Assisted Suicide (Carter V Canada)

In February of this year, the Supreme Court of Canada unanimously decided that an absolute ban on assisted suicide is unconstitutional.

In September of 1993, I was 11 years old and just starting 6th grade. At the same time, a woman by the name of Sue Rodriguez was fighting in front of the Supreme Court for the right to assisted suicide, an act she could not perform herself because of her debilitating ALS. I had never heard of assisted suicide before, nor had I really contemplated the end of life or the suffering of others. I was mostly interested in baseball cards and girls, but Sue Rodriguez lost her case, and all of a sudden I was outraged.

By the end of that year, my teachers grew bored of my endless essays on the topic. I spouted human rights and dignity. I spoke of pain and suffering. I often quoted Sue Rodriguez in asking “whose body is this?” In short, I was an annoying kid, but I had very strong beliefs; beliefs that I still mostly hold today.

So in some respect, I was surprised at the significant sadness I felt when I heard of the Supreme Court’s decision in Carter vs Canada. This was a decision I had always felt was legally and morally correct. It should have felt like a victory, but it just filled my heart with sorrow. I wasn’t hearing a victory for human rights and personal freedoms. I was just hearing a disheartening cry for help.

I have spent more than half of the two decades between these decisions training to become a physician. Although I now practice emergency medicine, my passion throughout medical school was always palliative care. I spent most of my elective time with the palliative care team. Amongst the exhausting grind of medical training, my time in palliative care was rejuvenating. To many, that may sound strange, but I am sure that anyone who has witnessed good palliative care will understand me.

So many things we do in medicine have such a small impact. I can talk for hours about diet and exercise, knowing that most patients will never be able to make a significant change. I arrange rehab for patients, only to see them back in the department drunk and injured again. As a family doctor, I was devoted to preventative medicine, tackling diabetes, hypertension, and cholesterol, but it was impossible to know if I had ever actually helped a particular patient.

My days in palliative care were such a refreshing change. We would start the day rounding on newly referred patients, with pain, or nausea, or shortness of breath so severe their regular doctor could not find a way to help them. We would talk to the patient and listen to their hopes and goals. Then we would start an aggressive treatment plan. When we finished our day by rounding on the same patients again, every patient would feel better. We were making instant, impactful changes. I had never seen patients so grateful. Nothing else I do is as rewarding.

What this time in palliative care taught me is that we can treat suffering, but sadly, it is something that we frequently do poorly. So when I hear the arguments for assisted suicide, I no longer hear the logic about personal liberty and the right to choose. Instead, I hear a faulty premise. I hear patients that are suffering, who think that the only way to stop their suffering is death. That is heart breaking, but I think it is wrong. Suffering can be treated. Suffering must be treated, and we must do a better job of treating it before we ever consider death as the answer.

When an individual presents to the emergency department with suicidal thoughts, we don’t discuss their personal rights. We recognize their suffering and we do everything in our power to help them. We must similarly recognize suicidal ideation in the terminally ill as a sign of suffering and do everything we can to treat it.

I won’t debate whether assisted suicide is right or wrong. I think that is the wrong question. The better question is: how can we help these individuals, who are obviously in desperate need? We need to demand better palliative care in this country. If done properly, I think much of the desire for assisted suicide would quickly disappear.

Research, Rants, and Ramblings

Today I am going to launch a secondary feature on my site, called Research, Rants, and Ramblings, where I will be able to break from my usual format and share my thoughts on a wider variety of topics. I don’t plan on publishing here often, but anyone who knows me knows that I love to rant, so this will give me the occasional outlet. Also, I currently write a monthly literature review newsletter for my group highlighting the best articles I read each month, and I thought I would share that here as well, in case anyone was interested.

For anyone who is not interested in receiving updates about these non-core First10EM topics, I would suggest using the following RSS feed, which will only contain the core content:
http://www.First10EM.com/category/first10em-cases/feed/

If you want to receive updates about everything on First10EM, you can continue to use this RSS feed:
http://www.First10EM.com/feed/

Massive Hemoptysis

A simplified approach to the initial assessment and management of emergency department patients with massive hemoptysis

Case

The charge nurse grabs your arm and pulls you into the resuscitation bay, where EMS have just unloaded a 45 year old guy in obvious distress, coughing up a significant amount of blood. The paramedic tells you, “He doesn’t speak English, so we don’t know a lot about him. My guess is that he has already coughed up about 250ml of blood on route. He still sating OK, and his pressure is holding, but I’m just glad we got here. He’s all yours doc…”

  Continue reading “Massive Hemoptysis”

Procedure: Umbilical Vein Catheterization

A review of umbilical vein catheterization

Case

You find yourself leading a code pink in L&D, with no pediatricians to be found. You have already moved efficiently through the neonatal resuscitation algorithm, but despite clearing the airway, bagging, and chest compressions, the baby is still flat with a HR of 50. It is time for medications, but your experienced neonatal nurses have not been able to get a line. They look at you expectantly: “umbilical line, doc?”…

  Continue reading “Procedure: Umbilical Vein Catheterization”

Neonatal (Newborn) Resuscitation

Case

Code pink in labour and delivery, and you are the only doctor in the hospital tonight…

 There is a newer version of this post available, based on the updated 2015 ILCOR/AHA/ERC NRP guidelines. Please click here to see the most recent version.  Continue reading “Neonatal (Newborn) Resuscitation”

The Simplified Approach to PEA (non-traumatic)

A simplified approach to the initial assessment and management of emergency department patients in PEA

Case

A 60 year old woman is brought into your resus room VSA with CPR in progress. The paramedics tell you that she had a witnessed arrest and bystander CPR was performed for 4 minutes before they arrived on scene. They found her in PEA, took over CPR, started an IV, and rapidly transported as they were only 5 minutes out…


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The Difficult Delivery: Umbilical Cord Prolapse

A simplified approach to the initial assessment and management of emergency department patients with umbilical cord prolapse

Case

Once again, a 34 year old G5P4 woman at 39 weeks gestation is wheeled into your resus room in what appears to be precipitous delivery. You perform a quick exam, but instead of encountering the presenting part, you feel a pulsatile cord. Oh no, you remember hearing about umbilical cord prolapse back in medical school…

  Continue reading “The Difficult Delivery: Umbilical Cord Prolapse”