Recently our profession has faced a number of controversial issues—physician-assisted dying, narcotic prescribing for nonmalignant pain, and the use of medicinal marijuana to name a few. I’m not an expert on any of these issues so naturally I will tell you how things are.
The process of legalizing doctors to aid in the deaths of their patients has brought forth strong emotions on both sides of the issue. Words such as “killing,” “murder,” “torture,” “inhumanity,” and more have been used to bolster one position or the other. I believe most patients, if offered good palliation, would choose not to end their life. But, on the other hand, how do you effectively palliate conditions such as amyotrophic lateral sclerosis? To observe your body dying around you is not a death I would wish on anyone.
The College’s recent standards and guidelines on prescribing narcotics for chronic nonmalignant pain have raised the ire of a number of physician groups. Walking the line between reducing prescription drug abuse/deaths and alleviation of suffering is difficult indeed. However, in my over 20 years of clinical practice, I can count on one hand the number of patients for whom daily narcotic use for chronic nonmalignant pain improved quality of life.
The ever-increasing use of medicinal marijuana is also quite polarizing. I have had a number of dying patients report that marijuana eased suffering and made their last days more comfortable. However, I now have patients using medicinal marijuana for fatigue, insomnia, depression, fibromyalgia, musculoskeletal discomfort, and more. These prescriptions didn’t come from my hand, but none of my patients had any trouble obtaining them. I am troubled by the large number of people taking a central nervous system active substance with little scientific evidence to support its use.
Why bring up these controversies? The British Columbia Medical Journal is the perfect place for BC physicians to share their points of view on all topics. It is an honor to publish the various opinions of our readers and act as a vehicle of respectful discourse in all matters. We might not always agree, but we are definitely in this together, so please continue to send in your thoughts and musings.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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