Will to Die Mailbag

We've had some pretty strong reaction to our Will to Die show feautring Nagui Morcos.  If you missed it, you can catch it today at 11:30 am (3:30 pm) on CBC Radio One.  In the meantime, here are some of the emails you have sent us.  We'll read a selection of your emails and play some of your messages to our vox box on our show this Saturday, April 9.

Many of you agreed emphatically with Nagui's right to choose to end his life.  As you'll see, a fair number of you took issue with me questioning what my role as a physician is supposed to be when seeing a patient of sound mind who wants to die.

"We do not live forever. My friends and I talk about potential eventualities and we all chorus, "shoot me first". Unfortunately, we do not live in a country with a creative repertoire of solutions to life's problems, like the Netherlands. We live in a time and place that supports the multitude of businesses for sick care while punitively denying biologically condemned individuals the right to humanely script their own life's end. Yesterday I heard a fully sane, reasonable and resourceful adult with Huntington's disease talk responsibly about bringing his life to a fitting milestone.  By gifting peace of mind to himself and all in his circle of care he lends dignity and honour to the cherished life he was given.  Bravo for opening the dialogue!"
From:  Gila Cupchik, Toronto

"I worked for 40 years in health care as a registered nurse and have been retired for the past 10 yrs.  I am now a senior in my 70s and so I have the life experience of those years.  I'm sad to think that anyone would feel they had the right to deny Nagui Morcos the right to die.  No one but him can know the suffering he is presently facing or will face in the future.  No one should have the right to deny him the right to die.  It is his body and his life.  Our culture has such a stigma and a fear around death.  We don't even like to use the words.  We say things like "passed on" or "passed away" rather than say the word 'die'.  Death is as much a part of life as birth, and we will all die someday.  There are worse things; living a life with no quality, no future and unbearable pain, makes no sense.  I believe health care professionals should support an individual's wishes out of respect for them and help them be comfortable until the time they choose to end their life."
From:  Marlene Coram, Qualicum Beach, BC

"Your premise in regard to cases like Nagui's is wrong. The mistake you are making in Nagui's case is that you think you need to counsel him and patients like him. He did not ask for counselling.  He was telling his doctors what he is planning so that his wife and others can be legally protected (by his doctors' testimony) when the time comes for him to leave his failing carcass.  You sound like one of the old school, paternalistic physicians who feel like it is their imperative that life continue to a natural end. Well, you know, if medical staff would truly let people die a natural death that would be a lovely idea.  But medical people of a certain bent are prone to keeping people going long beyond the point that nature would.  Their basis for action is life at any cost with no consideration for quality, all consideration for quantity, as if death is the enemy.  I have had direct experience of this philosophy with my father's life.  My father was terminally ill with metastatic bone cancer. Standing orders for weekly x-rays, daily blood tests, heart medication and so on, meant his heart kept beating while they broke more bones and caused him pain. I had to fight to get them to stop. Staff lied about what they were doing, so I had to read his chart and get the physicians on duty at night to remove standing orders.  And my direct presence at his bedside was the only way to get them to stop the heart meds. Nagui is intelligent and informed.  Why do you think you know better than he how his life should end?  Who made you God, judge, jury and overseer of the lowly masses?  Do you think your philosophy is superior because you went to medical school?  I'm not trying to berate you.  Please just examine the bases for your ideas. What are they and what makes you believe they are valid?  Death is not the enemy.  Death is as much a part of life as birth.  I love your show. All the best to you and yours."
From:  Cathi Urbonas, Indian Harbour, Nova Scotia

"I'm not sure I understand why you think a physician is any more than a consultant to an individual and her or his health or life choices.  It sounded to me that you believe you have some kind of ownership of that person's life and therefore a duty to encourage "life" or "death" in your role as that person's physician.  I do understand that your training as doctor is deeply rooted in the medical model and that your profession is slowly emerging from a "doctor knows all" mentality, but very quickly, I believe, new doctors need to be trained, and doctors with more experience need to be re-trained, to see themselves as only part of a "team approach" in treatment plans (with the patient at the table in an equal position), bringing not personal opinions to that table, but wisdom derived from medical knowledge.  Furthermore I expect physicians, just like social workers and other
professionals to support the people they extend their skills to and at all times to remember it's not about what we believe to be true, but about what the people we work with believe to be true.  I know that this challenges us at many points regarding our individual integrities but that is the challenge that we accept as professionals.  I absolutely love your program and continually enjoy the view you present from your side of the gurney!!
From:  Jacquelyn Poetker, BA, MSW, RSW, Graduate Certificate in Gerontology

"Brian, Thank you for the show today.  Dr Cohen is behaving in a humane, ethical and honourable way with respect to her patient with Huntington's Chorea who intent on ending his own life - when the time comes.  I believe it is powerful medicine to tell a patient that you enjoy their company, that you are glad to know them and that you wish for and offer what support you can for their dignity, joy and fulfillment.  Perhaps health is a proxy for fulfillment.  The historical proscription of suicide stems from our inevitably imperfect Judeo-Christian conceptualization of the will of God.  We do our best work when we are humblest about what we think we know.  We do our worst work when we are sure we know - to wit the Pope's officer at the siege of Beziers saying "Kill them all - God will know his own".  I too have seen "codes" that went too far.  I am comfortable talking about code status and level of care issues.  I would not be comfortable arming a patient I knew was intent on self-destruction with the means to do it.  I am uncomfortable with abortion but I always support a woman's right to choose.
I recognize the jurisdiction of the Province in allocating ambulance resources, even though response time can predict survival.  I agonize over the unequal geographic distribution of necessities of living and of opportunity.  It pains me not to understand these matters.  To be useful and happy at all we must do what we can and put much of the rest out of one's mind.  We are beasts of burden with a little extra education. I would not act to stop Dr Cohen's patient, as described, from exercising his self appointed right to die in a manner and at a time of his choosing.  For now, I will put many of all my other ethical dilemmas on hold.  I will not drop what I am doing to go help at a cholera clinic in Haiti.  God and Hippocrates might have trouble forgiving this decision, just as you sound troubled by Dr. Cohen's approach."
Humbly, Chris Ayers,  B Eng, MD, CCFP

"My husband & I absolutely, 100% support Nagui Morcos' decision to control his end of life in a caring, loving environment. We are both very healthy & in our 60's, but for 30 years have always said we would agree to a controlled end of life for each other if all the future held was extreme pain, physical & mental deterioration.  We still plan that if need be.  Thanks to people like Nagui, & indeed your show, I hope this issue becomes even more in the open for intelligent discussion.  Good luck Nagui, & we intend to find out more about Dying with Dignity."
From:  Jane Styles, Vancouver

"I was listening to Dr. Goldman and his guests discussing what doctors do when they are informed a patient wants to kill himself.  Both my parents are deceased and I am glad they are: I am glad because seeing what happens to old people in our country is reprehensible!  We make a good talk but do not do the walk.  The fact is life has whatever meaning one gives or brings to it.  No one can make a case for life.  Life does not need an advocate because life exists whether we are aware of it or not.  The real truth is we are living as if our days are guaranteed.  Knowing this minute that I am aware and realize that I may or may not be alive by the end of the day gives me joy that I am but a leaf blowing in the wind.  We cannot control death, whether it happens by accident or by will or by decease or sickness.  Every moment of our life is an eternity.  Doctors should stop trying to save everything - and should stop medicating people - we must allow ourselves to feel our pain so that we are able to feel the pain of others.  Thank you."
From:  Charm Darby

"I just heard your dilemma about assisting suicides.  I listened to you and I think based on what I heard that you must be religious. That is the only reason you would want to keep someone here and suffering.  I don't understand people like that who have some inflated sense of morality.  I believe firmly in quality of life.  We can't simply keep people alive who don't want to be and are suffering immensely.  I do not feel death is to be feared, for death as much a part of life as birth."
From:  Jayme Newton, White Rock

Some of you saw things differently.

"I enjoy listening to you and was very happy that you felt very uncomfortable with the physician who felt fine with Mr. Marcos' decision to end his life because of Huntington's disease.  I am very much in favour of improving palliative care and encourage an ill person to hold on to life and to use the many pain-controlling medications available.  A physician's job, indeed, is to encourage and uphold life, all life, from conception to old age."
From:  Netty Vanassen, Alberta

"One of my thoughts in listening to the conversation was that Nagui talked a lot about sparing his loved ones from witnessing the changes and ultimate agony that he witnessed when his father was suffering and not about sparing himself so much.  Was the discussion ever had with him about ensuring and planning a dignified and peaceful end when the time came with interventions that would alleviate the struggle to breathe and any pain as is done in palliative care for cancer patients.  I wondered if he was caring too much about others than about himself and his right to live to live as long as he comfortably can.  His experience could be very different from his father's, especially with his own self-awareness, support from his wife and doctors, and so much more knowledge about the disease.  I hope he will reconsider his choice."
From:  Jane Johnstone, North Vancouver

I'm giving the last word for obvious reasons - as you'll read below - to Kim Burke of Halifax.

"I moved to Halifax in 1995 and became peripherally involved with two brothers with Huntington's disease.  Archie was my friend who was just starting to show symptoms with movement and speech and had told me about his older George who was in a long-term care facility.  Archie was reluctant to introduce me to George but as my cooking capabilities became more apparent, Archie decided that George needed some fattening up.  Once a strapping Navy cook, when I met George, he weighed maybe 40 kilograms.  At the time, I didn't know the severe nature of this disease and what Archie was both watching and facing.  Feeding George was like feeding a baby bird.  George has since passed away due to pneumonia.  I tracked down Archie three years ago. The last time I saw him he was strapped to his wheel chair as his motions threatened his physical health. This wonderful, proud man needed more protection than a baby.  I was fortunate enough to work for Nagui Morcos some twenty-five years ago.  It's not an easy name to forget, and I hold him responsible for my marketing diploma.  Even back then, he was a very dignified man.  Your sensitive and understanding approach with him and the way you questioned yourself during the program struck a nerve.  He sounded as wonderful and intelligent as I remember him.  This is a very sad disease for everyone.  Thank you for telling his story as I've been thinking about it all day long.  And thank you, Nagui Morcos."

And thanks to all of you for your many thoughtful emails.

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