‘That terrifies us’: Canadian doctors get virtually no training on handling a patient’s desire to die


There is a similar clash in Manitoba, and over the last four years doctors have shown discontent at times in almost every province. Officials speak of the Canadian health system as ”one of the best in the world,” but the Canadian Medical Association says the system is underfinanced. Doug Geekie, spokesman for the association, said Canada was devoting to health care 7.2 percent of its gross national product, the sum of all goods and services produced. He said that among Western nations only Britain spent less than this and that the United States devoted about 10 percent of its G.N.P. to health care. Ottawa Cuts Contributions With inflation running high and the federal Government anxious to keep its deficit down, the 10 provinces, which are responsible for their own health systems, are undergoing a particularly tight financial squeeze this year. Ottawa has cut the rate of growth of its contributions to the provinces for health care by about 15 percent. Well before the cuts, doctors’ incomes were losing ground to those of other professional groups, the Medical Association says. It cited tax figures indicating that between 1971 and 1977 lawyers, dentists and accountants increased their incomes at a much faster rate than doctors. In Ontario, according to an association spokesman, the average net income for a doctor is about $53,000 a year. The doctors want their yearly incomes increased to well over $100,000 in some cases, and Mr. Geekie acknowledged that it was difficult to get support for this from ordinary Canadians making much less.

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Librach respectfully declined every time, insisting that the patient would be sufficiently sedated in his final moments to make the end bearable. It didnt quite unfold that way, the death being much less peaceful than planned, but the case underlined a little-known dilemma for many health-care workers. As other Canadians debate assisted suicide as a largely academic issue, doctors and nurses are routinely asked by dying patients for a medical push over the edge, specialists say. And yet, they get little preparation for arguably the most difficult conversation they will ever have with a patient. Most doctors finish their degrees and five years of specialty training with virtually no instruction on how to deal with death generally, let alone patients who ask for help with suicide, said Dr. Mike Harlos, medical director of palliative care for the Winnipeg Regional Health Authority. The most frightening interface with the health care system is the dying bit. That terrifies us, said Dr. Harlos. And yet its the least addressed. In response, Dr. Librach has developed a unique program to teach health professionals how to deal with assisted-death requests in a country where saying Yes could lead to murder charges and a flat No might cut short an important conversation. The course offered through the University of Torontos Joint Centre for Bioethics suggests that a cry for help with suicide likely points to unidentified suffering. So health-care workers are urged to put aside their personal reservations and fear of the law to get to the bottom of those problems. Everybody who is terminally ill thinks about, Is it easier just to shorten my life? said Dr.

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