Trust is a very difficult thing to pin down, but we all know when we have it and when it’s lost. Most can be learned from examples from practice. There are two sources that are worth reading:
Katherine Mannix’s tells a story about a man, Ujal, living in the Netherlands who is desperate to come to the UK to die (Pp 179-195). He says:
“They didn’t mean to frighten me. I think they thought it was a comfort. But it was every day, every ward round, they told me that if I want to, I can choose to die…..“
Mannix goes on to explain that
“His only criticism is that there was a subtle, entirely unintended nuance in every consultation once his cancer had spread. In the end this nuance was too frightening to tolerate…Ujal ran away from that certain, controlled dying to live with the hope of uncertainty…Ujal lived with us [at the hospice] for two months…before dying very quietly while Tabitha [his daughter] was running and laughing the the garden outside his room.
She concludes that
“Once the euthanasia genie is out of the bottle, you must be careful what you wish for.”
Christopher de Bellaigue in a Guardian article gives further reinforcement to this concern and extends it to tensions between doctors in a tragic cameo.
“For all the safeguards that have been put in place against the manipulation of applicants for euthanasia, in cases where patients do include relatives in their
decision-making, it can never be entirely foreclosed, as I discovered in a GP’s
surgery in Wallonia, the French-speaking part of Belgium.
“The GP in question – we’ll call her Marie-Louise – is a self-confessed idealist who sees it as her mission to “care, care, care”. In 2017, one of her patients, a man in late middle-age, was diagnosed with dementia and signed a directive asking for euthanasia when his condition worsened. As his mind faltered, however, so did his resolve – which did not please his wife, who became an evangelist for her husband’s death. “He must have changed his mind 20 times,” Marie-Louise said. “I saw the pressure she was applying”.
“In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her desk, walked over to the filing cabinet and, adopting the persona of the infuriated wife, slammed down her fist, exclaiming,
“If only he had the courage! Coward!”
Most medical ethicists would approve of Marie-Louise’s refusal to euthanise a patient who had been pressured. By the time she went away on holiday last summer, she believed she had won from her patient an undertaking not to press for euthanasia. But she had not reckoned with her own colleague in the practice, a doctor who takes a favourable line towards euthanasia, and when Marie-Louise returned from holidays she found out that this colleague had euthanised her patient.
‘When I visited Marie-Louise several months after the event, she remained bewildered by what had happened. As with Marc, guilt was a factor; if she hadn’t gone away, would her patient still be alive? Now she was making plans to leave the practice, but hadn’t yet made an announcement for fear of unsettling her other patients.
“How can I stay here?” she said.
“I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”
APM Comment:
- The specialty is very aware of how good relationships with patients and families matter and how our actions and words affect how patients and families see us
- Physician assisted suicide or euthanasia is an unnecessary additional pressure on doctors’ clinical relationships and should not become a new duty of care for them
- If actions to end life become legal, the process and implementation should be kept hermetically sealed from medicine to preserve and protect the doctor-patient relationship