Conscientious objector

June 28, 2016 -- Sarah Mundell

Conscientious objector
A Canadian surgeon helps patients face their suffering without speeding up death

By Sarah Mundell

An 81-year-old cancer patient was pleading with him: in case the surgery went badly, she did not want to survive.

Normally, Dr. Rosaire Vaillancourt, a thoracic surgeon from Québec, Canada, would not operate on someone her age. But besides her cancer, she was exceptionally — and she had things to do, she said. The surgery offered her around 80% chance of cure versus palliative radiation therapy with significant chances of late complications.

But she was scared about the chances of it not going well, what she would have to live through if, instead of helping, the surgery created excruciating pain. She was afraid of losing her autonomy.

Last December, euthanasia became a legally recognized medical treatment in Québec. Hospitals must now provide it upon patient request and certain conditions; although doctors there still have the option to conscientiously object. So this patient’s plea was not theoretical, but Vaillancourt had not put his name on the list of providers.

With more than 27 years of experience, and having lived through other similar moments with other patients, Vaillancourt understands the pain, the fear and the real chance that something can always go wrong in surgery. But he explains to his patients from the beginning why euthanasia is not an option he will provide. For some this is reassuring; others are indifferent.

“I hope that by taking care of my patients and assuring them that they will be comfortable, it will help them not to choose that path to euthanasia,” he explains.

He seeks all other ways possible to care for his patients, and when necessary, to help them live their sufferings with dignity. In the case of unsupportable pain, he offers the assurance of pain relief and comfort. In the face of fear, support and compassion. And when death comes too soon from a late discovered illness or after major complications of surgery, he offers the chance for families to meet with him afterwards to process what happened.

With this 81-year-old patient, he met with her and her children to discuss palliative care in the case the surgery ended in greater suffering. “There is a lot you can do that is ethically in line with Catholic teaching,” he said. “You can manage pain, but you cannot purposely speed up death.”

Offering this patient support also meant preparing her for how things would be different after surgery. “We all will lose our capacities one day,” he told her, explaining that she will need help for weeks or months after the surgery, and that it was normal. Then he made sure that her daughters knew what she wanted. She was peaceful with the solution, and the surgery went well.

“Today people don’t want to accept that they will suffer and die,” he said. “Patients get frustrated with being sick. They ask me to ‘get rid of this for me,’ but that is not always possible. So part of my job is to help them accept their limits.”

In other areas of life and social service, Vaillancourt has seen how suffering also has value, both for those who suffer and those around them. “It can be a wake-up call to a deeper experience,” he said. “There is some kind of spiritual process in this.”

So with his patients, too, he tries to allow time for this process to occur: to prepare them for change. Except in the case of sudden death, it is possible for him to discuss with patients and their families the options they have and allow them to process the idea of a sometimes difficult future.

Even with all the options, he knows there may be a day when a patient asks for a different doctor in order to receive the pharmaceutical cocktail that would end their life early. “I would be required to refer them to the medical director, who would just send them to another doctor who will comply. It’s not a perfect solution, but it is what I can do in this moment to stay true to my conscience.”

Vaillancourt is grateful that so far in Québec (the debates are still underway), his conscience is still protected by law, as this is no longer the case in some other provinces. And he is working with other medical professionals to ensure that this right to follow one’s conscience and not provide euthanasia remains as the local government works out the dynamics of how the procedure will be available.

If Québec law ever changes and he would have to offer euthanasia, he would stop doing major surgeries or even consider retiring, since he’s near the time. But in the meantime, he does his best to offer his patients the best care possible while helping them accept an eventual natural end of life.   ​

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