application process in time to give the patient the type of death she was hoping for.

Physician support

Stories like these are a part of our new reality. So how do we deal with our own emotions and with those of our colleagues?

Many jurisdictions have some form of support for health care teams providing MAiD. In Quebec, an interdisciplinary support network has been built into the process. The Netherlands has specially trained consultants to support and educate physician providers and to consult with every provider before and after each event. Here in Alberta, a supportive review is completed after each assisted death, allowing the team members to discuss their perspectives and experiences should they wish to do so. Initiatives like this acknowledge the emotional impact on those involved. For more information about the review process refer to MEDICAL ASSISTANCE IN DYING: Values-Based Self-Assessment Tool for Health Care Providers (including Physicians).

Dr. James Silvius, the Alberta Health Services (AHS) lead for Medical Assistance in Dying Preparedness, says there is significant variability in the emotional impact on providers; some seem to take it in stride, while others have unexpected emotional responses. He also acknowledges the difficulties caused within teams when the issue provokes friction between physicians or between physicians and other health care providers. AHS continues to explore ways to assist those involved in MAiD through education and direct support.

In my own experience of discussing MAiD with physicians, I’ve been impressed with the deep level of thought that they’ve given to this issue. In sharing their stories and emotions, they’ve shown remarkable empathy for the experiences and feelings of their colleagues, even those with opposing views. I have been struck by the ability of these physicians to understand, respect and accept perspectives other than their own.

A study in Oregon confirmed that MAiD is emotionally intense and stressful for physicians. The sources of their discomfort included concerns about adequate management of symptoms and suffering, not wanting to abandon their patients, and having an incomplete understanding of their patients’ preferences. Although they recognized their stress, few sought support from colleagues or their professional organizations, with most turning to their spouse for support.2

While reaching out to family is natural during times of stress, our profession will be healthier and stronger if we also reach out to each other. MAiD is just one of the challenges we face in the shifting landscape of medicine. Our support for each other will help us develop the resilience needed for our journey into new and challenging territory.

Share your feelings and experiences. Reach out to your colleagues. In addition, the Physician and Family Support Program (PFSP) assistance line will connect you with a fellow physician for confidential support (1.877.767.4637).

We don’t need to walk alone.

References available upon request.

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