On 10 February 2014, André Picard’s column in the Globe and Mail describes the case of Margot Bentley, whose explicit directions for how she wanted to have her life end were rejected. What a travesty of common sense this has become. A few days later I was heartened to see that the January/February 2014 issue of the BC Medical Journal had four items on the topic of end-of-life care.
As physicians we are often actively involved in helping our patients determine how they wish to end their lives, so there is greater pressure on us to sort out our thinking on this matter. Fortunately, our position in society as God-like authority figures has diminished, yet the mantle is easily picked up by organizations—in the Bentley case, by the Maplewood Seniors Care Society and the Fraser Health Authority. The complexities of end-of-life issues need to be discussed openly, especially by the professionals involved in caring for the dying. Because of our active role in this matter, we tacitly confirm these as health issues, or, as is happening now, as bureaucratic/legal issues.
The core problem is a moral one. Though we may disagree with our patients’ moral values, in most cases we can establish a working relationship and provide medical services without difficulty. If there is a sticking point we don’t force our patients into our value system, nor are we obliged to use treatments that offend our moral values.
Society depends on a dynamic balance between the rights and responsibilities of the one versus the group. Dr Allan Donkin (BCMJ 2013;56:6) identified the inherent difficulties in resolving these differences and clearly stated his position along the continuum. My position leans more toward the individual. I believe the ultimate decision on how to die must stay with the person (or delegate) taking that journey. We agree with this sentiment by accepting our patients’ requests to stop treatments, but their wishes are often deserted as patients reach the end of life.
Let us continue to broaden these discussions.
—William Gardner, MB, ChB
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
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.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org