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Posted: April 18, 2009, 10:25 AM by Yoni Goldstein Cristina Alarcon
Let me tell you about Jane*. Jane was in her 60s and had been my patient for many years. As her pharmacist, I knew she had been battling depression for a long time, but she was always chirp and cheerful when she walked into the pharmacy for her monthly pills.
Slowly, she started going downhill. Medications were not helping and she said she just wanted to die. One day she came in and asked specifically to see me. From her pocket she pulled out several tablets, one I recognized as a powerful narcotic, the other a sleeping pill. She said, “My friend gave me these … how many would I need to take to make sure I die?”
Protection of conscience was a hot-button topic in Canada last year when the Ontario College of Physicians and Surgeons, urged by the Ontario Human Rights Commission, entertained the idea of restricting the freedoms of conscience and religion of its members. In Canadian pharmacy practice, changes in codes of ethics since the mid-1990s have also led to the prioritizing of patient autonomy at the expense of conscience- and virtues-driven professionalism of some practitioners. But has anyone really thought about what our patients really want or really need? Do they want health professionals who deliver services as automatons, following a pragmatic, guidelines-driven ethics, or do they want professionals who are also genuinely human?
Now let’s go back to Jane.
Were I to follow my current code of ethics, I would have to tell Jane that I could not get involved because I would be imposing my morality. If she really wanted to die, then it was her own business as she was an autonomous human being. In fact, policy number 35, I’d have to say, prohibits me from discussing with you any moral objections I may have.
Instead, I used my God-given conscience and common sense. I immediately took Jane aside. We talked for over half an hour, and I told her I didn’t think this was a good idea.
Finally I said to her: “I can’t ask you this as your pharmacist, but as your friend, do you believe in God?”
“No,” she answered.
“Well, I do,” I answered, “And I believe He loves you and created you for a very special purpose. You still have a lot to give to others. Do you mind if I pray for you?”
“That would be good,” she answered. And then she gave me a big hug.
Some weeks later, Jane did try and failed to kill herself. After her hospitalization, she came in to thank me for my prayers. She was convinced that they had helped to keep her alive. She was ready to give life another chance and she seemed happy and hopeful. But again several months later, the medication was not working, and, in the end, Jane eventually did succeed in taking her life. There are many others like her who slip through the cracks of our pragmatic bureaucracy.
More and more, medical licensing boards proclaim that we must not “preach” to our patients or “impose” our morality. What they fail to see is that we are not just dealing with a body we are dealing with a human being.
It is absurd that, should euthanasia be legalized, I would be prohibited by my licensing board from expressing my concerns to someone like Jane. Not only that, but were she to present me a prescription for an overdose of morphine, I would be required to give it to her if no one else were available to do so. My only other option would be to tell her, “Look Jane, I can’t help you to kill yourself, but my colleague will.”
– Cristina Alarcon is a pharmacist at Hollyburn Medicine Centre in West Vancouver.