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Dr. John Patrick

Photo: Christian Medical & Dental Society

On May 11, Sharon Dewey Hetke spoke with Dr. John Patrick about assisted suicide and the need for conscience protection for Ontario physicians. Their conversation  coincided with the hour that thousands of Canadians joined the “March for Life” on Parliament Hill in Ottawa.

TAP: I know that Bill 84, the Ontario government’s legislation on assisted suicide, did not change the Ontario College of Physicians and Surgeons’ policy of forcing physicians to either participate in or refer for assisted suicide. Is it still possible to change the mind of the College?

JP: It’s always possible to change it – this is largely one man who controls the committee that makes these decisions, and he’s influential. I do believe it can be done. They do believe in democracy, and pluralism, so show a bit! 

TAP: Are there physicians of various faith backgrounds who are opposed to this?

JP: Well yes, of course – all the great Abrahamic faiths should in principle be opposed to this. There are always people who aren’t, but the bottom line is we’re supposed to be practicing patient-centred medicine. Now if this goes through, then no really serious Christian doctor will be available to anyone at their death. You can’t have, if the College has its way, a seriously orthodox Christian doing palliative care even. We started it, for goodness sake!

TAP: And what is the importance of those final, palliative days or weeks?

JP: An awful lot of people make their peace with God right at the end of their lives. The last 6 weeks are a time of incredible reconciliation in many deaths, and they want to cut that out. And one of the driving forces are the bureaucrats who just see the short-term money saving. But just as we’ve discovered with abortion, the consequences of going down that route produce a patient with huge medical needs.

TAP: And what are the repercussions for those, the doctors and the family, who participate in the act or the decision leading to it?

JP: If you are slated to connive in the premature death of someone you love, it’s likely to plague you. And we already see doctors – who are not notorious for thinking too deeply about things, we’re too busy! – but those who said “Yeah, I’ll do it” some are already saying “This is more serious than I realized.”  The first euthanasias were done by doctors in Germany because the Germans passed a law saying that you could die if you had medical problems, and furthermore you could kill patients who had a “life not worth living.”  Now the doctors who started doing that initially did it by injection. But that was too close to the event, so it was a doctor who built the first gas chamber. And when you got to Aushwitz, you were met on the platform by a doctor in an SS uniform. And he did a very cursory examination. He looked at you to decide if you had enough muscle mass to work. If not, straight to the gas chamber. If yes, we’ll get some work out of you first. Jay Lifton wrote a book called The Nazi Doctors after the Second World War because he wanted to understand what drove these people to do what they did. And they lived schizophrenic lives – they were apparently nice people, and then went to the office and became a killer.

TAP: So it’s not the first time that physicians have been co-opted into a death regime.

JP: Pre-Hippocrates, killing is profitable! There is a clear conflict of interest in this. Because when people die, money changes hands. Doctors will have opportunities for a little quiet corruption. You can imagine a young man coming up to a bar one night and saying “You know, if my Uncle George doesn’t survive this illness, you might get a Mercedes.” And any class of medical students today will tell you there are people in their class who they know would do it. They know within weeks that about 20% of the class are not trustworthy. The faculty never know, because these scoundrels are clever. So the whole thing has not been discussed at a deep enough level. The key question is “What is entailed when you kill? What must you believe?” You must believe that the life you’re taking is not worth living. And we’re already attacking about 30 conditions that cost a lot of money and are difficult to live with. But the children I’ve looked after that have those conditions don’t express a desire to die; they wish they didn’t have the disease, but they still want to live.

TAP:  It’s very strange…especially when it comes to the mentally ill. The “argument” is that if someone is suffering so badly, then suicide is an acceptable option. Well, isn’t everyone who commits suicide suffering terribly?  So why are we doing anti-suicide programs at all?

JP: Well, we will stop doing them because it becomes logical not to. The difference between our world now and the world 400 years ago, and it’s been declining ever since, is loss of purpose. When it was Christendom, everybody believed that the best way to live was to love God and enjoy him forever. And love was not defined as a feeling, but as obedience.

TAP: I think a lot of people would say “We understand why you shouldn’t be made to do it, but why not refer to a doctor who will?”

JP: Put yourself in the situation of a person when the Nazis were looking for Jews. It’s the same phenomenon. You say, “But it’s just referring, he’s not killing the Jews…”  But that would make him complicit in the act. And to be complicit in an act, we’ve understood throughout history – maybe we’ll make a slightly lower punishment, but we don’t say it’s forgivable. It’s still illegal.

TAP: I know a lot of Anglicans would say this is the way of compassion, just as you would do with putting down a sick dog, or a cow.

JP: C.S. Lewis nailed that a long while ago in “First and Second Things.”  This is the problem of getting something that is secondary, first. Truth is the first in the Judeo-Christian tradition, overall. So the analysis should be about what is true. Now they define compassion as a feeling, but the real word means “to suffer with.” If you suffered with them, you would help them to die a better death. The liberal Anglicans have gotten themselves into a terrible mess. They have done so many things now based on how you feel. Well, if you start running your morality on that basis, you’re going to get into trouble. I know that as a young doctor, there were several times, if it had been the norm to kill someone, and I hadn’t thought about it…

TAP: And how much of that would have been compassion and how much would have been you, as the doctor, taking an easy way out? 

JP: It’s very hard to sort that out. In most cases of terrible suffering, it’s ourselves we’re most concerned about. I spent a lot of my life dealing with severely disabled children. Not all the children suffered but those who did we could make comfortable. The people suffering were the people who were being pushed toward empathy. And they were feeling what the children didn’t feel. That’s precisely what these children are meant to do in society.

TAP: Are you concerned about the slippery slope in all of this?

JP: We’ve gone off the cliff. There’s nobody that’s safe anymore. If it’s a bad day, and the doctor decides that you’re better off dead, they can do it and get away with it. The decision on euthanasia was totally ahistorical. There was NO discussion of the fact that the Nazis began their slippery slope with euthanasia of the Jews. NO discussion of the fact that with all the legal and procedural barriers that were put in place, the Dutch did that 25 years ago, but every year statistics [show] between 500 and 1000 people are killed without any evidence of consent – and nothing happens. Given the “feeling culture”, those laws are no defence at all. If you go to hospital in Amsterdam, it’s quite likely that after a while of being in bed, someone will come along and say “For a small fee, I can sit and make sure nobody puts anything that will kill you into your drip.”  That’s where it’s got to in Holland – who ironically were the one nation, under the Nazis, who refused to kill the handicapped. Even when Hitler killed some of their leaders, they still wouldn’t do it.

TAP: I saw a headline recently about Denmark celebrating the fact that they’re going to be “Down’s Syndrome-free” within a few years, precisely through screening and abortion.

JP: In Denmark the royal family wore the yellow star, so that was another place where the killing of the Jews was reduced. It boggles the mind. And Down’s Syndrome children are not unaware that a lot of people think they shouldn’t be here. But in fact they are huge sources of joy and goodness that we lack. The medieval said of the mentally disabled that they carry no grudge into tomorrow. If we could do that, how much better our world would be.

TAP: Do you think assisted suicide changes the relationship between patient and doctor?

JP: Once doctors kill, it rationally undermines trust. Hippocrates said, “We will not kill, because we want to increase trust.” This will rationally undermine trust. So my line, and I’m not joking, is I think only lawyers and politicians should be allowed to do it; in fact they should be required to do it. Doctors are the one group who should be forbidden to do it. It’s not difficult. A few hours’ training would be enough to make you a killer. So why do they want doctors to do it? The only possible reason is they want to co-opt the reputation of medicine so that this gets an “aura of goodness.”  But what they’re doing is destroying even further the reputation of doctors. So lawyers and politicians – at the very least they ought to be present when it happens. When I say that a lot of people laugh, and then they say, “But you’re right.” They make the laws, they should suffer from them. I see the doctors suffer already in Ontario, because so many say, “I can’t do this.”

TAP: And what will you do, or what will other Christian physicians do if the mind of the Ontario College can’t be changed?

JP: I’m retired...but others have no option but to either stop medicine or find another area of medicine. Or, and they can do this, and some are doing it: every time they’re asked to do it, they phone in – they need stress leave. You get stress leave for everything else, you can have it to avoid this. I don’t know how far this will go before we wake up.

TAP: As far as I understand there is to be clear consent on the part of the patient. When does that line get crossed? In the Dutch case, did the law shift?

JP: No, no, the law’s still there. Procedures are still there. But people are being killed because they’re depressed and they say, “I don’t want any more depression.” There’s even a protocol for killing newborn babies, who are in no imminent danger of death, but because their life is judged by the doctors not to be worth living. That was published in the New England Journal of Medicine. And most of those children have spina bifida. Lots of children [with spina bifida] are in a wheelchair. And yes, they don’t like being in a wheelchair, but they’re glad they’re alive!

TAP: So the parent can consent on their behalf, in a case like that?

JP: Well it hasn’t been challenged, not in a definitive way.

TAP: Tell me what people can do.

JP: First, every church should get someone who knows what they’re talking about to give a talk on what euthanasia involves. I’ve done several now, and the question periods go on for an hour or more – after an hour’s lecture. They haven’t thought about the implications, what it will do to the whole structure of society. So they’re rather stunned as to what happens. What is entailed when you say, “I have the right to be killed.”  What does it do to other people? One person’s privilege will be the other person’s duty. If you’re an old person, and your family’s not very rich, and are having to pay for your care, you begin to feel guilty. Dr. John Scott, who is the head of palliative care in Ottawa, gives a wonderful talk on how we are losing the capacity to recognize a lament. When a patient says ‘Oh, my life’s not worth living – you’ve got to let me go.’ What they’re actually saying is ‘Tell me I matter.’ It’s a lament. And we should be saying ‘Oh, but you matter so much to us!  It’s our pleasure and joy to care for you.’   TAP

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