Doctors do not have magical powers
The End of Life Choice Act would make it harder for doctors to practise medicine, argues Dr Caroline Ansley.
The End of Life Choice Act tells doctors how to do their jobs. As a doctor of 18 years’ experience, most of that in general practice, I am deeply concerned about the conversation that is being had in New Zealand over an Act which cannot deliver what it promises.
The Act places the burden of the enactment of the law into the hands of medical practitioners with total naivety regarding how it will play out in clinical practice.
This doesn’t surprise me. If only I actually owned the crystal ball, magic wand and mind-reading capacity that the majority of my patients seem to think I possess.
The same naivety about medicine is behind this Act and the safeguards that supporters of the Act keep saying exist. In this Act, politicians are telling me what is possible within my skill set as a doctor, what I can accomplish in this role, and they are placing unnatural constraints around how can I achieve it.
In my reading of the Act, and my intimate understanding of the context it will play out in (most likely in general practice), I am left very concerned at the wide gap between the principles outlined in the Act and the implementation as it will play out in my consulting room. I think magic is the substance which will bridge the divide.
Doctors are required under the Act to do their best to ensure that the person expresses their wish free from pressure from any other person (section 11 (h)). Doctors are not all-knowing (I don’t own a Pensieve, and I don’t think any of my colleagues do either). We don’t keep truth serum in desk drawers. We can’t use such strategies to pull the truth from our patients’ minds.
Instead, we are trained to trust the testimony of the person sitting in front of us, who may not be telling us the truth. We cannot deliver adequately on this requirement of the Act to keep our patients safe.
In order to determine if a person is free to make their choice, the Act states that the doctor can only talk to members of the person’s family approved by the person (section 11 (h) (ii)). Doctors don’t have a magic spell which they can cast to reveal the presence of coercion, and without such a spell we can never be entirely certain that a person is free.
To increase our chances of understanding what is going on in a person’s life, especially when it comes to decisions which are so large, we need to gather information from multiple sources. This aspect of the Act constrains our clinical practice and reduces our effectiveness.
There is no requirement in the Act that the attending doctor (to whom the patient makes the request to die) needs to have met the patient before. Sadly, doctors are not able to read minds to determine why a patient does what they do or to make sense of their choices. Instead they use trust and depth of relationship developed over time to draw information out about the really big issues. This allowance in the Act increases access to this choice for the public, but it also increases the risk of the Act to the public.
The Act requires a doctor to give a prognosis and estimate time to death. Yet, there is no requirement in the Act that the doctor be experienced in the illness that the patient has. The doctor may be inexperienced, or simply lacking in knowledge in this area.
They don’t have to consult with other doctors to gain further information about the illness (the Act only requires this for the sake of ruling out coercion). Doctors cannot take a magic potion which gives them knowledge and experience, temporarily to solve the dilemma in front of them. And while under the influence of such a potion, they also cannot pull out their crystal ball to forecast ahead into the future and prophecy the timeframe the patient has left. Without a crystal ball we are hopeless forecasters, and get prognosis wrong all the time (even poorer still if the doctor is inexperienced).
We cannot deliver on this requirement of the Act.
Once the choice has been made and the assisted suicide has been completed, we also cannot raise from the dead. If only we could do this thing. Because there is one thing that doctors can do, and that is make mistakes. Like the rest of humanity, we are rather good at that.
We cannot do these things the Act asks of us without spending a few years first at a school of wizardry, and even then I suspect most of us are just simple humans. As non-magical doctors, what we can do is spend time, offer options and hope, provide symptom relief and probe deep into why a person is wanting the thing they are asking for, to discover the real reason behind it all.
The Act will take away our freedom to practise medicine the way we are good at, in this most sacred of spaces. It will hold us to one course of action, and will inflexibly require that we follow a path determined by legislators, not physicians. And if we don’t follow it, we will be liable to criminal charges.
In giving us power to use the death curse, a power that most doctors do not want as it fundamentally conflicts with our code of ethics, this Act will take away our freedom of choice in how we care for our patients.
Dr Caroline Ansley is a Christchurch-based GP with experience working across various general practices.