IN order to maintain good peace of mind, it is natural for us to go through life thinking all will be well and we will never fall ill to any serious disease. Those of us who are particularly religious will have faith that God will protect us and we will never get diseases such as cancer or any similar potentially fatal condition. Yet we know of many persons, ‘believers’ and non-believers, who invariably succumb to such terminal diseases.

So, for those who may be so afflicted in the future, what choices can they make, and from where may assistance to effectively relieve their pain and suffering come?

Medical doctors often grapple with many wrenching decisions throughout their medical careers. One very topical and ethically challenging decision is whether to try to prolong or bring an end to patients’ lives. We all know that doctors are obligated to relieve pain and suffering, and they are also honour-bound by the Hippocratic dictum to “do no harm”. However, in recent times, many members of the medical profession have been torn between the interpretations of these dicta, and the challenges posed by care for terminally ill patients in severe pain and suffering. Many doctors in the global community think that, provided the disease is incurable and terminal, they would support a patient’s decision to end their own life.

DOCTORS DIVIDED ON ISSUE

Whilst research in this matter has not occurred in Jamaica, some medical doctors overseas regard a doctor’s refusal to assist patients in accelerating the dying process as in fact causing them harm through prolonged pain and suffering. A 2014 survey asked doctors overseas: “Should physician-assisted suicide be allowed?” Fifty-six per cent of doctors in the USA responded “Yes”, 31 per cent responded “No”, whilst 15 per cent responded “It depends”.

In the United Kingdom (UK) and several European countries where the concept is referred to as ‘physician-assisted dying’, almost 4,000 medical doctors from more than 35 countries answered the ethics survey, with the majority of respondents being from the UK, France, Italy, and Germany. Forty-one per cent of doctors responded “Yes”, 41 per cent responded “No”, and 18 per cent responded, “It depends.”

Some believed that there were clearly some situations, such as excruciating pain from terminal cancer, or profound air hunger from ALS (amyotrophic lateral sclerosis, also called Lou Gehrig’s disease – a rapidly progressive fatal disease that attacks the nerve cells responsible for muscle control) where there should be some leeway in providing humane terminal sedation. They believed that this may be necessary when the extension of life involves unnecessary suffering for the patient.

RELIGIOUS VIEWS AND

PERSONAL MORES

Our doctors in Jamaica come from many different countries and have many different personal values, as would be expected in a pluralistic society. Doctors here would therefore likely be similarly conflicted on which choice they would make if a terminally ill patient, who is screaming in unrelieved pain and suffering, were to request aid-in-dying, or medication which they would then take to accelerate the dying process. Whilst the answer to this issue is clear in law, it is not as crystal clear in ethics because of the different interpretations of ‘doing no harm’. Many doctors, whether due to religious convictions or personal beliefs and values, would decline providing a terminally ill patient who is in unrelievable pain and suffering, any assistance to die. Such a position many persons think would be quite understandable.

However, some think that the other position is also not unreasonable where when all available medications and medical procedures have failed to relieve terminally ill patients of their intractable pain and suffering, then it is ethical to hasten the process of their dying to relieve their suffering. This viewpoint is based on the ethical dictum that says, inter alia – where a doctor cannot provide cure, he or she should always provide relief from suffering. According to this view, to ignore the obvious pain and suffering of the patient would, in fact, be ‘doing harm’. It is this ethical dilemma that would cause doctors in the mentioned ethics survey to be divided on this issue.

There are no easy answers in this regard, and each doctor will have to reflect and reason deeply on the issue, to determine how they would proceed. The doctor and the patient may be religious in their beliefs and outlook, or they may be atheists but still secularly moral in their approach.

What would be the humane thing to do? What do you think personally, whether for yourself or for your loved one in severe unrelieved suffering?

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency – CARPHA. (The views expressed here are not written on behalf of CARPHA)