I’ve twice already written about Paula, the amazing six-year-old girl with an incurable leukemia and how she faced the end of her short life with astonishing composure.
I cannot say the same about my own emotional reaction to her fatal illness.
I was both angry and sad that we physicians could not save her life.
Even though all this took place many years ago, I still have the feeling that somehow we failed both her and her parents.
Thinking about it in a rational way, this, of course, is rather silly, since there was absolutely nothing humanly possible to save her life.
On the positive side, Paula’s illness and premature death helped me come to the realization that I was not cut out to become a pediatrician, even though I had seriously thought about that career path. But that meant I would get referrals from my colleagues asking me to look after terminally ill children. I could not face the prospect that all too often I would have to deal with other children suffering from similar fatal diseases and unable to change the course of events.
As a pediatrician, I would have had many gratifying opportunities to take care of a very ill child, find a cure and nurse him or her back to good health. I was very doubtful that such experiences would compensate for the feelings of helplessness and frustration when even the best treatment would be futile.
As a family physician, I would also have to deal with end-of-life issues throughout my career, but looking after a very old person who is going to die is a lot less emotionally draining than having a young child succumb.
On the contrary, to make sure that an older patient receives the kind of care that makes the road to the inevitable end as comfortable and painless as possible leaves both the family and physician less sad.
When given the choice, most people would opt for a humane death. Unfortunately, there are many people and doctors who believe we should prolong life at any cost, even if it means inflicting a lot of misery in the face of a certain death.
Our patients are often not given any say in how the last chapter of their lives would be managed. They are often unsure about the various options, and neither the patient nor the physician will take the time to explore these.
And even if a person has clearly stated how they want the medical profession help them, the law makes a criminal of the physician if he or she dares to comply with the patient’s wishes.
Currently, the courts are asked once again to rule on assisting a terminally ill patient to end their life in a manner they have chosen.
Even though the majority of the population is in favor of having clear rules on how to proceed, our politicians still do not have the courage to deal with this issue and leave it to the courts to make, in effect, new laws, a task that should be entirely in the hands of parliament.
Our elected representatives do not have to reinvent the wheel, since there are some other countries and several states in the U.S. with sensible laws allowing people to make such decisions for themselves, according to strict rules.
Their experiences are generally very positive and there is no evidence whatsoever to support the argument of the ‘slippery slope,’ where people are given a free hand in getting rid of demented or otherwise incapacitated parents or relatives.
It is my hope that when my days are numbered, I will have the right to choose and advise my doctor of my wishes, and he or she will have the privilege of assisting me with impunity.
No physician should be forced to perform such a task if it is incompatible with his religious or other beliefs, just as I opted out of becoming a pediatrician.
Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.