Week 6: Overview & Reflection

The Physiopedia  PHT402 Professional Ethics Course has been such an exciting CPD activity and eye-opening experience.   It is  a blessing to be able to connect with physiotherapists and students from different walks of life, all around the globe, as each on of us have valuable and diverse perceptions and opinions to share.  It has been an amazing journey, brainstorming, writing and discussing challenging and thought-provoking moral and ethical dilemmas of life and physiotherapy practice.  This will be my final blog post reflecting on the PHT402 course and my learning portfolio.

 

 

The themes I found particularly difficult was equality, torture and assisted dying.  These topics challenged me to objectively look both sides of the coin and argue the point of view or opinion I share.  I tried to look at it, firstly as a human being and secondly as a health care professional.  After receiving some feedback from my peers, I realised that I kept my distance from sharing too much of my professional experience in every post, as I felt that I may become judgmental if I try and use patient experiences and analyse their behaviour or decisions.  In addition to my weekly post, I wrote a reflective post after reading and discussing with other participants the theme of the week on my original blog post and theirs, which made it easier to identify areas I need to develop and summarise opinions and perspectives.  As in life, there were some participants who did not share my opinion on or perception of various topics/themes, but I respect this difference of opinion and accept that it is their prerogative to freedom of speech and expression.  Furthermore, I applaud the brave participants who went against the grain and who took an honest  look at themselves and/or their lives and admitted their fears, shortcomings, challenges and personal experiences.  It is a wonderful opportunity to be “forced” to be open-minded and take a good, hard look at yourself, your life and your practice.  I will definitely incorporate what I have learned in my life and practice.  Mostly to be careful of becoming too involved with my little patients and truly respect the decisions and opinions of all my patients, while still following the rule of the law.

 

It was really hard for me to write my blog post on equality, as I had so much to say and found myself jumping around and not settling on a specific direction.  Growing up and living in South Africa, I had to be sensitive and really search high and low to find diverse and relatable information on equality.  It was so interesting to read the posts by my fellow participants residing in a different country, experiencing equality, as a global issue and struggle.  To sum up my opinion on equality…  Equality is an idealistic notion.  Due to political and social interference, inequality is more common in reality.   You have no right to judge or discriminate against another human being because you don’t approve of their choices or behaviour.   It is with sensitivity and an open mind that we need to approach matters of equality, as seen in the current debate on marriage equality, racism, sexual orientation and gender identity.   I believe that focusing on how you act and engage with others, is what is important. It is a personal goal to try and see people without judgement, as your equal, a human being, deserving of equal respect, protection, understanding, kindness and care. This should be carried forward into our practice as health care professionals.

 

Week 4’s theme of torture really touched me deeply.  Just imagining being tortured or someone I loved being tortured gave me such an emotional reaction that it took me some time to gather my thoughts and start researching this topic objectively.  The discussion on my blog post and many other participants’ blogs, revolved around when we condemn torture for one reason but perceive it as acceptable for another.  I am still of the opinion that the concern needs to be on the protection of the human rights of all human beings.   I believe we should respect the rule of law and the principle of upholding fundamental rights and freedoms, for all, even when we personally feel that a person (terrorist or criminal) is not deserving of any rights as a human being.  This is particularly important in clinical practice where student-physiotherapists and physiotherapists in public health sector are faced with treating incarcerated human beings.  As health care professionals we must treat all our patients equally without judgement and not allow or cause them any discomfort or pain as a result of refusing or delaying treatment (as seen in the Steve Biko case).   It is sad that torture is still in practice, globally, behind closed doors in police and military custody.

 

This 5th week’s theme of assisted-dying and end-of-life decision-making, was difficult for me as a physiotherapist (who is trained to improve quality of life) and a Buddhist (who believes in freedom from suffering), trying to objectively see and argue both sides of the coin without judgement. I have no idea what my choice will be when I am in a situation where I am given the choice or when it comes up in a discussion again. That is the beauty of life, we grow, we change, we evolve.   I know that my opinion and perspective on this will change as my life changes in the years to come.  Exploring the relationship and comparison between passive involuntary assisted-dying (legalised abortion) and voluntary assisted-dying (the last human right) helped me put things in perspective.  After reading my fellow participants’ blogs, I conclude that everyone has the right to life and to be treated with dignity and respect, in life and death.

 

I would like to thank all my fellow participants for reading my posts and engaging discussions on these sensitive topics that we face on a daily basis in life and practice.  I will leave this course as a better human being with a new found understanding and goal, to live a balanced life, cherish human compassion and seek further understanding of the complexity of human connection.

 

I will leave you with “The Physics of the Quest”, something to live by:

“If you are brave enough to leave behind everything familiar and comforting;

and set out on a truth-seeking journey;

and if you are truly willing to regard everything that happens to you on that journey as a clue;

and if you accept everyone you meet along the way as a teacher;

and if you are prepared, most of all, to face and forgive some very difficult realities about yourself;

Then truth will not be withheld from you.”

Elizabeth Gilbert: Eat, Pray, Love

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For PHT402 Professional Ethics Course: Week 6: Overview

 

Week 5: Assisted-Dying

“A belief in assisted-dying is by no means a fringe view in western society.
There is broad agreement, associated with notions of modernity and evolved thinking,
that assisted-dying is an appropriate action to take in certain cases and should be allowed by law”
Bruce Falconer

Discussing this concept of assisted-dying, which is a choice at the end of the day, with anyone can be difficult and challenging, not just because of differences in religious/spiritual beliefs, moral values, legislation and medical-ethical considerations, but for the multiplicity of terms used to describe it.  Terms I think are relevant to this discussion are active and passive, voluntary and involuntary assisted-dying and physician-assisted-dying. Many other terms such as suicide and euthanasia (active/passive, voluntary/involuntary, by omission/action) and are also used but carries social stigma and negative religious connotations.

This week’s theme of assisted-dying and end-of-life decision-making, has been difficult for me as a physiotherapist and a Buddhist, trying to see both sides of the coin… The individual right to life and to be treated with dignity and respect versus the bigger picture of the society and the impact of such legislation.  Buddhists are not unanimous in their view of physician-assisted dying, and the teachings of the Buddhadharma don’t explicitly deal with it. In Buddhism, the way life ends has a profound impact on the way the new life will begin. So a person’s state of mind at the time of death is important – their thoughts should be selfless and enlightened, free of anger, hate or fear. This suggests that suicide, albeit assisted or not, is only “approved” for people who have achieved enlightenment and are at peace with themselves and the life they had.

Personally I do not believe in artificial means of prolonging life.  I believe in the “do not resuscitate” order, also known as the “No Code”, which may be seen as a passive assisted-dying by some.  Dying does not scare me as it’s part of life, the natural progression of life, or if your life is cut short, it’s part of the path you had to or need to walk. Perhaps my perspective will change once I have children.  Then the thought of leaving them behind will make me reconsider.  But at this stage in my life, I believe that your time is your time and letting nature takes it’s course after you’ve exhausted all your options in medicinal and therapeutic terms.  But science has made it possible to cure disease, recover from disability, reduce perceived pain and suffering and improve quality of life, so I do believe that you should make use of what is available.  Therefore I am not pro assisted-dying for myself, but I am not against it for others.

The potential negative consequences or effects after resuscitation and prolonging life artificially is a reality, so too are the life saving chances. I have seen this with some of the kids I have treated.  One is a little boy who was brain dead after a car accident and his parents instructed the doctors to save him and keep him on life support as long as possible.  They had to resuscitate him 3 times and after 5 months of living on machines, he only recovered enough to sustain breathing through a trachi (tracheotomy), with a “Glasgow Coma Scale” of 3 (Eye 1 (no reaction or movement), Verbal 1 (no expression, sound, attempt), Motor 2 (reacts to painful stimuli)), which hasn’t improved or deteriorated in the last 2 years.  But he needs 24h care, therapy and constant medical attention and intervention.  Is this a life worth having or living, or is it selfishness to have forced life despite the package it comes in?

Then there’s the question of physician-assisted-dying.  This really hit home in 2012, when Sean Davison, a physician, professor and head of the Forensic DNA Analysis Lab at The University of Western Cape in South African, returned home after five months’ house arrest in New Zealand for helping his terminally ill mother die.  He was found guilty of the lesser charge of counselling and procuring the suicide of his mother, by giving her, as requested and consented, a lethal dose of morphine after she tried to starve herself to death.  He has formed a non-profit organisation, Dignity SA and hopes to educate people and champion a law change in South Africa.

I agree with the slogan of Dignitas, “To live with dignity, to die with dignity” and that this is the last human right, or it should be.  But unfortunately the mastermind behind the Dignitas organisation (an international centre for assisted-dying), Ludwig Minelli (a self-described humanitarian and lawyer), who might have had the best intentions to start with, has become something of a side show and with his toxic reputation, has resorted to shocking the public and forcing his opinions on others.   Under Switzerland’s permissive and unique legal environment,  assisted-dying has developed into suicide-tourism.

The problem we have is that every human being has the right to life and a quality life at that, but quality is subjective and each person has their own perspective on what living a quality, full life means.  Two people with terminal cancer will not consider assisted-dying the same, they will not consider medical management and intervention the same… but is their suffering the same, as pain, stress, discomfort and fear are all perceived emotions, reactions and sensory processing which varies from person to person?  So why does one person choose to fight to the end, whilst another lets nature takes it course?  And what about people who are choosing to “give up” or end the suffering and requires assistance?  Should they have the choice?  Tony Nicklinson who suffers from Locked-in Syndrome has been fighting against the legal system for “Death with Dignity” laws.  These laws allow a terminally ill patient to hasten an inevitable, insufferable and unavoidable death. It’s not suicide or euthanasia; rather, a possible option if the physical or emotional  pain from the underlying illness gets to be too much or quality of life too degraded. If one is of the opinion to agree with legal active and passive assisted-dying for compos mentis, suffering, living, human beings, what would be the criteria? Should this be a right to all suffering human beings, a choice of how they want to live and die? But what about a person who has lost the will to live?  Should they have this right or is this only for people who have exhausted all medical or health/healing interventions and therapies in trying to recover, reduce or manage the pain and disability?  And then, is emotional and physical pain the same?  Are we to say that such people are weak? Are we to say that everyone should endure?

If we think about it, compared to abortion, it makes the moral question a bit more simple.  In South African it is legal to have an abortion, even from the age of 13, as shocking as it may be for some.  Medically speaking in terms of anatomy and physiology, the embryo as a blastocyst has living cells after implantation on day 8-10 and then the embryo develops into a fetus at 8 weeks gestation when heart cells start beating.  Furthermore, from 10-13 weeks gestation, the fetus’s nervous system sensitizes and develops integration of pain/noxious stimuli which cannot be termed a mere reflex. The fetus also bears all human traits at this stage including the basic/core structure of cardiac-circulatory and nervous system cells, which are reactive.  But abortion is legal up to and including at 13 weeks gestation.  Thus it can be seen as involuntary assisted-dying of the unborn fetus (although the mom is the active participant and decision maker).  Others might call this murder.  Just because the baby is inside the womb, once it has a heart beat, it is considered alive, a living human being. So what makes a born living human being’s life more important or special than a unborn human being’s life?  Thus scientifically speaking within morality and ethics, the answer to involuntary and passive assisted dying is quite straight forward, it’s wrong.  I believe that voluntary assisted-dying is a choice as you alone are responsible for your own life, and the choices you make.

A great video on the assisted-dying debate:

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For PHT402 Professional Ethics Course: Week 5 – Assisted-Dying