Nfld. & Labrador

Palliative-care doctor left wondering 'what if?' after patient takes his own life

There was something about Leo — how he died, and how he lived — and Dr. Susan MacDonald can't stop thinking about it.

Dr. Susan MacDonald reflects on 'Leo' and whether she should have told him about assisted death

Dr. Susan MacDonald, a palliative care doctor in St. John's, wonders if more could have been done for her patient 'Leo.' (Ariana Kelland/CBC)

Susan MacDonald can't quite pick one reason why Leo sticks with her, pushing her to put pen to paper to tell the story of her patient, and how she feels she failed him.

Asked what sets Leo —  a pseudonym — apart from the rest, the palliative-care doctor shakes her head and sets her gaze away, "About Leo … I think, for one, I really liked him. I just really liked him."

The second fact, MacDonald said, is that his death — suicide by taking his own opioids for insufferable pain — was not his only option.

Medically assisted death would have allowed Leo to die without having health-care professionals standing over him in a fruitless attempt at reversing his overdose, she said.

"He was such an intensely private person and his death was so public, and it didn't need to be that way," MacDonald said. "There were options. It just really struck me and made me think."

MacDonald, an associate professor of medicine and family medicine at Memorial University of Newfoundland, reflected on her patient and what she could have done differently, in an article in the Canadian Medical Association Journal, titled Leo Died The Other Day.

The patient died within the last couple of years, MacDonald said, unable to comment further due to physician–patient confidentially. 

To raise — or not to raise — the option of assisted dying

For five months, she and Leo worked hard to control his intense nerve pain. But Leo's death was inevitable. He had cancer, and by MacDonald's estimation, had only weeks — maybe months — to live. 

Whether it was the physical pain that became too unbearable or the emotional struggle of his impending death, MacDonald doesn't know why he took his own life. 

"It was a very distressing clinical case for me because I felt, at the end of the day, I hadn't done the best I could for this particular patient," MacDonald said.

"It was a reflective exercise for me to look back and say, 'What could I have done better? Where are the problems? And what do we need to do about it?'"

Leo took his own life after battling terminal cancer and insufferable nerve pain. (CBC)

MacDonald said she never raised medically assisted death as an option for Leo. Neither did he. But she wonders if some patients want to bring it up but can't. 

Medically assisted death in Canada is legal. However, MacDonald said, there are no strict guidelines on how a doctor should broach the topic with a patient.

Changing the way she does things

Until Leo's death, MacDonald would wait for the patient to bring it up, but the manner in which he died has her pausing for second thought. 

"There may be people like Leo, who could avail of that option if they knew about it or if it was offered to them," she said.

"On the other hand, you have the potential to do harm by raising that question," she said, adding doctors run the risk of offending patients by even mentioning assisted dying as a option.

Medically assisted death is legal in Canada. However, there are no strict rules guiding how physicians should broach the topic with patients. (Radio-Canada)

"I've been doing this for 25 years now, and I still haven't figured out always the right thing to say and the right thing to do for people."

MacDonald hasn't gotten many more inquires about medically assisted death since it was legalized, she said. "Not nearly as many as you'd think."

Now, as she continues caring for those whose deaths are inescapable, she has Leo to think about.

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About the Author

Ariana Kelland is a reporter with the CBC Newfoundland and Labrador bureau in St. John's.