Doctor-Assisted Death (Their Own)

"We've done pretty well with the general public in terms of reducing the stigma associated with going for help. But we still have so far to go in the house of medicine."
"When I did this research [for his book Why Physicians Die By Suicide: Lessons Learned from their Families and Others Who Cared], and I saw there were these families where the [doctor] husband or wife went from well to ill, to death, without going to anyone, like a family doctor, an internist, a psychologist, a social worker, the clergy, a psychiatrist, none of that. They killed themselves. And I thought, this is unprecedented in medicine."
"They want to get it right; they want it to be foolproof [their suicide]; they want to die quickly and completely."
Dr. Michael Myers, professor of clinical psychiatry, SUNY Downstate Medical Center, Brooklyn, New York

"People who feel burned out feel overextended and tired, with nothing left to give. They can become negative and cynical and lose feeling for other people, including patients."
Dr. Paul Garfinkel, professor emeritus University of Toronto: A Life in Psychiatry: Looking Out, Looking In

"Some operations you go into knowing that you're likely going to produce a neurological deficit for this patient."
"You do an excellent job; you do everything right. But despite that there's a decent chance the patient is not going to be a perfectly happy camper at the end of the day. And, that weighs on you."
"If all the family doctors and neurologists who send me brain tumour patients, if they all read this article [outlining his own clinical depression] and said, 'this guy is depressed, I better not send him any more cases', I could have seen a drop in referrals. [Instead], I had people reaching out."
"I think the bigger piece [hanging in] is the workload, the bandwidth issue -- the making patients wait, the not 
-having-enough-hours-in-the-day ... the administrative crap, the system imperfections, the constant worry that you're not going to serve patients well enough ... It's that sensation of drowning all the time. And that's the way a lot of doctors are functioning in our system. It's frightening and it's exhausting and it leads to depression."
Dr. Mark Bernstein, neurosurgeon, Toronto Western Hospital

"We just really need to make it normative for physicians to get help if there's a problem."
"We need to help them realize it doesn't make them a worse physician or a worse person."
Dr. Katherine Gold, department of family medicine, University of Michigan

Molly Ferguson for STAT

When people become ill they consult with their family doctors. When the family doctor makes a diagnosis, he/she prescribes medication, or a non-pharmaceutical protocol, or refers to a medical specialist to further investigate a condition the specialist is more familiar with. Sometimes that specialist makes a referral to a medical surgeon, skilled in certain specific areas of surgery. Along that chain of appointments, diagnoses and the dispensing of medical advice, there is huge stress.

The patient is under stress and so is the patient's family. The doctors all along the chain of diagnosis and treatment are also under stress because of the weight of their professionalism and because the human tendency is to not only bear witness but to bear sympathy for whoever is undergoing the trauma of a blighted health situation. Little would it occur to most people who make medical appointments and trust in the medical expertise of the physicians that the very people they seek help from require the same kind of help themselves.

And little would it occur to patients that the skilled physician in whom they place their trust may be harbouring feelings of inadequacy and fears of their own. Doctors, it appears through studies and statistics, commit suicide at a higher rate than do those in the rest of the population. For male doctors the rate of suicide closes in on twice that for other men, and for female doctors the risk is seen to be two to three-fold higher than for other women in society.

The 2007-08 Canadian Physician Health Survey found, through a random sampling of over 3,200 doctors, that close to 25 percent reported having experienced at least a two-week stint of depressed mood. One fifth of the doctors reported a type of flattened emotional numbness termed "Anhedonia". At the present time, 300 doctors are on disability, the majority of them for mental illness, in Ontario alone.

These breakdowns are attributed to many causes; perfectionism, obsessive detailing, heavy work load, stress, and emotional vulnerability, all leading to burnout, making doctors susceptible to self-annihilation. "The inner conflict and the irony of self-destruction and despair" among doctors struggling to "uphold the demands of their professional persona" equates with doctors struggling to overcome their mental illness on their own, avoiding asking for help for fear to do so might result in risking hospital privileges, their license to practise; risking their professional lives.

And when doctors finally make the decision, they want it to be irreversible. Because of their familiarity through their profession with the manner in which various pharmaceuticals affect the human body, they carefully choose which they will use; drugs for example, certain to produce rapid loss of consciousness leading to expeditious death.

A recently published survey of over 2,100 female doctors who are also mothers who took membership in a closed Facebook page saw fully half affirming their belief they could meet the criteria for mental illness at some point in their careers, yet had never sought professional help. A mere six percent who had received a formal diagnosis reported the result to their licensing boards. Many of these female doctors took to writing their own prescriptions for tranquilizers or antidepressants.

Another finding is that frequently when doctors plan to commit suicide, they dress for the occasion. If they are not wearing professional scrubs, they take pains to change their clothing into scrubs. They are doctors, medical professionals, and choose to die as medical professionals. Whether this constitutes a subliminal message is anyone's guess.

"Could the means of death or setting of death have medical meaning? That in the moment of time, the individual is really in the role of physician?"
"We can only hope the doctor has found some good memories and comfort in those lonely final moments of life", mused Dr. Myers
 

(Steve Cukrov/Shutterstock.com)

In every population, suicide is almost invariably the result of untreated or inadequately treated depression or other mental illness that may or may not include substance or alcohol abuse, coupled with knowledge of and access to lethal means. ^[2] Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females. ^{[3, 4]} Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms. ^{[5, 6, 7, 8, 9]}  This is not an isolated North American phenomenon. Studies from Finland, Norway, Australia, Singapore, China, Taiwan, Sri Lanka, and others have shown increased prevalence of anxiety, depression, and suicidality among students and practitioners of medicine. ^{[10, 11, 12, 13]}