by:  Dr. Will Johnston

On Oct 18, 1859, John Brown's ragtag band of fanatical anti-slavery activists, with the blood of several pro-slavers already on their hands, attacked the U.S. government arsenal at Harpers Ferry, Virginia. John Brown was insane in that special way that all fanatics are - he held his chosen cause above the lives of those who got in his way.

We now see the abolition of slavery as a major step toward true civilization, but it was not achieved by terrorists. Others did the real work-a slow and painful process of debate, impassioned rhetoric, endless appeals to conscience and fairness. Finally, aided by political and economic changes as much as moral progress, they put an end to treating black people as objects.

One hundred and fifty years is not a long time - just long enough to change the victims, not long enough to change the bad logic that lets the killing continue on both sides of an issue which mirrors slavery in some fascinating ways: abortion. In John Brown's day, slavery was justified by talk of "States' Rights", the right of the (real) people to "choose" the advantages of slave ownership, and the conviction that a black slave could be the absolute property of his or her owner. Now we hear the claim of abortion as the centrepiece of women's rights, the choice above all choices, the proof that the unborn child must be the absolute property of his or her owner. Back then, the dreams and aspirations of the slave owner were seen as more important than the slave's very life. Now, we recoil from that, only to hang the baby's life from the same well-worn spot on that balance of convenience and self-interest.

A few days ago, someone with John Brown's kind of craziness murdered Dr. Slepian in Buffalo, New York. A hapless government soldier like Brown's victims 150 years ago, Slepian fell prey to a conflict much bigger than himself, a conflict which brushed away his life as easily as he had scraped away the lives of his patients' unwanted children. Facile talk about serial killers aside, a normal mind gasps at the monstrous arrogance of a deliberate, planned cancellation of someone else's life. Adding insult to lethal injury, Slepian died knowing that support for abortion inside his own profession is a mile wide but an inch deep. Why? Fewer and fewer doctors are willing to perform abortions, a trend that was firmly in place long before crazies started shooting abortionists. In the words of Vancouver gynecologist Gary Romalis, wounded by a sniper four years ago,

"Abortion has always been viewed as a kind of subterranean thing. Children don't walk around saying 'my father is an abortionist'. It's boring, it's repetitious, it's not particularly technically or intellectually demanding...."

Hardly recruitment-poster material for the next generation of abortionists, but there is another way to swell their dwindling ranks - coercion. Inside the "pro-choice" establishment which is currently in control of our health care system , some choices are more equal than others. Try rating the status of Margot Bourassa, a final-year resident in our own UBC Obstetrics training program:
"I have chosen not to perform or promote abortions. Unfortunately, this particular choice is not acceptable to the "pro-choice" lobby in our medical school. I am frequently challenged to defend my beliefs, and I am closely scrutinized lest I communicate my "bias" to patients. Residents who approve of abortion are accepted without question, and there seems little concern that pro-abortion bias will seep into their contact with patients. Likewise, little concern is shown for my discomfort at the widespread destruction of so much young human life."

Bourassa continues: "Meanwhile, the UBC Obstetrics program is receiving proposals from the pro-abortion movement that abortion training be mandatory for all residents. At present, that training is freely available but it seems that not everyone is eager to take it, to say the least. In one scenario, you could be forced to reveal your conscience on abortion before being accepted for Obstetrics training, while they could pass you over for someone else. If these people have their way, some day a woman will have no choice but to be the patient of a pro-abortion physician."

Amazing. "No choice but pro-choice", the crowning hypocrisy of this vacuous "choice" rhetoric. When you've sunk this low, something's gotta give. The public will eventually feel the outcome of this struggle, and the public needs to know just how illiberal and cranky things could get for these young dissenting doctors. The existing power structure feels as threatened by change as the slave states were in their day. As Bourassa puts it, "They can't handle dissent in any mature way. I feel like I'm expected to toe the party line."

A similar concern is expressed by second year medical student Katharine Smart. As she sees it, "Removing people's ability to be ethically opposed to something threatens to undermine all of our freedoms. I'm not sure if the abortion debate will ever come to a close, but I do not doubt that the wave of which side is more popular and accepted will ebb and flow. In the process, all of us are entitled to pick which side of the debate we stand on and should not be discriminated against because of our position."

Yet abortion is a "necessary service", say other medical students who defend the abortion status quo. Thus might young Southerners, raised in the fading glories of the plantation era, have railed at the passing of slavery and the loss of all those "necessary services" provided by slaves - so that more important people could be masters of their own destiny.

On Dec. 2, 1859, John Brown was executed, and the song "John Brown's Body" was taken up by anti-slavery crusaders as a dirge to his unlikely martyrdom. We see now that, no thanks to him, his cause was just - and so it was, ultimately, unstoppable.

Dr. Johnston is Secretary-Treasurer of Canadian Physicians for Life.  This essay was originally published in the Vancouver Sun on October 31, 1998

 

John Patrick, MD

For most people Hippocrates is a shadowy figure somehow connected to the ethical practice of medicine; they feel vaguely comforted by the supposed fact that doctors take a Hippocratic Oath of practice upon graduation. The truth is that very few take the Oath of Hippocrates; some take a revisionist version, which retains the name but removes the content; many make no commitment to rigorously defined ethical standards.

I have gathered a number of Oaths from Medical Schools across Canada. Not one of them contains several of the essential features of the Oath of Hippocrates. In other words, where the name is used it is used in the modern revisionist sense where the name of Hippocrates is used to make the public feel comfortable. But the reality that he stood for has been removed. Kierkegaard said we would be a passionless century that took the heart of meaning out of the institutions of our world and left the sham edifice standing.

Hippocrates would find little with which to sympathize in the dominant model for the teaching of medicine today, which is founded on the cultural hubris that our categories supersede those of Hippocrates because it presumes that medicine is adequately described by the categories of biology, psychology and sociology. The transcendent dimension is denied.

The significance of the invocation of the gods in the Oath of Hippocrates cannot be overstated. It places patients and their physicians in a world with a transcendental dimension. The practical value of such an enculturated understanding is that a physician who believes in transcendence, particularly where that belief includes the ideas of moral consequence and ultimate accountability with judgment, has reason to be ethical because he fears God appropriately. Solomon thought such fear was the beginning of wisdom and who are we to argue with him?

Transcendence was still active in the 17th century at the highest reaches of the practice of medicine. Why is it so different now?

The best that the bio-psycho-social model can offer is an unpredictable utility, without any guarantee that the dominant utility will be that of the patient rather than the economist, administrator or the physician. Those who deny the existence of objective truth and say that we create our own values have no basis for collegial laws. At the heart of medical ethics, as opposed to bio-ethics, lies the privileged relationship between the physician and the patient; a privilege which can be and is, on occasion, abused. Its control is not susceptible to simple bureaucratic measures

What the Hippocratic Oath gave substance to was a vision of a medical community with a predictable character of high ethical standards which could support justifiable trust between physician and patient with all the therapeutic benefit which such a community produces

The main reason for the modern dismissal of the Oath of Hippocrates by those who know its content is its commitment to the absolute sanctity of life. Neither abortion nor mercy killing find any place in the thought of Hippocrates. Why was this commitment so central?

Margaret Mead, the libertarian anthropologist, clearly understood, when she wrote;

"For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with power to kill had power to cure, including specially the undoing of his own killing activities. ... With the Greeks, the distinction was made clear. One profession, the followers of Asclepius, were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect - the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child. . . . [T]his is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer - to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient. . . . [I]t is the duty of society to protect the physician from such requests."

Hippocrates changed the direction of medicine. Those followers who took the Oath of Hippocrates generated a substantial trust and consequently became the physicians of choice.

It was patient choice and the desire to have an income, which forced the medical profession to adopt the higher ethical standards of the Hippocratic community not the intrinsic nobility of the medical community.

We might do far worse than to commence by addressing ourselves to finding out who are the Hippocratic physicians who will fore swear killing and join company with them so that when the Barbarians come to remove that bulwark we can retreat into a sector of medicine where that virtue can be kept alive. My suspicion is that we constitute more than enough to demand and achieve a legitimate and continuing sector of Hippocratic medicine in this pluralistic society.

In the meantime we must talk about the necessity of transcendence, of a commitment to the sanctity of life, to training within a moral ethos, and to the critical importance of the preservation of the moral integrity of the physician even over illegitimate claims of patient autonomy, if medicine is to be preserved. 

Excerpt from presentation to Christian Medical & Dental Society. For complete text see Resources at www.physiciansforlife.ca


Dr. John Patrick is Associate Professor of Biochemistry and Paediatrics at the University of Ottawa and member of Canadian Physicians for Life 

 

Proposal B" to legalize assisted suicide in Michigan was defeated 71% To 29% on November 3, 1998.

The Michigan coalition whose television ads were credited with a resounding defeat for the assisted suicide ballot initiative is running new statewide TV ads. This time, they have shifted gears to focus on alternatives to assisted suicide for terminally ill people, such as hospice care.

Kevin Kelly, managing director of the Michigan State Medical Society, said the group's new theme is physician-assisted living. The ads feature people of all walks of life, but focus mostly on the elderly and young children. The 60-second ads, twice as long as those urging defeat of Proposal B, include a Web site people can access for more information on alternatives to assisted suicide.

The ads are paid for by Citizens for Compassionate Care. The group of churches, doctors and disabled rights advocates raised $5 million to defeat Proposal B.

The coalition believes people wouldn't give a thought to assisted suicide if they had more information about hospice care, living wills, pain management and other ways of dealing with terminal illness.

"All of which leaves us looking to our future,'' the ad says. `"A future that, because of what we the voters did, will bring about more compassionate care for everyone.''

In addition to money being spent by the group, the Michigan state government is helping to expand education on options for the terminally ill by funding training for medical professionals in end-of-life care and promoting the 117 hospice care programs in Michigan.

Kelly said the failure of Proposal B means that people yearn for an alternative to assisted suicide. "This has been a big boost for people who provide end-of-life care,'' Kelly said.

 

Anti-euthanasia efforts take many forms. Compassionate Healthcare Network has been an important force in the battle to promote truth and proper care. International research and information distribution, most recently through the Internet, has been the cornerstone of this organization's work.

We would like to pay tribute to the incredible volumes of work performed by Cheryl Eckstein in this area. Unfortunately, for reasons of health and under funding, this organization is now going to become dormant.

Canadian Physicians for Life will seek to keep the Web Site alive. Anyone with an interest in international research and information collation is invited to lend their support.

 

by Dr. Rob Pankratz

I believe the issue of the morning after pill (MAP) or so-called Yuzpe 2+2 regimen is important because it represents a watershed area at the extreme end of the spectrum of abortion options. This is a current problem for pro-life physicians because there is increasing pressure from Planned Parenthood through our provincial licensing bodies to make this option universally available. In British Columbia, all physicians received PP pamphlets and posters advocating use of the MAP.

A colleague was recently censured by the BC College after a complaint from a patient who did not receive the MAP on request. The comment of the BC Deputy Registrar read, in part, "If you are morally convinced that you cannot prescribe the morning after pill, it is your duty to refer the patient to someone who will."

Not all pro-life physicians consider prescribing the MAP a problem. However, if one feels that human life begins at the completion of fertilization, then the mechanism of action of the MAP creates a concern.

In a review article by Grou and Rodrigues, various modes of action are discussed in detail. In summary, ovulation may be inhibited in about 25 percent of cycles if the MAP is taken just before ovulation. The predominant effect however is in the disturbance of the normal development and function of the endometrium which renders the nidation site unsuitable for implantation. This effect occurs within 72 hours after medication administration.

We all recall that fertilization occurs in the fallopian tube and it takes about three days for the fertilized ovum to reach the uterus and three more days of maturation before the blastocyst undergoes implantation or nidation. About one-third of these fertilized ova are lost spontaneously. Statistically speaking, with a single act of intercourse, the chance of a pregnancy occurring is eight percent, which is then reduced to two percent if the MAP is used. In other words, in the presence of the MAP within 72 hours of unprotected intercourse, only 25 percent of developing embryos will manage to implant and 75 percent are lost due to endometrial factors. Since the primary mechanism of action is contragestive, use of the MAP involves a direct attack on an already formed unique human life and is in the same league as the use of methotrexate and misoprostol (before 50 days) for medical abortions.

Reference: Grou F; Rodrigues I, The morning after pill -- how long after?, Am J Obstet Gynecol 1994 Dec; 171(6): 1529 -- 34.

When I explain the MAP to my patients, I remind them that this generally works by deliberately causing the rejection of a newly conceived human being. Interestingly, although widely employed in North America, there is currently no specific approval for the MAP by the Health Protection Branch or by the Food and Drug Administration, nor does the drug manufacturer recommend OVRALTM for that use. Of relevance to pro-life colleagues is the current feeling that teratogenicity is probably negligible for surviving pregnancies, although some sources cite concerns about possible cardiac defects. One source I consulted cited a tenfold increase in ectopic pregnancy rates following use of the MAP. (Scott: Danforth J. Obstetrics and Gynecology, 7th edition 1994, Lippincott- Raven Pub.) but the SOGC guidelines (November 1996) contradict this.

When I inform a patient that I do not prescribe the MAP for conscience reasons, I also explain the mode of action and possible side effects. Since printed information is helpful also from a medical legal standpoint I have recently finished a handout that I feel gives a balanced view of the issue.

One thing is certain and that is that increasing pressure will be exerted on individual physicians to prescribe the MAP. Although we may be able to avoid direct prescription, the BC College considers it an obligation to refer to someone who will. In the words of CPL Executive member Will Johnston:

"In analogous situations (like surgical abortion) this would be seen as a violation of conscience. With the daily arrival of more exotic reproductive technologies, some of which may eventually offend even the most laissez-faire of our current colleagues, this may not be a good time for our governing bodies to set precedents involving the overriding of individual conscience."

In a climate of increasing pressure to forego the ethic of life protection, it is good to know that we are members of a growing body of physicians in agreement on basic issues of life. I welcome your feedback.

Dr. Rob Pankratz is a family physician in Abbotsford, BC and president of Canadian Physicians for Life

Alasdair Palmer - October 11, 1998   Condensed from the Sunday Telegraph

The dominant reaction to genetic experiments on foetuses is one of horror. Most people think the idea repulsive. It is not just the fear that such experimentation might eventually lead to "designer babies", with parents selecting traits (hair and eye colour, leg length, hip and waist size) for their offspring, like flavours of ice cream. It is also the sense that the actual experimentation itself is morally bankrupt: human foetuses should not be treated like laboratory rats.

Bizarrely, the person who feels that most strongly is the man who raised the possibility of the research: Dr French Anderson of the University of Southern California. "My reaction to the headlines," he told me, "was very simple: that's horrible, disgusting. It's wrong. It shouldn't be allowed to happen." He has not in fact, personally carried out any embryo experiments - yet. But he knows for certain that they will happen, perhaps in as short a time as three years. Einstein, after the detonation of the atomic bomb, famously said: "If I had known, I would have been a locksmith." Dr. Anderson knows exactly what his research will inevitable lead to - yet he continues to pursue it.

It is easy to sneer at his confusion. Does he believe in embryo experimentation or doesn't he? Is it disgusting or not? Does the end justify the means or doesn't it? But at least he has qualms. Not everyone conducting research in this area does. And the incoherence of his thought is symptomatic of an almost universal inability to be consistent on the topic. That confusion and inconsistency is embodied in British law.

Consider the Polkinghorne Report on embryo research, the most recent official statement on the matter, and the source of Government "guidelines" on what kinds of work are permitted. It says that it is unethical to administer drugs or medical procedures in order to discover whether they might cause harm to the foetus. Embryos, like human individuals, should not be treated simply as a means to some social goal, such as improving the nation's health. If it is wrong to test a drug on a child in order to see if it is harmful - and even the most fervent advocates of research agree that it is wrong- it is wrong to do it to a foetus.

The Polkinghorne Report is unambiguous about that point. It followed the Warnock Report on embryology, which, four years earlier, was equally clear: embryos, once they were implanted in the womb - a process that normally takes place about two weeks after conception - are close enough to being people for it to be wrong to experiment on them.

So how is one to square that with the 1967 Abortion Act, which in effect permits abortion on demand up to 24 weeks, or the 1990 Embryology Act, which allows abortion up to term if the foetus has been diagnosed as having serious handicaps?

Our abortion law embodies the view that the foetus, right up until the moment of birth, is no different from a disposable cluster of chemicals. It is not even entitled to the same protections as a laboratory rat. Take that view of the foetus, and restrictions on research are simply silly - as silly as provisions "protecting" an appendix from unwanted surgical removal.

The legal situation that the contradiction between these two views creates is bizarre. It makes Dr Anderson's confusion on the rights and wrongs of embryo research seem mild.

Which view of the foetus should we take? Disposable bunch of chemicals or entity with rights and entitled to respect? There are of course potential benefits from taking the "cluster of chemicals" view. Scientific research would proceed more quickly. If cures can be found, they will be found more easily. Yet it is clear that science does not support the view that the embryo is no more than a cluster of chemicals. The scientists themselves are the ones who have insisted on the restrictions on embryo research for precisely that reason. But what is the point of having one law "respecting" the rights of an embryo in research when another says it can be killed whenever it suits?

The moral absurdity of the present position is clear. Perhaps eventually it will become clear even to politicians. But at the moment, the most common view, both among politicians and the public, is the research on embryos is "wrong, horrible, disgusting" - but killing them is just fine

 

The public wonders if I should be allowed to live

Judith Snow

Dr. Nancy Morrison's re-appearance in court, facing a Crown attempt to charge her for what amounts to "mercy killing," is likely to revive the public debate over euthanasia and assisted suicide. It comes on the heels of the CBC dramatization of Sue Rodriguez's life and death, and the continuing real-life courtroom drama of the Robert Latimer case.

In all of these instances, the media and public sympathy for the idea of arranging "easeful death" alarms and disturbs most Canadians with disabilities.

We will continue to tremble with the anxiety that comes from knowing all too well the bell does indeed toll for each and every one of us S we who are made more vulnerable everyday to a death sentence in the very airwaves we breathe.

As I approach my 50th year, I have accumulated a long list of infirmities. On my list are quadriplegia, 25% breathing capacity, inoperable fibroids, chronic kidney stones, hepatitis C, post-traumatic shock, osteoporosis, diabetes and a variety of food and drug allergies.

At various times, sometimes for years at a stretch, I have lived with relentless pain, itch and depression. I have stared my own death in the eyes not less than six times in 49 years.

I personally know many other people who, like Robert Latimer's daughter Tracy, are not able to share in words their appreciation for life or their own perceptions of the beauty and complexity of our world. Not speaking, but certainly not silent either, these people, these fellow travellers in life, have known the profound heights and depths of joy S and, as the media makes plain, great suffering too.

If Sue Rodriguez had reviewed her life and her relationships in the light of failing physical ability and privately decided to end it all S privately, I say S I would not have agreed with her decision, but I would never have complained either. But, of course, that is not what happened.

Many people believe they know what disability is all about. They never look closely at me, at my life, at my work, at my home S and so they never can understand either how I actually live and accomplish things that are meaningful to me. They cannot appreciate why my life is so important to me and those who love and work with me.

If the death mongers kept their private ignorance and irrationality to themselves, it would be one thing. But the publicly promulgate their death sentences, drawing the comfort of assumed solidarity from convincing others that I should be dead. Now, on top of my physical disabilities,

I have to deal with a public that wonders why I want to live or even if I should be allowed to.

With Robert Latimer, the media go out of their way to dwell on every negative shade of Tracy's life while turning a blind eye to all that was worthwhile in it and her presence among us. Absent from their accounts are the words and pictures about what might have been S if only true attention had been turned to the search for ways to support, develop and enhance her gifts.

Just think, Tracy would have been celebrating her 16th birthday this month! What about some new clothes? Say some leggings, a mini-kilt, some make-up, or a purple streak in her hair to bring out her laughing eyes? How about a henna tattoo, and an accessible taxi to the school dance accompanied by some school chums to make sure all goes well? Afterward, some pizza and music in the rec room to round out a perfect birthday? I know that this sort of thing happens for girls like Tracy everywhere S but it can never happen for her now.

The media only concentrate on the pain and the daily struggles. Even worse, the pain and struggles are magnified with none of the important questions asked: Were there really no alternatives? No one else willing to step in?

In the last years of the millennium, with access to state-of-the-art medical technology, with millions of dollars going into human services in Canada, with every sort of innovation getting a test run in North America S can there really be no alternatives to death?

The very worst thing about being a Canadian with disabilities is the death sentence in our culture's eyes, the death sentence that casts a veil of ignorance over every person who lacks the courage to look past the surface or think past the hype.

People easily decide that I want to be, soon will be, should be, already am, dead. Robert Latimer and his wife were handed an excuse by a society that has already passed judgment on us S helped in large measure by media that feed on the sensational and sentimental.

Save me from one thing and one thing alone. Save me from all those who would have me dead for my own good.

Judith Snow is chairperson of the Ontario Advocacy Coalition.   This column originally appeared in the National Post, Oct. 28, 1998. Reprinted with permission

 

Council on Palliative Care - Conseil des Soins Palliatifs - In Association with McGill University www.med.mcgill.ca/orgs/palcare/copchome.htm

Edmonton Palliative Care Program   Our Web site was created with the health care professional in mind, hoping to appeal to primary care physicians, nurses and allied workers as well as to specialists in the fields related to Palliative Medicine. Although the focus remains on health care professionals, we have created a sub-page to provide basic information to assist patients, families and friends cope with the dying process.

Of interest: Euthanasia and physician-assisted suicide: a comparative survey of physicians, terminally ill cancer patients, and the general population. J Clin Oncol 1997; 15(2):418-427. Suarez-Almazor, Belzile, Bruera

Sample web site information from

The University of Ottawa Institute of Palliative Care

A Crisis of Trust - The societal debate on euthanasia and assisted suicide demonstrates public awareness of the importance of these issues. The cry for euthanasia also reflects fear and mistrust at both the individual and societal level. The fear of death and of the process of dying is a powerful psychological force. It can drive both patient decision-making and legislative changes.

Unlike euthanasia, palliative care focuses on controlling suffering and maximizing quality of remaining life, and is founded on highly-developed clinical expertise in pain and symptom management, timely and responsive patient-centered communications, and interdisciplinary team work. Palliative care opposes legalization of euthanasia. Instead, it calls for justice through access to palliative care for all those who are dying. Enhancement of services, overcoming barriers to referral, and increased training and research in the control of suffering are the appropriate response to the present crisis.

Do We Have Your Name On Our List?  Pall-Connect is a support network for family physicians providing palliative care. Pall-Connect News is the group's official newsletter.

To get your name on our mailing list or to find out more about the network contact: Lynda Weaver, Tel: (613) 562-4262, Ext. 1018, Fax: (613) 562-4226, E-mail: lweaver@scohs.on.ca

You can also view the latest issue Pall-Connect News or add your name to our mailing list by visiting the Newsletters & Press Releases section of this web site.

Need Help?...Call PSMT  - A reminder that the Pain and Symptom Management Team (PSMT) is available to answer your palliative care concerns 24 hours/7 days a week. To talk to a palliative care physician about a case, physicians can simply call:  1-800-651-1139 or (613) 562-6397  E-mail: mmoisan@scohs.on.ca

Over fifty percent of physician calls to PSMT concern pain-related questions. General management issues involving the routes of delivery and correct dosage of opioids, to more specific questions about the use of adjuvant therapy in pain control, are a few of the topics discussed through telephone consultations