Is there a point when MAID aligns with the Hippocratic Oath?

W. GIFFORDJONES MD

DIANA GIFFORD-JONES

TC HEALTH REPORTER

Readers of a great age face a common problem. It’s called frailty or general weakness. The frail elderly are at risk of falls that require hospitalization, often leading to palliative care. As the condition progresses, independent living at home can become impossible. For people who have reached the end of their desire to continue, frailty presents a medical dilemma for doctors. How much frailty is needed before the doctor allows, “There’s reason enough to end life by Medical Assistance in Dying (MAID),” and would a veterinarian be the better professional to make this decision? One of the conditions that doctors must decide at the end of life is whether weakness is reversible. This obviously makes sense when considering life or death situations, but frailty is not like a mathematical problem where there is a right or wrong answer.

Many readers know that I have always fought to end needless suffering. I have followed the edict of Hippocrates, the Father of Medicine, who taught that doctors should do no harm. To my mind, allowing crushing agony to continue is more than terribly harmful.

It is because of this attitude that I fought for five years against well-known organizations, such as the Royal Canadian Mounted Police, pharmacists, and politicians who vigorously fought against the legalization of heroin to ease the pain of terminal cancer.

Two things finally helped to legalize heroin. I visited England and Scotland where heroin had been available for 90 years for pain relief. I talked to experts about pain control, which showed that the troubling perceptions surrounding heroin were wrong. I delivered in person forty thousand handwritten letters from readers who had seen loved ones die in pain to the Minister of Health in Ottawa. In 1984, heroin was legalized in Canada to treat pain for terminal cancer patients.

A CMAJ article reported that 53 patients who selected MAID had suffered “multiple geriatric syndromes,” a combination of medical, social and other conditions that involved unbearable suffering. These patients did not have a life-threatening disease, but their lives had degenerated to such a state that a decision to use MAID aligned with the Hippocratic oath. Other studies show that once severe frailty occurs, patients live 3.5 to four years. Weaknesses often lead to great frustration and depression. There is no universal answer to this dilemma for doctors. Some physicians will never end lives by MAID due to religious, moral, or ethical grounds. For them, there is no compromise.

My family, on the contrary, is quite pragmatic about the end of life. They know I would not want to suffer from severe frailty. A decision to conclude enough is enough would depend on my: doctor, wife, and children. I have only half-jokingly expressed the opinion that I would want a veterinarian to help make the decision. I know how veterinarians ease the suffering of animals. paul@carib101.com

Our family has seen the lives of several much-loved dogs ended by painless injection when they are in agony. It’s a shattering moment to bear. But it has always seemed consoling to me that veterinarians and families, without being able to converse with pets, know when their suffering is unbearable and needs to end. Yet some doctors, who are able to discuss this matter with patients, often allow severe weakness and suffering to continue much too long.

So, doctors should listen hard when patients say, “Please, I want to die and end this agony.” After all, the patient is the only one who knows the extent of the pain. Prolonging unbearable pain makes no sense, not to the veterinarian.

It was a phenomenal turnout when over 300 individuals were present for the Zoom meeting on Wednesday, July 26th, to strategize support for Kike-Kojo Thompson. As principal consultant of KOJO Institute she has received widespread mainstream media attention about former TDSB principal Richard Bilkszko who committed suicide after being present at her equity training sessions in 2021.

In the wake of the TDSB launching a lawsuit against her and the Ministry of Education conducting an investigation into the details of the training, Advocacy of Peel organized this meeting. There were: educators, community representatives, social justice advocates, and human rights activists such as Kingsley Gilliam who provided an historical analysis of this struggle.

In the email promoting the crisis meeting, it reads, “Dear Black Community Stakeholders, anti-racism work in the province is under attack, and as a collective of Black advocates, organizations, individuals, and stakeholders, we must respond now COLLECTIVELY.”

There are concerns expressed with respect to the fact that the Ministry of Education has decided to investigate the equity training session that KOJO Institute was a part of. The email notes, “It has come to our attention that this incident is being used to fuel a right-wing response calling for the dismantling and HALT to equity and antiracism work in our province.”

This planned meeting was orchestrated to demonstrate complete, total and full support of valuable, inclusive and revolutionary equity work that Kike does with KOJO Institute. The email notes, “We will not stand idly by as the progress we have fought so hard to achieve in the fight against systemic racism and discrimination is threatened. It is imperative that we come together as a united front to address this critical situation. The meeting would provide a post for us to strategize the efforts to undermine anti-racism work in our province.”

There were many discussions, conversations, and engagements among the participants regarding strategies, processes and protocols to follow in the days ahead.

Idris Orughu of Advocacy Peel and Kearie Daniel, co-founder of Parents of Black Children (PoBC) supported by the Ontario National Association of Black Educators hosted the event. Kathy McDonald, a Trustee with the PDSB and Karen Brown, President of the Elementary Teachers; Association of Ontario were in attendance.

The high-level summary of the meeting includes the following:

• Participants discussed the community’s concerns about the government’s approach in announcing a review of the incident to former TDSB principal that took his life

• The community spoke to and acknowledged the villainization and criminalization of the KOJO Institute and antiracism work as whole

• The very real threat to anti-racism work was identified and addressed

• The link to an equity training session and suicide was called out as misguided and irresponsible

• Many mental health providers spoke of the nuances of mental health and to the centuries of work the Black community has contributed to protecting the well-being of our children within these systems

• Not allowing anyone to threaten the anti-racism work occurring in Canada

• Not allowing anyone to eradicate the very necessary: equity, diversity and Inclusion work that contributes to the safety and well-being of our children

There are three specific steps that will be forthcoming within the next few days such as:

1.Meeting with Minister Leece: They have requested an immediate emergency meeting with Minister of Education. Select organizations will attend this meeting and share the summary of this meeting

2. Community-Person Press Conference: A tentative date was set for Wednesday August 2nd, 2023 at 10:00 am during which a joint statement to show solidarity and determination in preventing the dismantling of anti-racism work will be read.

3.Community Statement:

They will draft a community statement that will be released and read at a press conference. This statement will represent the Black community organizations’ collective stance.