Christine Cserti-Gazdewich / from YouTube
Although Canada has recognised a legal right to euthanasia, a number of loose ends need to be tidied up in the laws of the provinces and territories. Amongst these is defining the scope of conscientious objection for doctors who do not want to be associated with euthanasia.
A standing committee in the Ontario legislature is studying amendments to Ontario laws related to medically assisted death. Dr Christine Cserti‐Gazdewich appeared before the committee to testify in favour of conscience rights and gave the following presentation.
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I am a blood science specialist, stamped indelibly by the Krever commission. I know the dangers of system silence. I serve as an associate medical director to the laboratories dispensing safe, compatible blood products to dozens of Ontario hospitals, some as far north as Attawapiskat.
I am an assistant professor at a nearby medical school, with my primary appointments at the downtown teaching sites.
I am also a clinician, treating disorders marked by self-destruction, bleeding, clotting, or malignant overgrowth. My research has delved into the evolutionary biology of diversity and how to overcome barriers to blood and organ matching. At the end of the day, and with my colleagues, I love my patients, and we share the honour of caring as best we can.
I’m also a secular humanist, a vegan environmentalist, and the daughter of east European immigrants. Half a century ago and a decade apart, each of my parents fled a regime where the game was unanimity.
Personal experiences explain why I cannot thread the needle of MAID and why I hope for conscience protection in this land that my parents came to when they sought freedom for themselves and their children.
I was turning 20 when my mother was dying; she then was at an age similar to mine now.
When I reflected on the sorrow we felt with her suffering and the disappearance of future decades together, I thought that if a crystal ball had shown me what we were about to go through, I might well have shot the both of us before shedding the first tear. But then I was so thankful for the blind and healing linearity of time, and for every moment in between. I also thought that if she had asked me to inject her with an agent endowed singularly with the property of arresting her heart or to find someone else to give it, I could not and that I would be honest with her as to why.
After MAID was legalized, I realized that if I could not abet the suicide of the greatest love of my life, then I could not do the same for a stranger, whose place in my own practice I aim to position as reverently as that of my own kin. This is not out of arrogance, but humility.
Some years later, I got married, and my spouse and I tried to become parents. For medical reasons, the ease with which life comes into the world was not ours to have. I say this sincerely: Life, to me, is a breathtaking miracle in this mad universe. I know what it is to lose it, to hurt and to fail to channel it. I go to work every day joining others on similar journeys. But I fear that my values may soon be held against me when up to now they were an asset.
I am here to ask for two things: For patients to have the power to self-refer and for their clinicians to have the right to conscientiously refrain from MAID-related activity.
A care coordination service is a must. Some patients don’t have doctors. I will tell you practically: If “effective referral” is something that you think materializes quickly, think again. Insinuating an MD—even the most energetic and agreeable one—is another discriminant between the haves and the have-nots, and a spacer between communication and action. Patients considering MAID deserve no less than the same direct access and discretion afforded to others in the midst of their most private crises of reproductive or mental health.
As for conscience, the right to reasonably object to a procedure may percolate valuably into other Gordian knots. My colleague may recuse herself from inserting a nasogastric tube into a pregnant political hunger striker if indeed force-feeding is the preliminary order of a few decision-makers. We owe honest feedback signals to our hierarchies in uncharted territory. When commanding these edges of life, conscience deserves respect, and James Downar would agree. Laws aren’t mere instruments but cultural memoranda.
Conscientious objectors are not insulting our patients if they are enabled to seek their own will. Some of us hold an equally logical counter-position on life-terminating compounds. Today, veterinarians have more experience with euthanasia than we do, and American executions of human beings have been botched in imitations.
Uncertainty begs for analysis and criticism. Conclusions in science and legislative decisions utterly depend on such debate. Free conscientious objection to MAID is what peer review is to science. It’s something that reveals flaws and coaxes improvements. This constructive dialogue is not a bedside sword but the vitality of a system striving for excellence.
Prohibiting dissent and permitting disciplinary actions by licensing colleges will do this: bake a North Korean-styled moral Darwinism into Ontario. Only those who agree, and those too timid to disagree, comprise what remains.
Without amendments, we face quantitative and qualitative corrosion of our health care workforce. Scores of patients could flounder after default expulsions of their health care workers. Is such an effect preferable to the awkwardness of hinting at the sanctity of life?
I don’t disagree that we clinicians must, and do, sacrifice a lot to promote the fulfilment of our patients’ aspirations in the optimizable boundaries of their health. However, I don’t believe that this mandates collaboration in actions that can induce the moment of death, the other side of which remains inaccessible to science.
Many also know that clinician well-being is an essential precondition to best patient care. How do we reconcile new guidelines to limit exhaustion with the simultaneous dismissal of our moral anxiety?
We cannot afford that which further increases the pitch of medical error, burnout, functional extradition or gagging that which compelled many of us to dedicate our lives to the sick.
Assistant Professor Christine Cserti-Gazdewich is a haematologist at the University of Toronto.