2016-06-15

Many patients upset over assisted dying legislative limbo, says doctor

by Emma Smith

  • <p>EMMA SMITH PHOTO</p><p>Dr. David Abriel, a palliative care physician in Lunenburg, started dialysis for diabetic kidney disease a month ago.</p>

Dr. David Abriel watched from outside the room as a pack of doctors tried to keep his dad's heart beating.

His father was in the hospital after another heart attack, when suddenly Abriel and his family were dragged out, "and 20 people came in, they put tubes everywhere and they're doing CPR ... and it was really a horrible sight, and for something that would have been futile right from the very beginning," said the palliative care physician, who works in Lunenburg, Bridgewater and Liverpool.

He was 18, and it struck him then that his dad was dying, everybody knew he was dying, but no one told his family.

Years later, he sat beside his mom, who, after a lengthy battle with breast cancer, refused a feeding tube. As a long-time nurse, she'd seen enough people suffer, but fresh out of med school, Abriel didn't know how to reconcile this with his training to "fix, fix, fix."

Now, the deaths in his life guide his work in palliative care. They inform his patient-centred approach, and even as he faces his own body's failings, they bolster his belief that those who suffer should have the autonomy to choose when and how they die.

"How many times in my care have I seen people dying a slow and miserable death, no matter what we did, not the type of life they liked, and finding ways to do that better occupied a big part of my practice," said Abriel, who moved from family medicine to palliative care 14 years ago.

On June 6, doctor-assisted death became legal in Canada. But Parliament failed to meet the deadline to impose new legislation, so the rules around carrying it out remain murky for some.

In Nova Scotia, the College of Physicians and Surgeons has said the Supreme Court decision, as well as provincial guidelines, provide enough protection and direction for doctors, but nurses and pharmacists are reluctant to take part until there's more clarity from the province.

That could come any day, but until then, Abriel has had to break the news to his patients.

"I had one patient tell me I delivered the saddest news they ever got, from all the doctors that told them about their cancer, that it was going to be incurable, that they were going to stop treatment, when I told them that we still weren't able to do aid in dying because I couldn't get the stuff set up," he said.

Carter vs. Canada allows doctors to aid consenting adults suffering from "grievous and irredeemable" illnesses. But Abriel worries that the government's interpretation in Bill C-14, "could put so many restrictions in that it makes it impossible to use."

"They could leave out groups of people, like mature minors. God, if you're old enough to go to war, if you're old enough to have a driver's license, you're old enough to decide if you've suffered from your cancer long enough," he said.

Over the years, Abriel has had numerous requests from ailing patients to help them die. Most, he says, change their minds and die on their own. But for others, it starts a conversation.

Under the law, physicians aren't compelled to carry out assisted dying, but Abriel sees it as part of a doctor's duty.

"This is a patient-centred, publicly funded health care, that if you are paid by the public and you work for the public, and it's a legal procedure, you shouldn't be using ... your belief system to block it," he said.

At over 6 feet tall, Abriel towers above his patients, most of whom are confined to hospital beds. The first thing he does when he meets them is tell a joke. Humour is how he copes with his own diabetic kidney disease, which a month ago landed him on dialysis three days a week.

It's meant he can't jog anymore, but he's still working, walking and throwing the ball around with his dog. After seeing others battle through dialysis, he thought it would be the point where he considered life not worth living, but so far, he's been managing.

Even so, he's thought about the end, he knows when he might ask a doctor to do what so many patients have asked of him. Still, he says with a chuckle, "I'm not afraid of being dead."

A number of years ago, a heart attack landed him in the hospital, and his doctor told him this could be it.

"I had a long night to think about dying and being dead, and it changed the way I feel about it. I mean, there's being dead and there's being dead. I mean, we're all dead. Everyone for the last 10,000 years is dead," he said. "And it's got to be the natural thing to do. What do you fight about?"

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