Re: Physician-Assisted Suicide and Euthanasia: can you even imagine teaching medical students how to end their patients' lives? Perm J 2011 Fall;15(4):79–84. DOI: http://dx.doi.org/10.7812/TPP/11-099
Dr Boudreau's Response (Perm J 2012 Spring;16(2):75–7) ignores the main points of my critique: paternalism and reductionism, both serious shortcomings at any time, but worse in the arena of teaching. A valid response should have attempted to justify the peremptory, unconditional “No, of course not …” objection, irrespective of any circumstances, however exceptional; a congealed rhetoric, indeed pejorative as per his words.
Sociologist/theologian J Grand'Maison, referring to desperate agonies he calls “situations-limites,” reminded palliativists that: “One cannot at the same time recognize the complexity and the diversity of ‘situations-limites’ and yet maintain a univocal logic … in each case, one must search for the most humane solution … that is incompatible with rigid views [translation by author].”1 In the same vein, having described a situation-limite, ethicist DJ Roy wrote: “… the doctor would have been utterly justified ethically, in timing that death—upon the patient's request—for a moment of tranquility.” Adding: “This is only one story illustrating an ethically justifiable advancing of a death” [emphasis added].2
Given that in the Benelux countries (Belgium, Netherlands, and Luxembourg) such teaching exists (Joelle Bernheim, MD, PhD; personal communication; 2012 August),a,3 that Dr Boudreau finds inappropriate to compare notes with these colleagues, the problem envisaged is not a pedagogic hurdle but an ideologic choice. This is paternalism: choosing not to expose students and residents—for their own good—to dramatic situations they will surely be exposed to in the future. For, one cannot teach end-of-life/palliative care and not store terminal sedation carefully. So, once one has properly taught palliative care/terminal sedation, there will be no need to teach “how to end patients' lives.”
By the time students and residents have been exposed (as they should be) to proper end-of-life care and terminal sedation (well role-modeled), they should know—in the right circumstances—who could benefit from an “utterly ethically justified, requested, advanced death.” They already have the necessary skills. As everyone knows, terminal sedation has a hairline frontier with physician-assisted dying. A moral/religious hairline, maturing by the years within students and residents, which cannot be imposed. Anecdotally, a well-known university professor of palliative medicine in Montreal, Canada, told me that 70% of one of his large classes agreed with physician-assisted dying.
The goal of the title of the article is thus unmasked: to simply discourage medical schools from even considering physician-assisted dying, forgetting that no one teaching palliative care will ever have to teach how to end patients lives! The article describes euthanatologists who would come, perform and go, a mere impossibility. That is why euthanatrics appears to be a fiction.
The father of the very notion of suffering,4 Eric Cassell, MD, wrote: “Assisting a patient in dying is no easy way out … When terminally ill patients request assistance in dying because of their suffering, and their request meets commonly endorsed safeguards, their request should be honored.”5 One feels most uncomfortable at the thought of Dr Boudreau calling Dr Cassell a euthanatologist practicing euthanatrics.