Part II: The Authors
Dr. Anne Bruce PhD & Dr. Rosanne Beuthin PhD
[Title photo: Bruce (L); Beuthin (R)]
Part I presented comments from 8 anonymous physicians who were regular providers of euthanasia in Canada by 2020. Their comments were taken directly from the article by Dr. Rosanne Beuthin PhD and Dr. Anne Bruce PhD: “MAiD as human connection: Stories and metaphors of physician providers’ existential lived experience”, published December 2023 in the online journal, Death Studies.
The medical doctors were asked vague, open-ended questions. Clearly, the focus of the authors Beuthin and Bruce [B&B] was to ‘affirm’ the providers values and beliefs, rather than to analyze them in any reasonable way.
This article presents a selection of the most relevant comments made by the authors themselves. The quotations are taken directly from the article and are mostly in sequence.
Author’s comments:
“Being the one who provides an assisted death is complex and profound.”
“A narrative-hermeneutic approach revealed that for the eight providers we interviewed, this is an embodied existential experience.”
“The act of providing MAiD fostered embodied feelings of conviction, courage, compassion, and intimacy.”
“We ultimately find that the experience of providing MAiD is human connection.”
“…as shared experiences connect us to what it is to be human, especially at end of life.”
“We described the degree to which providing an assisted death was experienced as an art: of being able to see and hold both the clinical and the human, to be invisible and visible in process, to be technical and have grace, and to feel highly present and fatigued from the high level of alertness.”
“…specifically the expressed feelings of love, joy, and inner peace [the doctor/s] that we came to think of as existential life phenomena.”
“An intimacy is established, as the person living with a grievous and irremediable medical condition is at their most vulnerable, sharing the story of their health and indeed their life in thoughtful detail, hoping for an affirmation of their wish to end this life as they know it. Topics focus on quality of life, beliefs, suffering, and mortality.”
“…with an interpretive approach that had us pay attention to that which surprised us, evoked curiosity, and was particularly poignant.”
“Through listening and attuning to the tone and cadence of participants’ stories, the concept that came to resonate most strongly was that of “existential life experience” rooted in an ontological dimension of thinking about the world and language itself.”
“Listening to this transcript for the first time, I am taken aback by the honesty, the frankness, the raw language, and expressions of being. The bravery and courage. And I am deeply moved by the depth of intimacy shared.”
“I [an author] know these stories are historic and meaningful. And I feel a wave of grave responsibility to represent and do justice to what has been shared, offered to us as a gift. Humbled.”
“To understand differently, new truths that are at once revealed and concealed (what in hermeneutics would be described as aletheia), and from this meaning emerges as an opening of something that was closed; an enlivening and a remembering (Caputo, in Moules et al., Citation2015, p. 76).”
“In hermeneutic tradition, analysis is interpretation (Moules et al., Citation2015).”
“To this end, we listened to audio interviews, read and re-read transcripts, and generated notes, reflections and insights. We shared interpretations back and forth (between authors RB and AB) through face-to-face and zoom meetings, always going deeper and refining. We reflectively engaged the data using prompts: how are emotions and embodiment appearing or not; how are we impacted through listening and reading transcripts; how do participants verbally express or struggle to find words; how and what affective elements do providers share; is anything conveyed yet unspoken in participants’ stories?”
“Participants often spoke with hesitancy, uncertainty, and a rawness, as if they could not quite make sense or put into words that which was so unique and, in many ways, ineffable. Traces of emotion could be heard in the slower speech, softer tones, or more directly through the specific words they used in describing their experience of providing assisted death. Descriptors included: “Loving;” “a solitary practice;” “intimate contact;” “heartwarming,” “the most important medicine I do;” “satisfying medicine;” and “rewarding.” Other words reflected ethical and humanistic perceptions such as “an ultimate act of compassion;” “an honor;” “incredible gift;” “liberating;” “unlike anything I’ve ever…” and “extraordinary work.” For some, the experience seemed to hold a deeper societal ethic including terms of: “social justice;” “a crusade;” “empowering people;” and “the right thing in the right circumstance.” ”
“To provide the actual death, which is what we were focused on, the provider needs courage. And this courage holds so much: the risk is high, and tension builds.”
“…and the provider is part of that, feeling the awe, the profundity.”
“Metaphor has been described by Lakoff and Johnson (Citation1980, p. 3) as a “device of the poetic imagination and the rhetorical flourish – a matter of the extraordinary.” ”
“When we looked across the words, metaphors, and little stories, we began to see how the providers’ language and direct words revealed a depth of human connection and embodied emotion.”
“Some participants used the actual language of love.”
“Physicians who make the decision to be the one who provides this end of life alternative, who administer the drugs, seem to enter into an existential space and allow themselves to feel embodied emotions that come alive as courage, conviction and compassion.”
“Conviction based on long held beliefs about medicine, social justice, autonomy, and death; courage that is needed to offset the risks and intense effort; and compassion generated by bearing intimate witness to suffering whilst receiving outpourings of gratitude that satisfy at a deep level.”
“Providing the death aligns the mind/body/spirit with medicine practice; the experience is unlike anything else; the provider is transported into a rare, alternate reality and what they are doing is an intense, emotionally charged engagement, a finality; for some providers it was akin to a ritual. And this space that they found themselves in holds emotion and allows it to enter, to come alive.”
Commentary
As a retired doctor, I find this validation of the intentional killing of patients distressing. In Hippocratic ethics, the intentional killing of a patient is a boundary which should never be crossed.
I acknowledge that medicine — the healing of body & soul — indeed includes a two-way relationship between doctor and patient. That interaction should have meticulous respect for appropriate boundaries, with the doctor having most responsibility in maintaining appropriate limits. (Note: I do not consider that euthanasia or assisted suicide comes under the umbrella of true “Medicine.”)
When the doctors talked about killing their patient in terms of love, courage and intimacy, I suspect there has been an emotional boundary violation in the provider. The authors make no comment about the appropriateness of such feelings. Indeed, I cannot recall seeing even one negative comment or negative interpretation, throughout.
I also acknowledge that many recipients of euthanasia are likely to be thankful for this “service”, as are some family members. That said, B&B’s article provide no comments directly from any recipient of euthanasia or their family/friends. This means that the authors claim to a “human connection” which is potentially flawed. True human connection is a two-way relationship. One-sided ‘connection’ is more likely to be infatuation, delusion, or some perverse preoccupation. (Remember that the total contact with the provider/assessors can be just a couple of hours.)
Look at the litany of positive words used by the authors: “Profound; embodied existential experience; conviction; courage; compassion; intimacy; human connection; art; grace; love; joy; peace; sharing; poignant; honesty; frankness; meaningful”…and the homage continued throughout! This is not research — it is adulation.
The authors use several poorly-understood and poorly-defined words, as if this allows them to not review the material critically. Choice examples include “narrative-hermeneutic approach” and the “embodied existential experience.” They present “metaphors” and “stories” to appear insightful and perceptive beyond the norm. (And as the recordings are not available, a neutral review cannot now be made.)
Also, the author’s approach suggests that they are mind-readers: “…is anything conveyed yet unspoken in participants’ stories?”
Conclusion
The Beuthin & Bruce article is not research: it is the glorification of 8 providers and MAiD/euthanasia in general.
Unless there is a remarkable shift in the Supreme Court of Canada, it is unlikely that euthanasia will ever become illegal here again. To prevent a (legal) Canadian Dr. Shipman, I believe ‘frequent flier’ doctors — those providing euthanasia on a regular basis — should undergo a forensic psychiatric assessment. Then, if certain personality disorders or psychiatric illnesses are found, that person should be barred from the provision of euthanasia and assisted suicide.
Of course, that might exclude many repeat providers…
Kevin Hay
You can follow Kevin on 𝕏 (formerly Twitter) @kevinhay77