Vulnerable suffer if euthanasia seen as a virtue
By Susan Martinuk, Calgary Herald
March 19, 2010
In my first-ever column on euthanasia, I wrote about Frances and Ken. Fifteen years later, their stories remain far more compelling than my words in showing us what happens to individuals when society promotes life -- or death -- as a virtue.
The story of Frances appeared in Newsweek. On her 76th birthday, she wrote, "unassisted and by my own free will, I have chosen to take my final passage. I am still in control . . . this act is not one of suicide . . ." She then took an overdose of sleeping pills, tied a plastic bag over her head and committed suicide.
Why? She had no terminal illness. But she idolized Dr. Jack Kevorkian and possessed numerous well-worn publications from the Hemlock Society, as well as a suicide file. She spent the last years of her life focused on death and, according to her friend, "held a schoolgirl's romanticism about suicide, seeing it as noble and an act of strength."
When society promotes suicide as a virtue and the ultimate act of autonomy, lonely and vulnerable people like Frances are the first casualties.
Yet, last week it was reported that healthy, elderly people in the Netherlands who are "tired of living" could soon be allowed to end their lives with a lethal injection. In fact, the very helpful Right to Die group has suggested there's no need for the medical community to be involved in this death project and has proposed that non-medical staff be trained to administer the injection.
In Holland, inhabitants of nursing homes already fear for their lives and the possibility of "involuntary" euthanasia, while the depressed, the terminally ill, the not-so terminally ill and young ballerinas with arthritic toes all pride themselves in their right to voluntarily purchase this eternal one-way ticket.
In December, the health minister who led Holland's euthanasia bill into law admitted some regrets. Medical care for the terminally ill has declined and she believes it was a mistake to listen first to "the political and societal demand in favour of euthanasia."
In spite of what we now know about Holland, Bloc MP Francine Lalonde continues to envision this kind of a society for Canada. This week, she once again introduced a private member's bill to give medical doctors the right to directly and intentionally cause the death of a patient -- if the patient "appears to be lucid" and has chronic physical or mental pain (i. e. depression) or is terminally ill. She told Parliament, "We should not refuse them the right to die with dignity."
A November 2009 Environics poll showed that 61 per cent of Canadians apparently agree with Lalonde. But even though they may support legalized euthanasia, they still have a host of concerns about the consequences. Between 55 to 72 per cent of those who supported euthanasia still worried that a "significant number" of people could be put to death against their wishes (data from Holland broadly supports this concern). In addition, a large majority of those who showed tentative support for euthanasia believe we should place a greater priority on palliative and hospice care than euthanasia. In other words, Canadians are just as concerned with helping people live as helping them die.
That brings us to Ken, a 48-year-old Montreal poet who suffered from a rare, paralyzing form of Parkinson's disease. As his condition worsened, he repeatedly asked his friend for right-to-die literature and a lethal supply of sleeping pills. Then, one day, instead of saying "help me die," Ken began to ask his friend to "help me live."
According to Ken, "Life is beautiful and I haven't lost my appetite for life. I have proved the doctors wrong about my capacity to live, despite the disease, for years and years. But if I do not get help, I cannot continue to survive."
Ken then became a well-known advocate for home care in Quebec. Instead of using his final years to contemplate suicide, he used them to make life better for those with terminal illness.
There will be increasing pressure to legalize euthanasia as our population ages and a generation that has led a life of convenience comes to terms with death. Society must now choose. Will we focus on better palliative care or euthanasia? Will our nation promote life or death? Will Canadians help people live or help them die?
Susan Martinuk's column runs every Friday.
© Copyright (c) The Calgary Herald
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Euthanasia
Why Do Americans Balk at Euthanasia Laws?
Introduction
Why is euthanasia more controversial in the United States than, for instance, in the Netherlands? What would need to change before the U.S. would legalize physician-assisted suicide?
Read the Discussion »
http://www.nytimes.com/roomfordebate/20 ... y_20120411
Introduction
Why is euthanasia more controversial in the United States than, for instance, in the Netherlands? What would need to change before the U.S. would legalize physician-assisted suicide?
Read the Discussion »
http://www.nytimes.com/roomfordebate/20 ... y_20120411
Offering a Choice to the Terminally Ill
Last year, the radio host Diane Rehm watched in agony as her husband, John, starved to death over the course of 10 days.
Severely crippled by Parkinson’s disease, his only option for ending the suffering was to stop eating and drinking. Physicians in most states, including Maryland, where he lived, are barred from helping terminally ill patients who want to die in a dignified way.
“He was a brilliant man, just brilliant,” Ms. Rehm said in an interview. “For him to go out that way, not being able to do anything for himself, was an insufferable indignity.”
Ms. Rehm, whose current affairs talk show at WAMU is distributed by NPR, the public radio network, has brought a strong and poignant voice to a debate gaining attention in state legislatures around the country.
Currently, only Oregon, Washington, Vermont, New Mexico and Montana allow health care providers, under strict guidelines, to hasten the death of terminally ill patients who wish to spare themselves and their loved ones from the final, crippling stages of deteriorating health. Lawmakers in 15 other states and the District of Columbia have introduced so-called aid in dying bills in recent months to make such a humane option available to millions of Americans at a time when the nation’s population of older adults is growing.
The impetus for many of the bills was the widely publicized story of Brittany Maynard, a 29-year-old woman from California who moved to Oregon, after learning in the spring of 2014 that she had incurable brain cancer, so she could die on her own terms. The nonprofit organization Compassion & Choices, which has worked closely with Ms. Maynard’s relatives and with Ms. Rehm, has played a leading role in getting state lawmakers to introduce bills.
The right-to-die movement has strong opponents, including the Catholic Church, which opposes any form of suicide. Meanwhile, some medical professionals argue that the practice is at odds with their mission as healers and worry that it could be abused. Unfortunately, many Americans associate the issue with Dr. Jack Kevorkian, a notorious advocate of assisted suicide who was convicted in 1999 of murder and who aided dozens of patients, many of whom were not terminally ill, in ending their lives.
As local lawmakers around the country debate the bills, they should consider how successfully and responsibly the law has been carried out in Oregon. The state’s Death With Dignity Act, which went into effect in 1997, gives doctors the right to prescribe a lethal dose of medication to patients who are terminally ill and who have been advised of their alternatives, such as hospice care. The law provides layers of safeguards to ensure proper diagnosis of the disease, determine a patient’s competency to make the decision, and protect against coercion. Last year, 105 patients in Oregon, a record high, died after receiving a lethal dose of medication.
Health care providers in states where assisted suicide is illegal face wrenching choices when dying patients ask them for help. In one case, prosecutors in Pennsylvania perversely charged Barbara Mancini, a nurse, with assisting a suicide for handing a bottle of morphine in February 2013 to her 93-year-old father, who was in hospice care. A judge dismissed the case the following year.
Some doctors caught in these painful situations end up handing patients lethal doses of painkillers with a wink and a nod, right-to-die activists say. But these unregulated practices put patients and doctors on dangerous terrain. “Making a secret process transparent makes it safer,” Barbara Coombs Lee, the president of Compassion & Choices, said in an interview. Ms. Rehm said she and her husband had long agreed they would help each other die if either was in growing distress from a terminal illness. Her inability to help him die humanely is a situation no spouse should have to face.
“There was no question but that I would support him and honor whatever choice he would make,” she said. “As painful as it was, it was his wish.”
http://www.nytimes.com/2015/03/15/opini ... y-ill.html
Last year, the radio host Diane Rehm watched in agony as her husband, John, starved to death over the course of 10 days.
Severely crippled by Parkinson’s disease, his only option for ending the suffering was to stop eating and drinking. Physicians in most states, including Maryland, where he lived, are barred from helping terminally ill patients who want to die in a dignified way.
“He was a brilliant man, just brilliant,” Ms. Rehm said in an interview. “For him to go out that way, not being able to do anything for himself, was an insufferable indignity.”
Ms. Rehm, whose current affairs talk show at WAMU is distributed by NPR, the public radio network, has brought a strong and poignant voice to a debate gaining attention in state legislatures around the country.
Currently, only Oregon, Washington, Vermont, New Mexico and Montana allow health care providers, under strict guidelines, to hasten the death of terminally ill patients who wish to spare themselves and their loved ones from the final, crippling stages of deteriorating health. Lawmakers in 15 other states and the District of Columbia have introduced so-called aid in dying bills in recent months to make such a humane option available to millions of Americans at a time when the nation’s population of older adults is growing.
The impetus for many of the bills was the widely publicized story of Brittany Maynard, a 29-year-old woman from California who moved to Oregon, after learning in the spring of 2014 that she had incurable brain cancer, so she could die on her own terms. The nonprofit organization Compassion & Choices, which has worked closely with Ms. Maynard’s relatives and with Ms. Rehm, has played a leading role in getting state lawmakers to introduce bills.
The right-to-die movement has strong opponents, including the Catholic Church, which opposes any form of suicide. Meanwhile, some medical professionals argue that the practice is at odds with their mission as healers and worry that it could be abused. Unfortunately, many Americans associate the issue with Dr. Jack Kevorkian, a notorious advocate of assisted suicide who was convicted in 1999 of murder and who aided dozens of patients, many of whom were not terminally ill, in ending their lives.
As local lawmakers around the country debate the bills, they should consider how successfully and responsibly the law has been carried out in Oregon. The state’s Death With Dignity Act, which went into effect in 1997, gives doctors the right to prescribe a lethal dose of medication to patients who are terminally ill and who have been advised of their alternatives, such as hospice care. The law provides layers of safeguards to ensure proper diagnosis of the disease, determine a patient’s competency to make the decision, and protect against coercion. Last year, 105 patients in Oregon, a record high, died after receiving a lethal dose of medication.
Health care providers in states where assisted suicide is illegal face wrenching choices when dying patients ask them for help. In one case, prosecutors in Pennsylvania perversely charged Barbara Mancini, a nurse, with assisting a suicide for handing a bottle of morphine in February 2013 to her 93-year-old father, who was in hospice care. A judge dismissed the case the following year.
Some doctors caught in these painful situations end up handing patients lethal doses of painkillers with a wink and a nod, right-to-die activists say. But these unregulated practices put patients and doctors on dangerous terrain. “Making a secret process transparent makes it safer,” Barbara Coombs Lee, the president of Compassion & Choices, said in an interview. Ms. Rehm said she and her husband had long agreed they would help each other die if either was in growing distress from a terminal illness. Her inability to help him die humanely is a situation no spouse should have to face.
“There was no question but that I would support him and honor whatever choice he would make,” she said. “As painful as it was, it was his wish.”
http://www.nytimes.com/2015/03/15/opini ... y-ill.html
The Right Paperwork for Your End-of-Life Wishes
There is much confusion around this issue among patients and their families, and unfortunately among physicians as well. Which form is the right one? Who should have a copy?
An advance directive — each state has its own — is indeed an important legal document. Like any insurance policy, it is intended to prepare its owners in advance for difficult times. All responsible homeowners buy home insurance even though they will rarely, if ever, use it. But although everyone will eventually confront the end of life, their own and probably that of one or more loved ones, only about 20 percent of people complete an advance directive.
And even when they do, there is no set of clear and sequential instructions for I.C.U. doctors like me to follow. An advance directive is too reductionist to possibly do that. The human body and its workings are too unpredictable to plan for all possible eventualities. And then there are the myriad other factors: psychological, familial and spiritual considerations.
The advance directive should be seen as a conversation starter, an idea generator, a philosophical tool. It is a guide for your loved ones to work with your doctors and make decisions that are based on your goals and values as the situation unfolds. Its purpose is to chart the broad strokes, to delineate the guiding principles.
But it simply cannot be a detailed list of dos and don’ts.
The form asks that you choose between two general approaches to treatment — to prolong life or not to prolong life. There will be no confusion if you choose the first option — physicians’ default setting is to pursue every reasonable treatment, often until death. The problem is for those who would choose the latter.
Although the choice not to prolong life includes clarifying sentences — if the likely risks and burdens of treatment would outweigh the expected benefits, or if I become unconscious and, to a realistic degree of medical certainty, will not regain consciousness, or if I have an incurable and irreversible condition that will result in my death in a relatively short time — those conditions remain very subjective and can leave decision makers and doctors stumped. What does a relatively short time mean? Four days on a ventilator for someone with terminal cancer in excruciating pain might be a fate worse than death. But for someone else it might be a bridge to another six months of good life.
More....
http://opinionator.blogs.nytimes.com/20 ... 05309&_r=0
There is much confusion around this issue among patients and their families, and unfortunately among physicians as well. Which form is the right one? Who should have a copy?
An advance directive — each state has its own — is indeed an important legal document. Like any insurance policy, it is intended to prepare its owners in advance for difficult times. All responsible homeowners buy home insurance even though they will rarely, if ever, use it. But although everyone will eventually confront the end of life, their own and probably that of one or more loved ones, only about 20 percent of people complete an advance directive.
And even when they do, there is no set of clear and sequential instructions for I.C.U. doctors like me to follow. An advance directive is too reductionist to possibly do that. The human body and its workings are too unpredictable to plan for all possible eventualities. And then there are the myriad other factors: psychological, familial and spiritual considerations.
The advance directive should be seen as a conversation starter, an idea generator, a philosophical tool. It is a guide for your loved ones to work with your doctors and make decisions that are based on your goals and values as the situation unfolds. Its purpose is to chart the broad strokes, to delineate the guiding principles.
But it simply cannot be a detailed list of dos and don’ts.
The form asks that you choose between two general approaches to treatment — to prolong life or not to prolong life. There will be no confusion if you choose the first option — physicians’ default setting is to pursue every reasonable treatment, often until death. The problem is for those who would choose the latter.
Although the choice not to prolong life includes clarifying sentences — if the likely risks and burdens of treatment would outweigh the expected benefits, or if I become unconscious and, to a realistic degree of medical certainty, will not regain consciousness, or if I have an incurable and irreversible condition that will result in my death in a relatively short time — those conditions remain very subjective and can leave decision makers and doctors stumped. What does a relatively short time mean? Four days on a ventilator for someone with terminal cancer in excruciating pain might be a fate worse than death. But for someone else it might be a bridge to another six months of good life.
More....
http://opinionator.blogs.nytimes.com/20 ... 05309&_r=0
When Doctors Help a Patient Die
The patient was terminally ill. He had decided to end his life under his state’s “death with dignity” law, and his doctor prescribed the medication he would use to do it. But his death was unexpectedly delayed because he drank a large soda before taking the medication — an ordinarily lethal dose — and it apparently interfered with the drug’s absorption. I’ve been told that patients who want to die are now warned not to drink carbonated beverages before or after taking the medication.
In another situation, a physician assisting in a death for the first time prescribed less than the recommended dose of the lethal drug. Although the patient died, it might have been otherwise. And an A.L.S. patient who requested the prescription from his physician met one criterion (having a terminal illness) but not the second (prognosis of six months to live). These are just some of the unexpected wrinkles that have come up in the still-new world of physician-assisted death.
Providing the means for immediate death is contrary to the long history of medicine, where the primary intent has been to work for the patient’s survival. As a bioethicist in Washington, one of the five states that have legalized this, I find that for doctors, having the opportunity to help a patient die may resolve certain ethical issues but raises many others. It is especially important to consider these now, as many states are considering legislation on this practice.
A photo of Brittany Maynard, a terminally ill woman who moved from California to Oregon last year to legally end her life, rested on the dais as California lawmakers discussed a bill on medical aid in dying on March 25.Credit Rich Pedroncelli/Associated Press
Medical aid in dying is now allowed in Oregon, Washington and Vermont by legislation and in Montana and New Mexico through court decisions. The laws provide direction and protection for those involved. For example, in Oregon, Washington and Vermont, when terminally ill patients request physician assistance in dying, it is not considered suicide, and the death certificate notes the underlying illness as the cause of death.
In Washington State, two doctors must verify that the patient is competent, suffering from a terminal illness and that death is expected within six months. The request must be made and confirmed by a second request after a 15-day waiting period. The process requires a doctor who is willing to write the prescription and a pharmacist who is willing to fill it. The patient must have the capacity to take the prescription independently; that is, it must not be administered by another party.
Once a patient has the medication, he or she may decide when or whether to take it. Many patients have delayed taking the medication for weeks as they assessed when the timing was right. Most patients are not in a hurry to die. Some die of their diseases, never taking the medication. Surviving family members usually say that such patients felt a great sense of comfort in knowing they had the means to bring about their death if their suffering intensified. Many were willing to accept a certain level of pain as long as they were able to relate to loved ones and find at least a minimal level of satisfaction in living.
Legally, the act of aiding or abetting the death of another has been considered a felony. Ethically, physician assistance in the death of a patient has been contrary to the precepts of bioethics, and in earlier times physicians took an oath that they would not provide any deadly substance to patients. The passage of this law in 2008 in Washington has opened a new window on this practice and served as a reminder to physicians that many feel we are not doing a good enough job in caring for the dying by providing excellent palliative care at the end of life.
This is a new day for physicians. As one physician friend said: “I voted for this law when it was on the ballot, in principle, it seemed like a good idea. I never imagined that one of my patients would ask me to write a lethal prescription and participate in their decision to die.” Another doctor mused: “All of my training was to provide medications with the intent of curing illness or relieving pain. Writing a lethal prescription has a different intent.” Some physicians have examined their consciences and decided that they will not participate. Some health care organizations have decided to “opt out,” usually for religious reasons, and have established policies forbidding any employee of the institution from participating in physician assisted dying. Others have opted in.
Imagine, however, that a physician has decided to assist patients in situations deemed appropriate. When a patient makes a request for aid in dying, how should that conversation go? Is the patient driven by unreasonable fears or by discomforts that could be resolved through excellent palliative care? The request should trigger a careful discussion. These questions were not covered in medical school or resident training. To whom should one turn for this information?
If a decision is made to assist the patient, what happens next? Secobarbital — or seconal — is currently the most widely used prescription. Patients are advised to open the capsules and mix the powder with sweetened applesauce or a drink. There are a handful of cases where patients have regurgitated part of the medication, so an antiemetic should be taken first. The patient usually loses consciousness within moments of taking the medication, and death follows quickly. Physicians who prescribe medication in death with dignity cases usually seem to want to fly below the radar, avoiding publicity; they do not want to become known as “Dr. Death.” Given the desire for anonymity, there is little in the way of support from colleagues. I have recently met privately with two groups of physicians in the state, at their request, to discuss such issues and to provide support in the face of these complexities.
If other states pass death with dignity laws, learning from Washington State’s experience, they should require that the Department of Health provide standardized information to assist physicians. Additionally, professional support groups providing a neutral source of information and guidance for participating physicians should be offered. Even then, doctors will continue to struggle with their role in the process. As one physician I know put it, “a prognosis of six months or less is the same criterion for participation in hospice as it is for participation in physician-assisted death under the Death With Dignity Act — but I worry a lot more about the accuracy of the prognosis if a patient requests a prescription for a lethal dose of medication.”
Thomas R. McCormick is a senior lecturer emeritus in the Department of Medical History and Ethics at the University of Washington School of Medicine.
http://opinionator.blogs.nytimes.com/20 ... tient-die/
The patient was terminally ill. He had decided to end his life under his state’s “death with dignity” law, and his doctor prescribed the medication he would use to do it. But his death was unexpectedly delayed because he drank a large soda before taking the medication — an ordinarily lethal dose — and it apparently interfered with the drug’s absorption. I’ve been told that patients who want to die are now warned not to drink carbonated beverages before or after taking the medication.
In another situation, a physician assisting in a death for the first time prescribed less than the recommended dose of the lethal drug. Although the patient died, it might have been otherwise. And an A.L.S. patient who requested the prescription from his physician met one criterion (having a terminal illness) but not the second (prognosis of six months to live). These are just some of the unexpected wrinkles that have come up in the still-new world of physician-assisted death.
Providing the means for immediate death is contrary to the long history of medicine, where the primary intent has been to work for the patient’s survival. As a bioethicist in Washington, one of the five states that have legalized this, I find that for doctors, having the opportunity to help a patient die may resolve certain ethical issues but raises many others. It is especially important to consider these now, as many states are considering legislation on this practice.
A photo of Brittany Maynard, a terminally ill woman who moved from California to Oregon last year to legally end her life, rested on the dais as California lawmakers discussed a bill on medical aid in dying on March 25.Credit Rich Pedroncelli/Associated Press
Medical aid in dying is now allowed in Oregon, Washington and Vermont by legislation and in Montana and New Mexico through court decisions. The laws provide direction and protection for those involved. For example, in Oregon, Washington and Vermont, when terminally ill patients request physician assistance in dying, it is not considered suicide, and the death certificate notes the underlying illness as the cause of death.
In Washington State, two doctors must verify that the patient is competent, suffering from a terminal illness and that death is expected within six months. The request must be made and confirmed by a second request after a 15-day waiting period. The process requires a doctor who is willing to write the prescription and a pharmacist who is willing to fill it. The patient must have the capacity to take the prescription independently; that is, it must not be administered by another party.
Once a patient has the medication, he or she may decide when or whether to take it. Many patients have delayed taking the medication for weeks as they assessed when the timing was right. Most patients are not in a hurry to die. Some die of their diseases, never taking the medication. Surviving family members usually say that such patients felt a great sense of comfort in knowing they had the means to bring about their death if their suffering intensified. Many were willing to accept a certain level of pain as long as they were able to relate to loved ones and find at least a minimal level of satisfaction in living.
Legally, the act of aiding or abetting the death of another has been considered a felony. Ethically, physician assistance in the death of a patient has been contrary to the precepts of bioethics, and in earlier times physicians took an oath that they would not provide any deadly substance to patients. The passage of this law in 2008 in Washington has opened a new window on this practice and served as a reminder to physicians that many feel we are not doing a good enough job in caring for the dying by providing excellent palliative care at the end of life.
This is a new day for physicians. As one physician friend said: “I voted for this law when it was on the ballot, in principle, it seemed like a good idea. I never imagined that one of my patients would ask me to write a lethal prescription and participate in their decision to die.” Another doctor mused: “All of my training was to provide medications with the intent of curing illness or relieving pain. Writing a lethal prescription has a different intent.” Some physicians have examined their consciences and decided that they will not participate. Some health care organizations have decided to “opt out,” usually for religious reasons, and have established policies forbidding any employee of the institution from participating in physician assisted dying. Others have opted in.
Imagine, however, that a physician has decided to assist patients in situations deemed appropriate. When a patient makes a request for aid in dying, how should that conversation go? Is the patient driven by unreasonable fears or by discomforts that could be resolved through excellent palliative care? The request should trigger a careful discussion. These questions were not covered in medical school or resident training. To whom should one turn for this information?
If a decision is made to assist the patient, what happens next? Secobarbital — or seconal — is currently the most widely used prescription. Patients are advised to open the capsules and mix the powder with sweetened applesauce or a drink. There are a handful of cases where patients have regurgitated part of the medication, so an antiemetic should be taken first. The patient usually loses consciousness within moments of taking the medication, and death follows quickly. Physicians who prescribe medication in death with dignity cases usually seem to want to fly below the radar, avoiding publicity; they do not want to become known as “Dr. Death.” Given the desire for anonymity, there is little in the way of support from colleagues. I have recently met privately with two groups of physicians in the state, at their request, to discuss such issues and to provide support in the face of these complexities.
If other states pass death with dignity laws, learning from Washington State’s experience, they should require that the Department of Health provide standardized information to assist physicians. Additionally, professional support groups providing a neutral source of information and guidance for participating physicians should be offered. Even then, doctors will continue to struggle with their role in the process. As one physician I know put it, “a prognosis of six months or less is the same criterion for participation in hospice as it is for participation in physician-assisted death under the Death With Dignity Act — but I worry a lot more about the accuracy of the prognosis if a patient requests a prescription for a lethal dose of medication.”
Thomas R. McCormick is a senior lecturer emeritus in the Department of Medical History and Ethics at the University of Washington School of Medicine.
http://opinionator.blogs.nytimes.com/20 ... tient-die/
Doctors will be more and more confronted to asituations where they have to make a decision on helping or not a patient die. The AKU is preparing them for those decisions since a long time with a course on medical ethics. I hope more Universities across the world will follow suit with this kind of courses that should be made compulsory.
When I was preparing my will, the notary made me sign a paper which defined the person/persons that will be able to take those kind of decision on my behalf if I become incapable of taking decisions. I though that was the right thing to do. Why put the doctors in uncomfortable position where they are asked to make decisions on behalf of their patient.
Is not stopping medication and stopping treatment of a terminally ill patient, a form of passive euthanasia?
When I was preparing my will, the notary made me sign a paper which defined the person/persons that will be able to take those kind of decision on my behalf if I become incapable of taking decisions. I though that was the right thing to do. Why put the doctors in uncomfortable position where they are asked to make decisions on behalf of their patient.
Is not stopping medication and stopping treatment of a terminally ill patient, a form of passive euthanasia?
I don't think a solution has been found yet nor is there a simple one for this issue. However MHI has expressed the need to address such issues at the AKU in the coming decades as per statement below made at the McMaster Convocation May 15, 1987:Admin wrote:Doctors will be more and more confronted to asituations where they have to make a decision on helping or not a patient die. The AKU is preparing them for those decisions since a long time with a course on medical ethics. I hope more Universities across the world will follow suit with this kind of courses that should be made compulsory.
"Professional standards and assumptions can provide a form of intolerance, pride and myopia as intractable as the rigidities of traditional societies. As you know far better than I, science alone will not give us much guidance on when to prolong human life and whether to intervene in its creation.
The industrialized world only rather recently has rediscovered that these questions engage not merely professional ethics and standards; they touch the deeply held convictions of a Judeo-Christian tradition, an idea of humanity that has challenged the prophets and philosophers for thousands of years. Nations cannot assign these issues to a priesthood of scientists; they require the resources of the human spirit as well as the mind. The Islamic world is dealing with these questions on two fronts simultaneously; first, in the reintroduction of science and its sceptical world view that it is not part of current tradition; second, Islamic societies are redicovering the importance of the modern, secular world of their Islamic ethical underpinning. Is it any surprise that there is soul-searching and social upheaval, but also intellectual vitality and tumult, among the people of the Islamic world?
My message to all graduating doctors, nurses and health workers, then, is that the world needs your professionalism. But it also needs your imagination, your energy, and an abiding humility and curiosity about the human beings you serve - and about those subtle, deep, non-material forces that motivate them. During its first hundred years McMaster has shown an exceptional ability to ask new questions about old issues, and to ask the old - ethical - questions about new issues. Is this restlessness, this continually renewed freshness of intellectual approach, not the sign of a great institution? Surely it is. Nowhere has this been clearer than in McMaster's health sciences.
Science is a wonderful, powerful tool and research budgets are essential. But science is only the beginning in the new age we are entering. My hope is that, in Islamic Pakistan, The Aga Khan University and Hospital can make progress in developing new models. Islam does not perceive the world as two separate domains of mind and spirit, science and belief. Science and the search for knowledge are an expression of man's designated role in the universe, but they do not define that role totally. Surely there is no more worthy area in which East and West can work, to bond these two aspects of man's understanding, than the field of health sciences that our graduates enter this evening. The world is an infinitely exciting place. You have been wonderfully trained. I congratulate you and urge you to move forward with all reason, imagination, and human understanding. Thank You."
Healthy 24-year-old granted right to die in Belgium
Doctors in Belgium are granting a 24-year-old woman who is suffering from depression but is otherwise healthy the right to die as she qualifies for euthanasia under the Belgian law, even though she does not have a terminal or life-threatening illness.
The 24-year-old woman, known simply as Laura, has been given the go-ahead by health professionals in Belgium to receive a lethal injection after spending both her childhood and adult life suffering from "suicidal thoughts", she told local Belgian media.
Laura has been a patient of a psychiatric institution since the age of 21 and says she has previously tried to kill herself on several occasions. She told journalists: "Death feels to me not as a choice. If I had a choice, I would choose a bearable life, but I have done everything and that was unsuccessful." The date of Laura's death is yet to be decided.
Belgium passed a law to legalise euthanasia in 2002, the second country in the world to do so after the Netherlands. The law states that Belgian doctors can "help patients" to end their lives if they freely express a wish to die because they are suffering from intractable and unbearable pain.
Dr Marc Van Hoey, a general practitioner and president of the Right to Die Association in northern Belgium, is a vocal supporter of the legislation. Van Hoey told the Independent newspaper that he believes that sometimes euthanasia is the kindest option. "I've seen quite a lot of persons dying in - how do you say in proper English - agony?" Van Hoey said. "I never saw that when I gave someone euthanasia he or she asked for."
Over the past few years there has been a sharp increase in the number of euthanasia cases in Belgium. In 2013, there were 1,807 deaths recorded compared with 1,432 in 2012. More than half of last year's cases were patients aged 70 and over but there are increasing numbers of young people requesting to die legally, with the majority citing depression as their "intractable and unbearable pain."
However, not everyone is in favour of the law. Carine Brochier, a project manager with the Brussels-based European Institute of Bioethics, tells Newsweek that she believes too many people are dying as a result of Belgium's liberalised euthanasia laws.
She argues that many people who experience psychological suffering and treatable mental illnesses may be wrongly given the go ahead for euthanasia because "there is absolutely no way for healthcare professionals to measure another person's mental suffering to decide if they should receive euthanasia."
"Euthanasia is not the answer to all human suffering," Brochier continues. "We need to develop better palliative care for people," something she believes Belgium is not currently doing.
Earlier this year in February, the parliament in Belgium passed a bill also allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44. The vote makes it the first country in the world to have legalised euthanasia without an age limit.
In the Netherlands, the first country to legalize euthanasia, sick children are allowed to request it, but only if they are 12 years or older.
As of June 2015, euthanasia is legal in the Netherlands, Belgium, Colombia and Luxembourg.
http://europe.newsweek.com/healthy-24-y ... ium-329504
Doctors in Belgium are granting a 24-year-old woman who is suffering from depression but is otherwise healthy the right to die as she qualifies for euthanasia under the Belgian law, even though she does not have a terminal or life-threatening illness.
The 24-year-old woman, known simply as Laura, has been given the go-ahead by health professionals in Belgium to receive a lethal injection after spending both her childhood and adult life suffering from "suicidal thoughts", she told local Belgian media.
Laura has been a patient of a psychiatric institution since the age of 21 and says she has previously tried to kill herself on several occasions. She told journalists: "Death feels to me not as a choice. If I had a choice, I would choose a bearable life, but I have done everything and that was unsuccessful." The date of Laura's death is yet to be decided.
Belgium passed a law to legalise euthanasia in 2002, the second country in the world to do so after the Netherlands. The law states that Belgian doctors can "help patients" to end their lives if they freely express a wish to die because they are suffering from intractable and unbearable pain.
Dr Marc Van Hoey, a general practitioner and president of the Right to Die Association in northern Belgium, is a vocal supporter of the legislation. Van Hoey told the Independent newspaper that he believes that sometimes euthanasia is the kindest option. "I've seen quite a lot of persons dying in - how do you say in proper English - agony?" Van Hoey said. "I never saw that when I gave someone euthanasia he or she asked for."
Over the past few years there has been a sharp increase in the number of euthanasia cases in Belgium. In 2013, there were 1,807 deaths recorded compared with 1,432 in 2012. More than half of last year's cases were patients aged 70 and over but there are increasing numbers of young people requesting to die legally, with the majority citing depression as their "intractable and unbearable pain."
However, not everyone is in favour of the law. Carine Brochier, a project manager with the Brussels-based European Institute of Bioethics, tells Newsweek that she believes too many people are dying as a result of Belgium's liberalised euthanasia laws.
She argues that many people who experience psychological suffering and treatable mental illnesses may be wrongly given the go ahead for euthanasia because "there is absolutely no way for healthcare professionals to measure another person's mental suffering to decide if they should receive euthanasia."
"Euthanasia is not the answer to all human suffering," Brochier continues. "We need to develop better palliative care for people," something she believes Belgium is not currently doing.
Earlier this year in February, the parliament in Belgium passed a bill also allowing euthanasia for terminally ill children without any age limit, by 86 votes to 44. The vote makes it the first country in the world to have legalised euthanasia without an age limit.
In the Netherlands, the first country to legalize euthanasia, sick children are allowed to request it, but only if they are 12 years or older.
As of June 2015, euthanasia is legal in the Netherlands, Belgium, Colombia and Luxembourg.
http://europe.newsweek.com/healthy-24-y ... ium-329504
California Legislature Approves Assisted Suicide
SACRAMENTO — In a landmark victory for supporters of assisted suicide, the California State Legislature on Friday gave its final approval to a bill that would allow doctors to help terminally ill people end their lives.
Four states — Oregon, Washington, Montana and Vermont — already allow physicians to prescribe life-ending medication to some patients. The California bill, which passed Friday in the State Senate by a vote of 23 to 14, will now go to Gov. Jerry Brown, who will roughly triple access to doctor-assisted suicide across the country if he signs it. Mr. Brown has given little indication of his intentions.
Quote:
"In spite of the bill’s provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.
He pointed to a case in Oregon involving Barbara Wagner, a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for “physician aid in dying.”"
More....
http://www.nytimes.com/2015/09/12/us/ca ... 05309&_r=0[/b]
SACRAMENTO — In a landmark victory for supporters of assisted suicide, the California State Legislature on Friday gave its final approval to a bill that would allow doctors to help terminally ill people end their lives.
Four states — Oregon, Washington, Montana and Vermont — already allow physicians to prescribe life-ending medication to some patients. The California bill, which passed Friday in the State Senate by a vote of 23 to 14, will now go to Gov. Jerry Brown, who will roughly triple access to doctor-assisted suicide across the country if he signs it. Mr. Brown has given little indication of his intentions.
Quote:
"In spite of the bill’s provision about coercion, Dr. Aaron Kheriaty, director of the medical ethics program at the University of California, Irvine, School of Medicine, said that low-income and underinsured patients would inevitably feel pressure from family members to end their own lives in some cases, when the cost of continued treatment would be astronomical compared with the cost of a few lethal pills.
He pointed to a case in Oregon involving Barbara Wagner, a cancer patient who said that her insurance plan had refused to cover an expensive treatment but did offer to pay for “physician aid in dying.”"
More....
http://www.nytimes.com/2015/09/12/us/ca ... 05309&_r=0[/b]
Quebec province is introducing Euthanasia under Doctor supervision. It required Quebec Residency as the province does not want to encourage Euthanasia Tourism.
The doctor will be free to refuse. There are conditions also as it is not Euthanasia for all, what is proposed is Euthanasia with the consent of the patient for terminally il, when suffering is increasing everyday and is unbearable and death is inevitable in a short time because of the disease.
This has created a debate on the ethics of Euthanasia...
The doctor will be free to refuse. There are conditions also as it is not Euthanasia for all, what is proposed is Euthanasia with the consent of the patient for terminally il, when suffering is increasing everyday and is unbearable and death is inevitable in a short time because of the disease.
This has created a debate on the ethics of Euthanasia...
Miracles Don’t Come Cheap
As I rushed through the hospital lobby on my way to the intensive care unit, I saw the palliative care team speaking to a young woman in a wheelchair. She was beautiful, her cheeks full and round, her mouth in a constant soft smile as she spoke. She sat regally in her chair, the red of her sweatshirt anchoring my eyes in the dim hospital lobby. She was such a vision of beauty and health that it took me a second to realize that her right leg was amputated below the knee.
One of my colleagues smiled in introduction and gestured ceremoniously to the patient. “Dr. Zitter, you remember Michelle Moore.” My mind grappled for traction. I recognized the name (which I’ve replaced with a pseudonym to protect her privacy), but her face drew a blank. “I believe that you took care of Michelle in the I.C.U. when she first came to the hospital last year.” And then it came to me: When I had known this woman, she had been covered by so many tubes and wires, I could barely make out her face.
As the treating doctor for this critically ill patient, I had been sure she would die. And I was wrong. Her very presence in the lobby felt like a reprimand.
As Nicholas Christakis describes in his book “Death Foretold,” doctors are significantly more likely to overestimate a patient’s life expectancy than to underestimate it. And not just by a little. According to a large study he conducted in 2000, they overestimated survival by a factor of five. In that vein, it is the rare case where I feel confident that an outcome will be bad and the patient proves me wrong.
Michelle’s heart valve had become infected from a batch of bacteria-laden heroin. These delicate valves act as a backstop for the heart, preventing blood from flowing backward. In Michelle’s case, a critical valve was caked with pus and a cabbage-like mass clung to it like a rider on a rodeo horse. The majority of blood flowed backward with every contraction of her heart, instead of toward her oxygen-starved organs, and her blood pressure was critically low.
In addition to compromising her blood flow, the heaving vegetation had been steadily showering drops of pus downstream, to any location where blood flowed. Pus had woven into her muscle fibers, her kidney, her liver, and lodged into the distal regions of her extremities. Her hands and feet were so chock-full of it that they were beginning to die. But her brain, the control center of life, was our biggest concern. The CT scan showed that it was saturated throughout with fine pustules and inflammation, severe enough in some parts to have caused bleeding into its delicate tissues. The neurologists met with the family to break the bad news that significant recovery was extremely unlikely.
I, too, spent numerous hours with her family, providing support and information, and transmitting my increasing concern that she would not recover. We were approaching the two-week mark of her hospitalization, the point at which we become concerned that continuing pressure from the breathing tube can break down the delicate tissues of the throat and airway. A solution is to sew the breathing tube directly into the neck at the level of the Adam’s apple, a procedure called a tracheostomy or trach, to more safely continue to provide support from the breathing machine.
Although the procedure itself is not significantly risky, its implications are serious. Unlike the temporary breathing tube of the first two weeks, a trach does not expire. And therefore, while it may serve as a bridge to improvement, it may also function as a tomb for one who does not improve.
I use this two-week decision point as an opportunity to reassess goals of care with the family. Is it time to focus on comfort more than the prolongation of life? Or not? By that time, I have gathered more data, observed the trajectory of the illness, and have a clearer view of where things are heading. If recovery, or even improvement, doesn’t seem likely, families may decide to remove the temporary breathing tube and allow their loved one’s body to die. Many families elect to place the trach despite a poor prognosis, but I feel it is my role to enable them to opt out of the default decision to prolong life, so common in our nation’s I.C.U.s.
I presented Michelle’s mother with both options: Withdraw the breathing tube and allow her to die, or replace it with a trach and keep her on machines. When they asked me what I would do if this were my family member, I said I probably would not perform a tracheostomy. Still, her mother, a religious woman, decided she would hold out for a miracle. And so against my better judgment, we trached her.
For the first several months of her hospitalization, she was cited as a sad case of nonbeneficial life prolongation, with extensive nursing needs and continued medical setbacks. But one day a colleague said to me: “Hey, did you hear that Michelle Moore woke up?” I looked up, incredulous. “No, I’m serious,” she continued. “Dr. Rodriguez was standing next to her bed and she said hello.” I was stunned and thrilled.
Her unexpected turnaround began to affect our hospital culture. “Remember that patient with the valve infection?” became a common refrain for doctors considering whether to break bad news. What if they were wrong?
I had delivered bad news to Michelle’s family several times. I had presented them with the option of disconnecting her from the breathing machine. Their belief in miracles had kept her alive. And now she was here in our hospital lobby thanking me for all I had done for her. I wondered whether I would ever be able to give a family bad news again.
Before we parted, I hugged her and almost wept with joy. Yet as I walked away, I was overcome by a cloud of apprehension. Should I have kept my doubts to myself? Was it wrong to consider stopping the full-court press?
But over the course of that week some clarity returned. In my 25 years of experience with thousands of patients, I can count miraculous cases like Michelle’s on one hand. Numerous doctors besides me had been convinced she would die, or at least be severely brain damaged if she were to survive. And that consensus of thought is something I believe that families do deserve to hear.
The fact is, there are two types of risk in cases like these. One risk is that a patient will be deprived of the chance at a miracle. But the far more likely risk is that a patient with no chance of recovery will become permanently attached to machinery designed to automate breathing and feeding, and spend the rest of her life in a nursing home, being washed by strangers, enduring infections and skin breakdown, family visits ebbing because it’s simply too painful. Survey after survey shows that most people would never choose this path.
A friend used the analogy of a lottery. Why not go for it? Even if there is only a chance in a million, isn’t it worth trying? My response to this question is as follows. Are you, as a future patient, and future surrogate of loved ones, willing to take the risk of being on the other side of Michelle’s odds? This is where the lottery analogy falls away completely. It’s not $5 on the line. It’s everything.
For the sake of my future patients, I must remember that miracles are just that… miracles.
Jessica Nutik Zitter, a critical care and palliative care physician at Highland Hospital in Oakland, Calif., is writing a book about end-of-life issues.
http://opinionator.blogs.nytimes.com/20 ... d=45305309
As I rushed through the hospital lobby on my way to the intensive care unit, I saw the palliative care team speaking to a young woman in a wheelchair. She was beautiful, her cheeks full and round, her mouth in a constant soft smile as she spoke. She sat regally in her chair, the red of her sweatshirt anchoring my eyes in the dim hospital lobby. She was such a vision of beauty and health that it took me a second to realize that her right leg was amputated below the knee.
One of my colleagues smiled in introduction and gestured ceremoniously to the patient. “Dr. Zitter, you remember Michelle Moore.” My mind grappled for traction. I recognized the name (which I’ve replaced with a pseudonym to protect her privacy), but her face drew a blank. “I believe that you took care of Michelle in the I.C.U. when she first came to the hospital last year.” And then it came to me: When I had known this woman, she had been covered by so many tubes and wires, I could barely make out her face.
As the treating doctor for this critically ill patient, I had been sure she would die. And I was wrong. Her very presence in the lobby felt like a reprimand.
As Nicholas Christakis describes in his book “Death Foretold,” doctors are significantly more likely to overestimate a patient’s life expectancy than to underestimate it. And not just by a little. According to a large study he conducted in 2000, they overestimated survival by a factor of five. In that vein, it is the rare case where I feel confident that an outcome will be bad and the patient proves me wrong.
Michelle’s heart valve had become infected from a batch of bacteria-laden heroin. These delicate valves act as a backstop for the heart, preventing blood from flowing backward. In Michelle’s case, a critical valve was caked with pus and a cabbage-like mass clung to it like a rider on a rodeo horse. The majority of blood flowed backward with every contraction of her heart, instead of toward her oxygen-starved organs, and her blood pressure was critically low.
In addition to compromising her blood flow, the heaving vegetation had been steadily showering drops of pus downstream, to any location where blood flowed. Pus had woven into her muscle fibers, her kidney, her liver, and lodged into the distal regions of her extremities. Her hands and feet were so chock-full of it that they were beginning to die. But her brain, the control center of life, was our biggest concern. The CT scan showed that it was saturated throughout with fine pustules and inflammation, severe enough in some parts to have caused bleeding into its delicate tissues. The neurologists met with the family to break the bad news that significant recovery was extremely unlikely.
I, too, spent numerous hours with her family, providing support and information, and transmitting my increasing concern that she would not recover. We were approaching the two-week mark of her hospitalization, the point at which we become concerned that continuing pressure from the breathing tube can break down the delicate tissues of the throat and airway. A solution is to sew the breathing tube directly into the neck at the level of the Adam’s apple, a procedure called a tracheostomy or trach, to more safely continue to provide support from the breathing machine.
Although the procedure itself is not significantly risky, its implications are serious. Unlike the temporary breathing tube of the first two weeks, a trach does not expire. And therefore, while it may serve as a bridge to improvement, it may also function as a tomb for one who does not improve.
I use this two-week decision point as an opportunity to reassess goals of care with the family. Is it time to focus on comfort more than the prolongation of life? Or not? By that time, I have gathered more data, observed the trajectory of the illness, and have a clearer view of where things are heading. If recovery, or even improvement, doesn’t seem likely, families may decide to remove the temporary breathing tube and allow their loved one’s body to die. Many families elect to place the trach despite a poor prognosis, but I feel it is my role to enable them to opt out of the default decision to prolong life, so common in our nation’s I.C.U.s.
I presented Michelle’s mother with both options: Withdraw the breathing tube and allow her to die, or replace it with a trach and keep her on machines. When they asked me what I would do if this were my family member, I said I probably would not perform a tracheostomy. Still, her mother, a religious woman, decided she would hold out for a miracle. And so against my better judgment, we trached her.
For the first several months of her hospitalization, she was cited as a sad case of nonbeneficial life prolongation, with extensive nursing needs and continued medical setbacks. But one day a colleague said to me: “Hey, did you hear that Michelle Moore woke up?” I looked up, incredulous. “No, I’m serious,” she continued. “Dr. Rodriguez was standing next to her bed and she said hello.” I was stunned and thrilled.
Her unexpected turnaround began to affect our hospital culture. “Remember that patient with the valve infection?” became a common refrain for doctors considering whether to break bad news. What if they were wrong?
I had delivered bad news to Michelle’s family several times. I had presented them with the option of disconnecting her from the breathing machine. Their belief in miracles had kept her alive. And now she was here in our hospital lobby thanking me for all I had done for her. I wondered whether I would ever be able to give a family bad news again.
Before we parted, I hugged her and almost wept with joy. Yet as I walked away, I was overcome by a cloud of apprehension. Should I have kept my doubts to myself? Was it wrong to consider stopping the full-court press?
But over the course of that week some clarity returned. In my 25 years of experience with thousands of patients, I can count miraculous cases like Michelle’s on one hand. Numerous doctors besides me had been convinced she would die, or at least be severely brain damaged if she were to survive. And that consensus of thought is something I believe that families do deserve to hear.
The fact is, there are two types of risk in cases like these. One risk is that a patient will be deprived of the chance at a miracle. But the far more likely risk is that a patient with no chance of recovery will become permanently attached to machinery designed to automate breathing and feeding, and spend the rest of her life in a nursing home, being washed by strangers, enduring infections and skin breakdown, family visits ebbing because it’s simply too painful. Survey after survey shows that most people would never choose this path.
A friend used the analogy of a lottery. Why not go for it? Even if there is only a chance in a million, isn’t it worth trying? My response to this question is as follows. Are you, as a future patient, and future surrogate of loved ones, willing to take the risk of being on the other side of Michelle’s odds? This is where the lottery analogy falls away completely. It’s not $5 on the line. It’s everything.
For the sake of my future patients, I must remember that miracles are just that… miracles.
Jessica Nutik Zitter, a critical care and palliative care physician at Highland Hospital in Oakland, Calif., is writing a book about end-of-life issues.
http://opinionator.blogs.nytimes.com/20 ... d=45305309
Religious leaders call for better palliative care as assisted dying debate heats up
Religious leaders from several faiths are calling on Canadian lawmakers to improve palliative care and respect human life as the contentious debate over doctor-assisted dying heats up.
The Canadian Conference of Catholic Bishops and the Evangelical Fellowship of Canada, along with other faith leaders, held a joint news conference on Parliament Hill to release a declaration physician-assisted death.
The statement has been endorsed by more than 30 Christian denominations, as well as Jewish and Muslim leaders from across the country. It calls for more palliative care, as well as "respect for the dignity of the human person, human solidarity and psychological, spiritual and emotional support as the only ethical and moral response in end of life care."
In a unanimous landmark ruling on Feb. 6, 2015, the Supreme Court of Canada struck down the ban on physician-assisted dying, on the grounds that it violated Canadians' Charter rights. Justices gave the federal and provincial governments 12 months to prepare for the decision to come into effect.
The College of Physicians and Surgeons of Manitoba says in its draft statement on physician-assisted dying that two physicians have to participate to process of a patient's request for help in ending his or her life. (Reuters)
This week, CBC News reported the incoming Liberal government is considering asking the Supreme Court for a six-month extension to draft new laws.
The Conservatives had set up an independent panel this summer to hear from Canadians. Work was suspended during the three-month election campaign.
Dr. Cindy Forbes, the new president of the Canadian Medical Association, appeared before the panel last week and requested federal leadership on the issue.
"What we're hoping is that there will be a national approach to this so that there wouldn't be a patchwork of different legislation across the country, so that it wouldn't matter where you live in Canada the regulations, the process and the service would be similar and access would be similar right across the country," she told CBC News.
The CMA has done its own consultations on this issue. Forbes said at first doctors were divided about whether or not they should be allowed to help a terminally ill patient end his or her life.
Since the Supreme Court ruled, Forbes said, the conversation has changed.
"How should this occur? What about physicians who wish to participate — are they protected? And what about the physicians who would not wish to participate due to issues of conscience?" Those are the kinds of questions doctors are asking now, Forbes said.
Defeated Conservative MP Steven Fletcher had his own private member's bill on the issue, and has long been an advocate for physician-assisted dying.
He would prefer the federal government let the provinces deal with the issue going forward.
"I'm not sure what kind of legislation the government could bring forward. What the Supreme Court did was, when they made their decision, they took the meat of my private member's bill and put it into their decision. So the framework, the boundaries are already in place," Fletcher said.
Fletcher said all political parties dodged this issue in any kind of detail in the election campaign.
Prime Minister-designate Justin Trudeau is expected to ask the Supreme Court of Canada for a six-month extension to craft new laws around physician-assisted dying. (Sean Kilpatrick/Canadian Press)
"Politicians are terrible at making laws that deal with morality, particularly telling cognitive adults what they can or can not do," he said.
But, he added, he heard from many voters about their support for physician-assisted dying, and he believes the political tone will change going forward, not because it's a new government, but because of what Canadians are telling their politicians.
"The people who went door knocking in the last three months would have heard about this on their doorstep. And what people would say, in my experience was, the vast majority were in favour of physician-assisted death with the appropriate caveats," Fletcher said.
http://www.cbc.ca/news/politics/canada- ... -1.3293919
Religious leaders from several faiths are calling on Canadian lawmakers to improve palliative care and respect human life as the contentious debate over doctor-assisted dying heats up.
The Canadian Conference of Catholic Bishops and the Evangelical Fellowship of Canada, along with other faith leaders, held a joint news conference on Parliament Hill to release a declaration physician-assisted death.
The statement has been endorsed by more than 30 Christian denominations, as well as Jewish and Muslim leaders from across the country. It calls for more palliative care, as well as "respect for the dignity of the human person, human solidarity and psychological, spiritual and emotional support as the only ethical and moral response in end of life care."
In a unanimous landmark ruling on Feb. 6, 2015, the Supreme Court of Canada struck down the ban on physician-assisted dying, on the grounds that it violated Canadians' Charter rights. Justices gave the federal and provincial governments 12 months to prepare for the decision to come into effect.
The College of Physicians and Surgeons of Manitoba says in its draft statement on physician-assisted dying that two physicians have to participate to process of a patient's request for help in ending his or her life. (Reuters)
This week, CBC News reported the incoming Liberal government is considering asking the Supreme Court for a six-month extension to draft new laws.
The Conservatives had set up an independent panel this summer to hear from Canadians. Work was suspended during the three-month election campaign.
Dr. Cindy Forbes, the new president of the Canadian Medical Association, appeared before the panel last week and requested federal leadership on the issue.
"What we're hoping is that there will be a national approach to this so that there wouldn't be a patchwork of different legislation across the country, so that it wouldn't matter where you live in Canada the regulations, the process and the service would be similar and access would be similar right across the country," she told CBC News.
The CMA has done its own consultations on this issue. Forbes said at first doctors were divided about whether or not they should be allowed to help a terminally ill patient end his or her life.
Since the Supreme Court ruled, Forbes said, the conversation has changed.
"How should this occur? What about physicians who wish to participate — are they protected? And what about the physicians who would not wish to participate due to issues of conscience?" Those are the kinds of questions doctors are asking now, Forbes said.
Defeated Conservative MP Steven Fletcher had his own private member's bill on the issue, and has long been an advocate for physician-assisted dying.
He would prefer the federal government let the provinces deal with the issue going forward.
"I'm not sure what kind of legislation the government could bring forward. What the Supreme Court did was, when they made their decision, they took the meat of my private member's bill and put it into their decision. So the framework, the boundaries are already in place," Fletcher said.
Fletcher said all political parties dodged this issue in any kind of detail in the election campaign.
Prime Minister-designate Justin Trudeau is expected to ask the Supreme Court of Canada for a six-month extension to craft new laws around physician-assisted dying. (Sean Kilpatrick/Canadian Press)
"Politicians are terrible at making laws that deal with morality, particularly telling cognitive adults what they can or can not do," he said.
But, he added, he heard from many voters about their support for physician-assisted dying, and he believes the political tone will change going forward, not because it's a new government, but because of what Canadians are telling their politicians.
"The people who went door knocking in the last three months would have heard about this on their doorstep. And what people would say, in my experience was, the vast majority were in favour of physician-assisted death with the appropriate caveats," Fletcher said.
http://www.cbc.ca/news/politics/canada- ... -1.3293919
The End
Casualties of War
It has been 15 years since my mother called and asked, “Do you have some time at the end of July or the beginning of August? Your father and I have decided to kill ourselves and we would like you to come and find our bodies.”
My parents, who lived in England, were Czech refugees from the Holocaust. My father, a 26-year-old newly minted lawyer, escaped deportation in 1939 by walking across the border from his native Czechoslovakia into Poland, with England as his goal. My mother’s parents put her on a train in Prague, with Shanghai as her eventual destination. She was 18.
My mother’s parents died in Lodz and Auschwitz. My father told me that his father had committed suicide during the transport of Jews from Ostrava to Nisko in 1939. This information might have come from his mother, who was deported to Minsk and murdered there in 1942.
During the early years of World War II, chance and good fortune brought both my parents to London, where they met and married in 1945. Within a couple of years, they had established themselves as an academic couple with two children and started to make their way up the social and economic ladder. Their careers were distinguished, with honors and privileges bestowed by their adopted country.
They had made it clear for as long as I can remember that, because of the deaths of all four of their parents in the Holocaust, their lives were their own, to continue or end as they saw fit and whenever they saw fit. They had even made a pact wherein, if one of them died, the other need stay alive for only six months before taking his or her own life, if that life proved unbearable.
My mother’s health began to fail in 2000 and, with her phone call from England, it was clear that my parents had abandoned their pact and were planning to end their lives together.
In answer to my mother’s macabre question, I said, “I can come to England on the night that you kill yourselves and then come to the house with a doctor and the police, if that is what you want.” But, no, that was not what my mother wanted.
“We would like you to come and say goodbye to us, to go to London for the day, and then to return alone to find our bodies.” I’m not that tough; I could not agree to do that. So my mother said that they would make other arrangements.
A few weeks later, in mid-August, a doctor was called to their house and found my parents dead, with garbage bags tied over their heads and pillows resting on their suffocated faces. She also found a statement of their intent to kill themselves.
In October, the coroner ruled, “I have to be sure beyond reasonable doubt that both these persons intended to take their own lives. They have done so, I am sure.”
We shall all die and most of us want some control over the manner of our dying. Some want to be sure that they will be able to kill themselves; some want the right to assisted suicide if they are unable to kill themselves; some want purely palliative care; and some want every possible medical intervention.
I hope, too, to have some control over my dying and I am repelled neither by the idea of suicide nor by the idea of assisted suicide. However, my experience with my parents’ deaths gives me pause.
Since my parents’ deaths, many of my friends have seen their parents die in the hospital or under hospice care. I envy all these friends. Their parents brought them into this world and they were there for their parents when their parents left this world. By depriving me of this filial role, my parents rejected me more forcefully than they could possibly have understood — or, maybe, they just did not care. Or was their request that I be the one to find their bodies an indication of their great love for me? This is a question that I can never answer.
Most of the time, I do not think of my parents’ deaths. But they are a result of the Holocaust as surely as the deaths of my grandparents. And it is at the most inopportune times, when I am worried about my own health, that I have to confront all six deaths. When a physician asks for my family history, I have to say, “My grandparents perished as Jews in the Holocaust; my father died, according to his autopsy, in perfect health; and my parents killed themselves.”
Sherwin Nuland, the author of “How We Die,” taught me that one cannot control how one dies but one can have some control over how one lives. But I wonder how much control I shall have over my own death and, more profoundly, how much control is best for me and, even more important, for my children and grandchildren. It is my descendants, after all, who will be dealing with the manner and consequences of my death when I am gone.
Ann M. Altman is a scientist, a writer and a political adviser.
http://opinionator.blogs.nytimes.com/20 ... ef=opinion
Casualties of War
It has been 15 years since my mother called and asked, “Do you have some time at the end of July or the beginning of August? Your father and I have decided to kill ourselves and we would like you to come and find our bodies.”
My parents, who lived in England, were Czech refugees from the Holocaust. My father, a 26-year-old newly minted lawyer, escaped deportation in 1939 by walking across the border from his native Czechoslovakia into Poland, with England as his goal. My mother’s parents put her on a train in Prague, with Shanghai as her eventual destination. She was 18.
My mother’s parents died in Lodz and Auschwitz. My father told me that his father had committed suicide during the transport of Jews from Ostrava to Nisko in 1939. This information might have come from his mother, who was deported to Minsk and murdered there in 1942.
During the early years of World War II, chance and good fortune brought both my parents to London, where they met and married in 1945. Within a couple of years, they had established themselves as an academic couple with two children and started to make their way up the social and economic ladder. Their careers were distinguished, with honors and privileges bestowed by their adopted country.
They had made it clear for as long as I can remember that, because of the deaths of all four of their parents in the Holocaust, their lives were their own, to continue or end as they saw fit and whenever they saw fit. They had even made a pact wherein, if one of them died, the other need stay alive for only six months before taking his or her own life, if that life proved unbearable.
My mother’s health began to fail in 2000 and, with her phone call from England, it was clear that my parents had abandoned their pact and were planning to end their lives together.
In answer to my mother’s macabre question, I said, “I can come to England on the night that you kill yourselves and then come to the house with a doctor and the police, if that is what you want.” But, no, that was not what my mother wanted.
“We would like you to come and say goodbye to us, to go to London for the day, and then to return alone to find our bodies.” I’m not that tough; I could not agree to do that. So my mother said that they would make other arrangements.
A few weeks later, in mid-August, a doctor was called to their house and found my parents dead, with garbage bags tied over their heads and pillows resting on their suffocated faces. She also found a statement of their intent to kill themselves.
In October, the coroner ruled, “I have to be sure beyond reasonable doubt that both these persons intended to take their own lives. They have done so, I am sure.”
We shall all die and most of us want some control over the manner of our dying. Some want to be sure that they will be able to kill themselves; some want the right to assisted suicide if they are unable to kill themselves; some want purely palliative care; and some want every possible medical intervention.
I hope, too, to have some control over my dying and I am repelled neither by the idea of suicide nor by the idea of assisted suicide. However, my experience with my parents’ deaths gives me pause.
Since my parents’ deaths, many of my friends have seen their parents die in the hospital or under hospice care. I envy all these friends. Their parents brought them into this world and they were there for their parents when their parents left this world. By depriving me of this filial role, my parents rejected me more forcefully than they could possibly have understood — or, maybe, they just did not care. Or was their request that I be the one to find their bodies an indication of their great love for me? This is a question that I can never answer.
Most of the time, I do not think of my parents’ deaths. But they are a result of the Holocaust as surely as the deaths of my grandparents. And it is at the most inopportune times, when I am worried about my own health, that I have to confront all six deaths. When a physician asks for my family history, I have to say, “My grandparents perished as Jews in the Holocaust; my father died, according to his autopsy, in perfect health; and my parents killed themselves.”
Sherwin Nuland, the author of “How We Die,” taught me that one cannot control how one dies but one can have some control over how one lives. But I wonder how much control I shall have over my own death and, more profoundly, how much control is best for me and, even more important, for my children and grandchildren. It is my descendants, after all, who will be dealing with the manner and consequences of my death when I am gone.
Ann M. Altman is a scientist, a writer and a political adviser.
http://opinionator.blogs.nytimes.com/20 ... ef=opinion
Archbishop of Toronto speaks out against assisted dying
'It is never justified' for doctors to kill, Cardinal Thomas Collins tells area Catholics
A cardinal's statement on assisted dying was read and shown by video today in more than 200 Catholic churches across the Archdiocese of Toronto.
In the statement, the Archbishop of Toronto, Cardinal Thomas Collins, calls on the federal government to protect the vulnerable and those who care for them.
"Dying is simply not the same as being killed," Collins said in the video, which the Archdiocese posted earlier this week to YouTube.
- Assisted dying much more complex when it comes to mentally ill: experts
"We are grateful for physicians and nurses and others who offer medical assistance to patients who are dying. But it is never justified for them to kill."
More...
http://www.cbc.ca/news/canada/toronto/a ... -1.3478091
'It is never justified' for doctors to kill, Cardinal Thomas Collins tells area Catholics
A cardinal's statement on assisted dying was read and shown by video today in more than 200 Catholic churches across the Archdiocese of Toronto.
In the statement, the Archbishop of Toronto, Cardinal Thomas Collins, calls on the federal government to protect the vulnerable and those who care for them.
"Dying is simply not the same as being killed," Collins said in the video, which the Archdiocese posted earlier this week to YouTube.
- Assisted dying much more complex when it comes to mentally ill: experts
"We are grateful for physicians and nurses and others who offer medical assistance to patients who are dying. But it is never justified for them to kill."
More...
http://www.cbc.ca/news/canada/toronto/a ... -1.3478091
Justin Trudeau Seeks to Legalize Assisted Suicide in Canada
OTTAWA — The government of Prime Minister Justin Trudeau introduced legislation on Thursday to legalize physician-assisted suicide for Canadians with a “serious and incurable illness,” which has brought them “enduring physical or psychological suffering.”
The proposed law limits physician-assisted suicides to citizens and residents who are eligible to participate in the national health care system, an effort to prevent a surge in medical tourism among the dying from other countries.
If the bill passes, Canada will join a group of countries that permit some form of assisted suicide, including Belgium, the Netherlands, Switzerland and Germany. Assisted suicide is legal in only a few American states, including Oregon and Vermont.
Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.
The legislation is the latest step in a decades-long and frequently emotional debate in Canada about the rights and protections of patients with serious medical conditions who might seek to end their lives.
The legislation is expected to pass, given the Liberal Party’s strong majority in the House of Commons. However, the government has promised to further study the issue after the law’s passage and may make changes to the system.
Photo
Prime Minister Justin Trudeau of Canada has said his support for doctor-assisted death was informed by the last days of his father, former Prime Minister Pierre Elliott Trudeau. Credit Alice Chiche/Agence France-Presse — Getty Images
“For some, medical assistance in dying will be troubling,” Jody Wilson-Raybould, the justice minister, said at a news conference on Thursday. “For others, this legislation will not go far enough.”
The bill would allow consenting adults “capable of making decisions with respect to their health” to choose to end their own lives or seek assistance in doing so from their doctors. A physician must decide that “natural death has become reasonably foreseeable, taking into account all of their medical circumstances.”
Officials said that a patient does not have to have a terminal condition, citing the example of someone with an immune system deficiency which leaves them vulnerable to lethal infections.
Two independent physicians must agree and the patient must wait 15 days before moving to end his or her life, though the bill would allow for that waiting period to be shortened under certain circumstances.
Doctors will not be required to help people die, but they must refer patients to another physician if they have an objection to participating.
“I’ve seen people die well and I’ve seen people die in misery,” Dr. Jane Philpott, the health minister who is also a family physician, told reporters on Thursday after the bill was introduced. “I want Canadians to have access to the best care possible.”
The government’s proposal is more restrictive than some proponents of legal assisted suicide had sought. It does not include provisions for minors who may be capable of making decisions about their own medical care to choose to end their lives, nor does it allow for people in the early stages of illnesses like dementia to request an assisted death while they are still competent.
More...
http://www.nytimes.com/2016/04/15/world ... d=45305309
*******
Aid in Dying in Canada
"Since 2014, aid-in-dying bills have been introduced in at least 26 states and Washington, D.C. While it’s important to provide a humane option to the dying, it’s also essential that lawmakers focus on the need to provide broader access to palliative and hospice care so that terminal patients do not choose death because pain relief is unaffordable. They must ensure that doctors be trained in prescribing life-ending medication and must encourage professional groups to offer education and support for those who want to provide such aid. And they should make funding available to study the effect of these laws."
http://www.nytimes.com/2016/04/24/opini ... inion&_r=0
OTTAWA — The government of Prime Minister Justin Trudeau introduced legislation on Thursday to legalize physician-assisted suicide for Canadians with a “serious and incurable illness,” which has brought them “enduring physical or psychological suffering.”
The proposed law limits physician-assisted suicides to citizens and residents who are eligible to participate in the national health care system, an effort to prevent a surge in medical tourism among the dying from other countries.
If the bill passes, Canada will join a group of countries that permit some form of assisted suicide, including Belgium, the Netherlands, Switzerland and Germany. Assisted suicide is legal in only a few American states, including Oregon and Vermont.
Under Canada’s proposed law, people who have a serious medical condition and want to die will be able to commit suicide with medication provided by their doctors or have a doctor or nurse practitioner administer the dose for them. Family members and friends will be allowed to assist patients with their death, and social workers and pharmacists will be permitted to participate in the process.
The legislation is the latest step in a decades-long and frequently emotional debate in Canada about the rights and protections of patients with serious medical conditions who might seek to end their lives.
The legislation is expected to pass, given the Liberal Party’s strong majority in the House of Commons. However, the government has promised to further study the issue after the law’s passage and may make changes to the system.
Photo
Prime Minister Justin Trudeau of Canada has said his support for doctor-assisted death was informed by the last days of his father, former Prime Minister Pierre Elliott Trudeau. Credit Alice Chiche/Agence France-Presse — Getty Images
“For some, medical assistance in dying will be troubling,” Jody Wilson-Raybould, the justice minister, said at a news conference on Thursday. “For others, this legislation will not go far enough.”
The bill would allow consenting adults “capable of making decisions with respect to their health” to choose to end their own lives or seek assistance in doing so from their doctors. A physician must decide that “natural death has become reasonably foreseeable, taking into account all of their medical circumstances.”
Officials said that a patient does not have to have a terminal condition, citing the example of someone with an immune system deficiency which leaves them vulnerable to lethal infections.
Two independent physicians must agree and the patient must wait 15 days before moving to end his or her life, though the bill would allow for that waiting period to be shortened under certain circumstances.
Doctors will not be required to help people die, but they must refer patients to another physician if they have an objection to participating.
“I’ve seen people die well and I’ve seen people die in misery,” Dr. Jane Philpott, the health minister who is also a family physician, told reporters on Thursday after the bill was introduced. “I want Canadians to have access to the best care possible.”
The government’s proposal is more restrictive than some proponents of legal assisted suicide had sought. It does not include provisions for minors who may be capable of making decisions about their own medical care to choose to end their lives, nor does it allow for people in the early stages of illnesses like dementia to request an assisted death while they are still competent.
More...
http://www.nytimes.com/2016/04/15/world ... d=45305309
*******
Aid in Dying in Canada
"Since 2014, aid-in-dying bills have been introduced in at least 26 states and Washington, D.C. While it’s important to provide a humane option to the dying, it’s also essential that lawmakers focus on the need to provide broader access to palliative and hospice care so that terminal patients do not choose death because pain relief is unaffordable. They must ensure that doctors be trained in prescribing life-ending medication and must encourage professional groups to offer education and support for those who want to provide such aid. And they should make funding available to study the effect of these laws."
http://www.nytimes.com/2016/04/24/opini ... inion&_r=0
Aid in Dying: A Good or a Harm?
Various views on this issue at:
http://www.nytimes.com/2016/04/30/opini ... ef=opinion
Various views on this issue at:
http://www.nytimes.com/2016/04/30/opini ... ef=opinion
Canada doesn't want to be a 'suicide tourism' destination
North America’s assisted-suicide landscape changed in a profound, historic way on Friday. As NPR reported, that was when Canada’s Senate approved that nation’s new physician-assisted-suicide law. The law was initially brought about by a ruling from Canada’s Supreme Court last year that banned a law against physician-assisted suicide, but left it to the country’s legislature to regulate and determine the scope of the practice.
One interesting aspect of Canada’s version of physician-assisted suicide is that only Canadians are eligible for it. This mirrors how it’s done in the handful of U.S. states where physician-assisted suicide is already legal, which include Washington, Oregon, and Vermont (California’s state legislature approved assisted suicide there recently, but things haven’t been finalized).
......
Belgium, which enacted its euthanasia law in 2002, is seen as taking one of the most liberal approaches, which has led to some rather strange and heart-wrenching stories. “In 2013, [the famous/infamous Belgian euthanasia physician] Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror,” wrote Rachel Aviv in her absolute must-read piece on this subject for The New Yorker a year ago. “‘Farewell, everybody,’ Verhelst said from his hospital bed, seconds before receiving a lethal injection.” More recently, the BBC reported on a Belgian man who wants to end his life because, he says, he can’t live with his pedophilia; the first step of his application was approved. As the BBC noted, “There were 1,807 confirmed cases of euthanasia in 2013, the most recent year for which figures are available.”
There are no easy or obvious answers for any of this, but if you want to know more about how physician-assisted suicide works in Europe, definitely read that New Yorker article or watch VICE’s recent mini-doc, which I mentioned in another recent post on the subject. These controversies are only going to grow more heated.
http://www.msn.com/en-ca/news/canada/ca ... lsignoutmd
North America’s assisted-suicide landscape changed in a profound, historic way on Friday. As NPR reported, that was when Canada’s Senate approved that nation’s new physician-assisted-suicide law. The law was initially brought about by a ruling from Canada’s Supreme Court last year that banned a law against physician-assisted suicide, but left it to the country’s legislature to regulate and determine the scope of the practice.
One interesting aspect of Canada’s version of physician-assisted suicide is that only Canadians are eligible for it. This mirrors how it’s done in the handful of U.S. states where physician-assisted suicide is already legal, which include Washington, Oregon, and Vermont (California’s state legislature approved assisted suicide there recently, but things haven’t been finalized).
......
Belgium, which enacted its euthanasia law in 2002, is seen as taking one of the most liberal approaches, which has led to some rather strange and heart-wrenching stories. “In 2013, [the famous/infamous Belgian euthanasia physician] Wim Distelmans euthanized a forty-four-year-old transgender man, Nathan Verhelst, because Verhelst was devastated by the failure of his sex-change surgeries; he said that he felt like a monster when he looked in the mirror,” wrote Rachel Aviv in her absolute must-read piece on this subject for The New Yorker a year ago. “‘Farewell, everybody,’ Verhelst said from his hospital bed, seconds before receiving a lethal injection.” More recently, the BBC reported on a Belgian man who wants to end his life because, he says, he can’t live with his pedophilia; the first step of his application was approved. As the BBC noted, “There were 1,807 confirmed cases of euthanasia in 2013, the most recent year for which figures are available.”
There are no easy or obvious answers for any of this, but if you want to know more about how physician-assisted suicide works in Europe, definitely read that New Yorker article or watch VICE’s recent mini-doc, which I mentioned in another recent post on the subject. These controversies are only going to grow more heated.
http://www.msn.com/en-ca/news/canada/ca ... lsignoutmd
Terminally ill woman holds party before ending her life
SAN DIEGO — In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: "These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness."
And just one rule: No crying in front of her.
The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.
"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her," said Niels Alpert, a cinematographer from New York City.
"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming."
1/4 SLIDES © Associated Press
This July 24, 2016 photo provided by Niels Alpert, Betsy Davis, smiles during a going away party with her family and friends in California
Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.
More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.
One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, "The Dance of Reality," based on the life of a Chilean film director.
As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.
Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a "rebirth."
"Obviously it was hard for me. It's still hard for me," said Davis, who wrote about it for the online news outlet Voice of San Diego. "The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion."
Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.
Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.
Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but "there are still millions of people in California threatened by the danger of this law."
Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.
"Dear rebirth participants you're all very brave for sending me off on my journey," she wrote in her invitation. "There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule."
During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.
At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a "Betsy souvenir" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.
Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.
Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.
"What Betsy did gave her the most beautiful death that any person could ever wish for," Alpert said. "By taking charge, she turned her departure into a work of art."
Her guests agreed to meet again on her birthday in June to scatter her ashes.
Photo at:
http://www.msn.com/en-ca/news/world/ter ... ailsignout
SAN DIEGO — In early July, Betsy Davis emailed her closest friends and relatives to invite them to a two-day party, telling them: "These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness."
And just one rule: No crying in front of her.
The 41-year-old artist with ALS, or Lou Gehrig's disease, held the gathering to say goodbye before becoming one of the first Californians to take a lethal dose of drugs under the state's new doctor-assisted suicide law for the terminally ill.
"For me and everyone who was invited, it was very challenging to consider, but there was no question that we would be there for her," said Niels Alpert, a cinematographer from New York City.
"The idea to go and spend a beautiful weekend that culminates in their suicide — that is not a normal thing, not a normal, everyday occurrence. In the background of the lovely fun, smiles and laughter that we had that weekend was the knowledge of what was coming."
1/4 SLIDES © Associated Press
This July 24, 2016 photo provided by Niels Alpert, Betsy Davis, smiles during a going away party with her family and friends in California
Davis worked out a detailed schedule for the gathering on the weekend of July 23-24, including the precise hour she planned to slip into a coma, and shared her plans with her guests in the invitation.
More than 30 people came to the party at a home with a wraparound porch in the picturesque Southern California mountain town of Ojai, flying in from New York, Chicago and across California.
One woman brought a cello. A man played a harmonica. There were cocktails, pizza from her favorite local joint, and a screening in her room of one of her favorite movies, "The Dance of Reality," based on the life of a Chilean film director.
As the weekend drew to a close, her friends kissed her goodbye, gathered for a photo and left, and Davis was wheeled out to a canopy bed on a hillside, where she took a combination of morphine, pentobarbital and chloral hydrate prescribed by her doctor.
Kelly Davis said she loved her sister's idea for the gathering, which Betsy Davis referred to as a "rebirth."
"Obviously it was hard for me. It's still hard for me," said Davis, who wrote about it for the online news outlet Voice of San Diego. "The worst was needing to leave the room every now and then, because I would get choked up. But people got it. They understood how much she was suffering and that she was fine with her decision. They respected that. They knew she wanted it to be a joyous occasion."
Davis ended her life a little over a month after a California law giving the option to the terminally ill went into effect. Four other states allow doctor-assisted suicide, with Oregon the first in 1997.
Opponents of the law in lobbying against it before state legislators argued that hastening death was morally wrong, that it puts terminally ill patients at risk for coerced death by loved ones and could become a way out for people who are uninsured or fearful of high medical bills.
Marilyn Golden of the Disability Rights Education & Defense Fund, said her heart goes out to anyone dealing with a terminal illness, but "there are still millions of people in California threatened by the danger of this law."
Davis spent months planning her exit, feeling empowered after spending the last three years losing control of her body bit by bit. The painter and performance artist could no longer stand, brush her teeth or scratch an itch. Her caretakers had to translate her slurred speech for others.
"Dear rebirth participants you're all very brave for sending me off on my journey," she wrote in her invitation. "There are no rules. Wear what you want, speak your mind, dance, hop, chant, sing, pray, but do not cry in front of me. OK, one rule."
During the party, old friends reconnected and Davis rolled in and out of the rooms in her electric wheelchair and onto the porch, talking with her guests.
At one point, she invited friends to her room to try on the clothes she had picked out for them. They modeled the outfits to laughter. Guests were also invited to take a "Betsy souvenir" — a painting, beauty product or other memento. Her sister had placed sticky notes on the items, explaining each one's significance.
Wearing a Japanese kimono she bought on a bucket-list trip she took after being diagnosed in 2013, she looked out at her last sunset and took the drugs at 6:45 p.m. with her caretaker, her doctor, her massage therapist and her sister by her side. Four hours later, she died.
Friends said it was the final performance for the artist, who once drew pictures on a stage with whipped cream.
"What Betsy did gave her the most beautiful death that any person could ever wish for," Alpert said. "By taking charge, she turned her departure into a work of art."
Her guests agreed to meet again on her birthday in June to scatter her ashes.
Photo at:
http://www.msn.com/en-ca/news/world/ter ... ailsignout
Aid in Dying Movement Advances
New York, Colorado and the District of Columbia may soon join the handful of states where doctors are allowed to help terminally ill patients die by prescribing a lethal dose of painkillers.
A proposal to allow physician-assisted dying will be on the ballot in Colorado next month. In the District of Columbia, the District Council’s Health and Human Services Committee last week approved a physician-assisted dying bill that the full council could vote on before the end of the year. New York lawmakers, meanwhile, are hopeful that support in the Legislature for aid-in-dying bills will soon overcome opposition from religious leaders and some medical groups.
Victories in the three jurisdictions would galvanize a movement that seeks to give terminally ill Americans a dignified alternative to the dismal choices they face in most of the country. In states where assisted dying is banned, some terminal patients manage to get a lethal dose of drugs from medical professionals under the table, which exposes the health care workers to prosecution. Others are advised to starve themselves to death.
More...
http://www.nytimes.com/2016/10/10/opini ... ef=opinion
New York, Colorado and the District of Columbia may soon join the handful of states where doctors are allowed to help terminally ill patients die by prescribing a lethal dose of painkillers.
A proposal to allow physician-assisted dying will be on the ballot in Colorado next month. In the District of Columbia, the District Council’s Health and Human Services Committee last week approved a physician-assisted dying bill that the full council could vote on before the end of the year. New York lawmakers, meanwhile, are hopeful that support in the Legislature for aid-in-dying bills will soon overcome opposition from religious leaders and some medical groups.
Victories in the three jurisdictions would galvanize a movement that seeks to give terminally ill Americans a dignified alternative to the dismal choices they face in most of the country. In states where assisted dying is banned, some terminal patients manage to get a lethal dose of drugs from medical professionals under the table, which exposes the health care workers to prosecution. Others are advised to starve themselves to death.
More...
http://www.nytimes.com/2016/10/10/opini ... ef=opinion
The VSED Exit: A Way to Speed Up Dying, Without Asking Permission
Del Greenfield had endured repeated bouts of cancer over four decades, yet kept working as a peace activist in Portland, Ore., into her 80s. “She was a powerful force,” said her daughter, Bonnie Reagan.
But in 2007, Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself. She’d lost much of her hearing. She required supplemental oxygen.
When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”
At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.
Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.
“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”
In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.
Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve.
“It’s for strong-willed, independent people with very supportive families,” said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center.
He was speaking at a conference on VSED, billed as the nation’s first, at Seattle University School of Law this month. It drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff. (Disclosure: I was also a speaker, and received an honorarium and some travel costs.)
What the gathering made clear was that much about VSED remains unclear.
Is it legal?
For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)
The question intrigues bioethicists. Can your current competent self cut off nutrition and hydration for your future demented self? In a handful of court decisions, judges have declined to enforce such directives.
Can VSED be comfortable and provide a peaceful death?
“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.
Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.
“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”
Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.
At the conference, the Dutch researcher Dr. Eva Bolt presented results from a survey of family physicians in the Netherlands, describing 99 cases of VSED. Their patients (median age: 83) had serious diseases and depended on others for everyday care; three-quarters had life expectancies of less than a year.
In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.
Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t. The median time from the start of their fasts until death was seven days.
Those results mirror a 2003 study of hospice nurses in Oregon who had cared for VSED patients. Rating their deaths on a scale from 0 to 9 (a very good death), the nurses assigned a median score of 8. Nearly all of the patients died within 15 days.
The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.
That’s hard on families and caregivers, though. And slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.
Other obstacles could restrict VSED. A quiet choice in a private home, it could be derailed in nursing homes and assisted living facilities where administrators fear lawsuits or regulatory sanctions. Physicians might decline to participate; home care aides might quit.
Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.
Phyllis Shacter and her husband, Alan Alberts, a computer scientist who received a Alzheimer’s disease diagnosis in 2011, had few doubts, however. VSED allowed him to escape the disease that had slowly killed his mother.
No state allows a person with dementia to use a “death with dignity” law, but with support from his wife, doctor and two caregivers, Mr. Alberts, 76, died peacefully at home in 2013 after a nine-day fast.
“I’m glad my husband fulfilled his desire not to live into the final stages of Alzheimer’s,” Ms. Shacter said.
On the other hand, Judith Schwarz, clinical coordinator of End of Life Choices New York, told of an 81-year-old attempting VSED with inadequate pain medication, crying out to his wife at night, “I’m dying of thirst.”
“And of course, he was, but slowly,” Dr. Schwarz said. “This was a horror show.”
Del Greenfield fared better. “She didn’t use any medicines, just some oxygen,” her daughter said. Ms. Greenfield’s children, grandchildren and great-grandchildren came to see her, and “she was completely peaceful, chatting and joking and telling people she loved them.”
She announced that she had one regret. “We all leaned in,” Bonnie Reagan said. “And she said, ‘I wish I’d seen the Rolling Stones the last time they came to Portland.’”
On the fifth day of fasting, “she just fell asleep,” and died about 36 hours later.
http://www.nytimes.com/2016/10/25/healt ... dline&te=1
Del Greenfield had endured repeated bouts of cancer over four decades, yet kept working as a peace activist in Portland, Ore., into her 80s. “She was a powerful force,” said her daughter, Bonnie Reagan.
But in 2007, Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself. She’d lost much of her hearing. She required supplemental oxygen.
When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”
At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.
Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.
“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”
In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.
Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve.
“It’s for strong-willed, independent people with very supportive families,” said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center.
He was speaking at a conference on VSED, billed as the nation’s first, at Seattle University School of Law this month. It drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff. (Disclosure: I was also a speaker, and received an honorarium and some travel costs.)
What the gathering made clear was that much about VSED remains unclear.
Is it legal?
For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)
The question intrigues bioethicists. Can your current competent self cut off nutrition and hydration for your future demented self? In a handful of court decisions, judges have declined to enforce such directives.
Can VSED be comfortable and provide a peaceful death?
“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.
Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.
“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”
Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.
At the conference, the Dutch researcher Dr. Eva Bolt presented results from a survey of family physicians in the Netherlands, describing 99 cases of VSED. Their patients (median age: 83) had serious diseases and depended on others for everyday care; three-quarters had life expectancies of less than a year.
In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.
Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t. The median time from the start of their fasts until death was seven days.
Those results mirror a 2003 study of hospice nurses in Oregon who had cared for VSED patients. Rating their deaths on a scale from 0 to 9 (a very good death), the nurses assigned a median score of 8. Nearly all of the patients died within 15 days.
The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.
That’s hard on families and caregivers, though. And slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.
Other obstacles could restrict VSED. A quiet choice in a private home, it could be derailed in nursing homes and assisted living facilities where administrators fear lawsuits or regulatory sanctions. Physicians might decline to participate; home care aides might quit.
Moreover, major religious groups have yet to declare whether they consider VSED an acceptable act of self-determination or a suicide, anathema in most faiths.
Phyllis Shacter and her husband, Alan Alberts, a computer scientist who received a Alzheimer’s disease diagnosis in 2011, had few doubts, however. VSED allowed him to escape the disease that had slowly killed his mother.
No state allows a person with dementia to use a “death with dignity” law, but with support from his wife, doctor and two caregivers, Mr. Alberts, 76, died peacefully at home in 2013 after a nine-day fast.
“I’m glad my husband fulfilled his desire not to live into the final stages of Alzheimer’s,” Ms. Shacter said.
On the other hand, Judith Schwarz, clinical coordinator of End of Life Choices New York, told of an 81-year-old attempting VSED with inadequate pain medication, crying out to his wife at night, “I’m dying of thirst.”
“And of course, he was, but slowly,” Dr. Schwarz said. “This was a horror show.”
Del Greenfield fared better. “She didn’t use any medicines, just some oxygen,” her daughter said. Ms. Greenfield’s children, grandchildren and great-grandchildren came to see her, and “she was completely peaceful, chatting and joking and telling people she loved them.”
She announced that she had one regret. “We all leaned in,” Bonnie Reagan said. “And she said, ‘I wish I’d seen the Rolling Stones the last time they came to Portland.’”
On the fifth day of fasting, “she just fell asleep,” and died about 36 hours later.
http://www.nytimes.com/2016/10/25/healt ... dline&te=1
On Assisted Suicide, Going Beyond ‘Do No Harm’
DURHAM, N.C. — Out of nowhere, a patient I recently met in my clinic told me, “If my heart stops, doctor, just let me go.”
“Why?” I asked him.
Without hesitating, he replied, “Because there are worse states than death.”
Advances in medical therapies, in addition to their immense benefits, have changed death to dying — from an instantaneous event to a long, drawn-out process. Death is preceded by years of disability, countless procedures and powerful medications. Only one in five patients is able to die at home. These days many patients fear what it takes to live more than death itself.
That may explain why this year, behind the noise of the presidential campaign, the right-to-die movement has made several big legislative advances. In June, California became the fifth and largest state to put an assisted suicide law into effect; this week the District of Columbia Council passed a similar law. And on Tuesday voters in Colorado will decide whether to allow physician-assisted suicide in their state as well.
Yet even as assisted suicide has generated broader support, the group most vehemently opposed to it hasn’t budged: doctors.
That resistance is traditionally couched in doctors’ adherence to our understanding of the Hippocratic oath. But it’s becoming harder for us to know what is meant by “do no harm.” With the amount of respirators and other apparatus at our disposal, it is almost impossible for most patients to die unless doctors’ or patients’ families end life support. The withdrawal of treatment, therefore, is now perhaps the most common way critically ill patients die in the hospital.
While “withdrawal” implies a passive act, terminating artificial support feels decidedly active. Unlike assisted suicide, which requires patients to be screened for depression, patients can ask for treatment withdrawal even if they have major depression or are suicidal. Furthermore, withdrawal decisions are usually made for patients who are so sick that they frequently have no voice in the matter.
Some doctors skirt the question of assisted suicide through opiate prescriptions, which are almost universally prescribed for patients nearing death. Even though these medications can slow down breathing to the point of stoppage, doctors and nurses are very comfortable giving them, knowing that they might hasten a “natural” death.
In extreme cases, when even morphine isn’t enough, patients are given anesthesia to ease their deaths. The last time I administered what is called terminal sedation, another accepted strategy, was in the case of a patient with abdominal cancer whose intestines were perforated and for whom surgery was not an option. The patient, who had been writhing uncontrollably in pain, was finally comfortable. Yet terminal sedation, necessary as it was, felt closer to active euthanasia than assisted suicide would have.
While the way people die has changed, the arguments made against assisted suicide have not. We are warned of a slippery slope, implying that legalization of assisted suicide would eventually lead to eugenic sterilization reminiscent of Nazi Germany. But no such drift has been observed in any of the countries where it has been legalized.
We are cautioned that legalization would put vulnerable populations like the uninsured and the disabled at risk; however, years of data from Oregon demonstrate that the vast majority of patients who opt for it are white, affluent and highly educated.
We are also told that assisted suicide laws will allow doctors and nurses to avoid providing high-quality palliative care to patients, but the data suggests the opposite: A strong argument for legalization is that it sensitizes doctors about ensuring the comfort of patients with terminal illnesses; if suicide is an option, they’ll do what they can to preclude it.
And, again, we are counseled that physicians should do no harm. But medical harm is already one of the leading causes of death — and in any case, isn’t preventing patients from dying on their terms its own form of medical harm?
With the right safeguards in place, assisted suicide can help give terminally ill patients a semblance of control over their lives as disease, disability and the medical machine tries to wrest it away from them. In Oregon, of the exceedingly few patients who have requested a lethal prescription — 1,545 in 18 years — about 35 percent never uses it; for them, it is merely a means to self-affirmation, a reassuring option.
Instead of using our energies to obfuscate and obstruct how patients might want to end their lives when faced with life-limiting disease, we physicians need to reassess how we can help patients achieve their goals when the end is near. We need to be able to offer an option for those who desire assisted suicide, so that they can openly take control of their death.
Instead of seeking guidance from ancient edicts, we need to re-evaluate just what patients face in modern times. Even if it is a course we personally wouldn’t recommend, we should consider allowing it for patients suffering from debilitating disease. How we die has changed tremendously over the past few decades — and so must we.
Haider Javed Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, is the author of the forthcoming book “Modern Death: How Medicine Changed the End of Life.”
http://www.nytimes.com/2016/11/05/opini ... inion&_r=1
DURHAM, N.C. — Out of nowhere, a patient I recently met in my clinic told me, “If my heart stops, doctor, just let me go.”
“Why?” I asked him.
Without hesitating, he replied, “Because there are worse states than death.”
Advances in medical therapies, in addition to their immense benefits, have changed death to dying — from an instantaneous event to a long, drawn-out process. Death is preceded by years of disability, countless procedures and powerful medications. Only one in five patients is able to die at home. These days many patients fear what it takes to live more than death itself.
That may explain why this year, behind the noise of the presidential campaign, the right-to-die movement has made several big legislative advances. In June, California became the fifth and largest state to put an assisted suicide law into effect; this week the District of Columbia Council passed a similar law. And on Tuesday voters in Colorado will decide whether to allow physician-assisted suicide in their state as well.
Yet even as assisted suicide has generated broader support, the group most vehemently opposed to it hasn’t budged: doctors.
That resistance is traditionally couched in doctors’ adherence to our understanding of the Hippocratic oath. But it’s becoming harder for us to know what is meant by “do no harm.” With the amount of respirators and other apparatus at our disposal, it is almost impossible for most patients to die unless doctors’ or patients’ families end life support. The withdrawal of treatment, therefore, is now perhaps the most common way critically ill patients die in the hospital.
While “withdrawal” implies a passive act, terminating artificial support feels decidedly active. Unlike assisted suicide, which requires patients to be screened for depression, patients can ask for treatment withdrawal even if they have major depression or are suicidal. Furthermore, withdrawal decisions are usually made for patients who are so sick that they frequently have no voice in the matter.
Some doctors skirt the question of assisted suicide through opiate prescriptions, which are almost universally prescribed for patients nearing death. Even though these medications can slow down breathing to the point of stoppage, doctors and nurses are very comfortable giving them, knowing that they might hasten a “natural” death.
In extreme cases, when even morphine isn’t enough, patients are given anesthesia to ease their deaths. The last time I administered what is called terminal sedation, another accepted strategy, was in the case of a patient with abdominal cancer whose intestines were perforated and for whom surgery was not an option. The patient, who had been writhing uncontrollably in pain, was finally comfortable. Yet terminal sedation, necessary as it was, felt closer to active euthanasia than assisted suicide would have.
While the way people die has changed, the arguments made against assisted suicide have not. We are warned of a slippery slope, implying that legalization of assisted suicide would eventually lead to eugenic sterilization reminiscent of Nazi Germany. But no such drift has been observed in any of the countries where it has been legalized.
We are cautioned that legalization would put vulnerable populations like the uninsured and the disabled at risk; however, years of data from Oregon demonstrate that the vast majority of patients who opt for it are white, affluent and highly educated.
We are also told that assisted suicide laws will allow doctors and nurses to avoid providing high-quality palliative care to patients, but the data suggests the opposite: A strong argument for legalization is that it sensitizes doctors about ensuring the comfort of patients with terminal illnesses; if suicide is an option, they’ll do what they can to preclude it.
And, again, we are counseled that physicians should do no harm. But medical harm is already one of the leading causes of death — and in any case, isn’t preventing patients from dying on their terms its own form of medical harm?
With the right safeguards in place, assisted suicide can help give terminally ill patients a semblance of control over their lives as disease, disability and the medical machine tries to wrest it away from them. In Oregon, of the exceedingly few patients who have requested a lethal prescription — 1,545 in 18 years — about 35 percent never uses it; for them, it is merely a means to self-affirmation, a reassuring option.
Instead of using our energies to obfuscate and obstruct how patients might want to end their lives when faced with life-limiting disease, we physicians need to reassess how we can help patients achieve their goals when the end is near. We need to be able to offer an option for those who desire assisted suicide, so that they can openly take control of their death.
Instead of seeking guidance from ancient edicts, we need to re-evaluate just what patients face in modern times. Even if it is a course we personally wouldn’t recommend, we should consider allowing it for patients suffering from debilitating disease. How we die has changed tremendously over the past few decades — and so must we.
Haider Javed Warraich, a fellow in cardiovascular medicine at Duke University Medical Center, is the author of the forthcoming book “Modern Death: How Medicine Changed the End of Life.”
http://www.nytimes.com/2016/11/05/opini ... inion&_r=1
Physician Aid in Dying Gains Acceptance in the U.S.
Extract:
In recent months, this option has become available to a growing number of Americans. Last June, aid-in-dying legislation took effect in California, the most populous state. In November, Colorado voters approved a ballot measure by nearly a two-thirds majority. The District of Columbia Council has passed a similar law, and the mayor quietly signed it last month.
Aid in dying was already legal in Washington, Vermont, Montana and Oregon. So even if the District of Columbia’s law is blocked, as a prominent Republican representative has threatened to do, the country has arrived at a remarkable moment: Close to 20 percent of Americans live in jurisdictions where adults can legally end their lives if they are terminally ill and meet eligibility requirements.
More..
https://www.nytimes.com/2017/01/16/heal ... 05309&_r=0[/b]
Extract:
In recent months, this option has become available to a growing number of Americans. Last June, aid-in-dying legislation took effect in California, the most populous state. In November, Colorado voters approved a ballot measure by nearly a two-thirds majority. The District of Columbia Council has passed a similar law, and the mayor quietly signed it last month.
Aid in dying was already legal in Washington, Vermont, Montana and Oregon. So even if the District of Columbia’s law is blocked, as a prominent Republican representative has threatened to do, the country has arrived at a remarkable moment: Close to 20 percent of Americans live in jurisdictions where adults can legally end their lives if they are terminally ill and meet eligibility requirements.
More..
https://www.nytimes.com/2017/01/16/heal ... 05309&_r=0[/b]
1,300 Canadians have died with medical assistance since legalization — here's one man's story
'I just told him I loved him, held him,' man's husband tells CBC about medically assisted death
On Friday Jan. 6, Rob Rollins and his husband John MacTavish woke up just as they would any other morning. John got his brother Bobby MacTavish, who is unable to speak or walk, ready to go to his day program. But this time, before he left, Bobby spent about an hour with Rollins in his bedroom. The two were saying goodbye.
One of the couple's closest friends, Claire Cowley, soon arrived and sat in the living room with Rollins and MacTavish. The three were chatting "like it was any other morning," MacTavish says. "Which was weird, because I kept looking at the clock, knowing that, you know, the doctor was going to drive in that driveway."
Before the doctor arrived, Rollins, 56, wanted to make sure some practical things were in order.
"[He] tidied up his desk, made sure I knew where things were and gave me the passwords," MacTavish, 54, says. "You know, made sure that I knew how to run the dishwasher."
A nurse from their rural village of Delta, northeast of Kingston, Ont., who had cared for Rollins as he battled throat and neck cancer, arrived at about 10 a.m. and inserted an IV tube into his arm. His family doctor also came, although he wasn't required to, and the group kept chatting.
MacTavish says when the local doctor who would do the final procedure arrived at the house "he talked to Rob to make sure that Rob knew what was happening and still agreeable."
The couple walked down the hallway of their small house and Rollins had a cigarette, while MacTavish held his hand. Then, they came back to the living room.
"He said goodbye to Claire, who's his best friend, to the doctors and the nurse," MacTavish remembers. "We went into the bedroom, he got into bed. I covered him up with his quilt. I laid down beside him. The doctor came in and asked if there was anything we needed to say to each other."
Then, he administered the lethal dose of medication through Rollins's IV tube.
"I just told him I loved him, held him," MacTavish says through tears. "And it was over in about five minutes. Very peaceful."
More..
http://www.cbc.ca/beta/news/health/medi ... -1.4056700
'I just told him I loved him, held him,' man's husband tells CBC about medically assisted death
On Friday Jan. 6, Rob Rollins and his husband John MacTavish woke up just as they would any other morning. John got his brother Bobby MacTavish, who is unable to speak or walk, ready to go to his day program. But this time, before he left, Bobby spent about an hour with Rollins in his bedroom. The two were saying goodbye.
One of the couple's closest friends, Claire Cowley, soon arrived and sat in the living room with Rollins and MacTavish. The three were chatting "like it was any other morning," MacTavish says. "Which was weird, because I kept looking at the clock, knowing that, you know, the doctor was going to drive in that driveway."
Before the doctor arrived, Rollins, 56, wanted to make sure some practical things were in order.
"[He] tidied up his desk, made sure I knew where things were and gave me the passwords," MacTavish, 54, says. "You know, made sure that I knew how to run the dishwasher."
A nurse from their rural village of Delta, northeast of Kingston, Ont., who had cared for Rollins as he battled throat and neck cancer, arrived at about 10 a.m. and inserted an IV tube into his arm. His family doctor also came, although he wasn't required to, and the group kept chatting.
MacTavish says when the local doctor who would do the final procedure arrived at the house "he talked to Rob to make sure that Rob knew what was happening and still agreeable."
The couple walked down the hallway of their small house and Rollins had a cigarette, while MacTavish held his hand. Then, they came back to the living room.
"He said goodbye to Claire, who's his best friend, to the doctors and the nurse," MacTavish remembers. "We went into the bedroom, he got into bed. I covered him up with his quilt. I laid down beside him. The doctor came in and asked if there was anything we needed to say to each other."
Then, he administered the lethal dose of medication through Rollins's IV tube.
"I just told him I loved him, held him," MacTavish says through tears. "And it was over in about five minutes. Very peaceful."
More..
http://www.cbc.ca/beta/news/health/medi ... -1.4056700
Should I Help My Patients Die?
OAKLAND, Calif. — I WAS leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.
I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.
California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.
More...
https://www.nytimes.com/2017/08/05/opin ... inion&_r=0
OAKLAND, Calif. — I WAS leafing through a patient’s chart last year when a colleague tapped me on the shoulder. “I have a patient who is asking about the End of Life Option Act,” he said in a low voice. “Can we even do that here?”
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn’t.
I could see my own discomfort mirrored in his face. “Can you help us with it?” he asked me. “Of course,” I said. Then I felt my stomach lurch.
California’s law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
But that is where the law leaves off. The details of patient selection and protocol, even the composition of the lethal compound, are left to the individual doctor or hospital policy. Our hospital, like many others at that time, was still in the early stages of creating a policy and procedure. To me and many of my colleagues in California, it felt as if the law had passed so quickly that we weren’t fully prepared to deal with it.
More...
https://www.nytimes.com/2017/08/05/opin ... inion&_r=0
A sombre success
The Australian state of Victoria legalises assisted dying
Some 50 bills have been introduced in different Australian states. This is the first to pass
THE quest has failed many times. The past 20 years have seen around 50 attempts to pass laws in different Australian states to allow doctors to help terminally ill people end their lives. All have suffered defeat. But on November 29th Victoria finally made history, when its parliament passed Australia’s first state law to legalise doctor-assisted dying.
The law, which will take effect in 2019, allows people with an advanced, incurable illness to request “assisted dying” if their suffering cannot be relieved “in a manner that the person considers tolerable”. Patients must make three successive requests for such help; doctors are banned from initiating discussion of it as an option. The original bill had proposed limiting eligibility to those who were expected to live no more than a year. Victoria’s lawmakers reduced that to six months, with a few exceptions.
Most earlier attempts to legalise assisted dying were private members’ bills, but the state government proposed this one. Brian Owler, a neurosurgeon advising the government, believes this was crucial to its success. Daniel Andrews, Victoria’s premier, and Jill Hennessy, its health minister, both said that seeing a parent suffer from a debilitating illness had led them to support the law.
Assisted dying is legal only in Colombia, Canada, a few European countries and some American states. Mr Andrews says the new law is the most conservative in the world. Yet it has rankled some other members of his party, Labor. Paul Keating, a former Labor prime minister, says it “stands for everything a truly civil society should stand against”.
It has divided doctors, too. Michael Gannon, head of the Australian Medical Association, a lobby group, says Victoria’s parliament has “changed one of the fundamentals of medical ethics”. Doctors are “concerned about where it might lead”. Mr Owler retorts: “It’s not about doctors. It’s about people who are suffering and dying.” Andrew McGee, a health-law specialist at Queensland University of Technology, thinks Victoria’s law prevailed because the government had embarked earlier on a “thorough” public inquiry that reassured people “this type of regime can succeed.”
Australia has six states and two self-governing territories. The Northern Territory legalised assisted dying 21 years ago. But the national government can overturn territorial legislation, and did so on that occasion within a year. It has no such power over state laws, however. Malcolm Turnbull, Australia’s prime minister, who leads the right-wing Liberal Party, says he would not have voted for Victoria’s law. But Mr Owler is confident it will become a “blueprint” for change elsewhere in Australia.
https://www.economist.com/news/asia/217 ... lydispatch
The Australian state of Victoria legalises assisted dying
Some 50 bills have been introduced in different Australian states. This is the first to pass
THE quest has failed many times. The past 20 years have seen around 50 attempts to pass laws in different Australian states to allow doctors to help terminally ill people end their lives. All have suffered defeat. But on November 29th Victoria finally made history, when its parliament passed Australia’s first state law to legalise doctor-assisted dying.
The law, which will take effect in 2019, allows people with an advanced, incurable illness to request “assisted dying” if their suffering cannot be relieved “in a manner that the person considers tolerable”. Patients must make three successive requests for such help; doctors are banned from initiating discussion of it as an option. The original bill had proposed limiting eligibility to those who were expected to live no more than a year. Victoria’s lawmakers reduced that to six months, with a few exceptions.
Most earlier attempts to legalise assisted dying were private members’ bills, but the state government proposed this one. Brian Owler, a neurosurgeon advising the government, believes this was crucial to its success. Daniel Andrews, Victoria’s premier, and Jill Hennessy, its health minister, both said that seeing a parent suffer from a debilitating illness had led them to support the law.
Assisted dying is legal only in Colombia, Canada, a few European countries and some American states. Mr Andrews says the new law is the most conservative in the world. Yet it has rankled some other members of his party, Labor. Paul Keating, a former Labor prime minister, says it “stands for everything a truly civil society should stand against”.
It has divided doctors, too. Michael Gannon, head of the Australian Medical Association, a lobby group, says Victoria’s parliament has “changed one of the fundamentals of medical ethics”. Doctors are “concerned about where it might lead”. Mr Owler retorts: “It’s not about doctors. It’s about people who are suffering and dying.” Andrew McGee, a health-law specialist at Queensland University of Technology, thinks Victoria’s law prevailed because the government had embarked earlier on a “thorough” public inquiry that reassured people “this type of regime can succeed.”
Australia has six states and two self-governing territories. The Northern Territory legalised assisted dying 21 years ago. But the national government can overturn territorial legislation, and did so on that occasion within a year. It has no such power over state laws, however. Malcolm Turnbull, Australia’s prime minister, who leads the right-wing Liberal Party, says he would not have voted for Victoria’s law. But Mr Owler is confident it will become a “blueprint” for change elsewhere in Australia.
https://www.economist.com/news/asia/217 ... lydispatch
Guernsey considers whether to legalise assisted dying
Coming out in favour could put the island on course for a constitutional clash with Britain
PEOPLE used to joke, “Welcome to Guernsey, please put your watch back 50 years,” recalls Tony Lee, who moved to the island in the 1970s to work as a doctor. The British crown dependency off the coast of France, formerly part of the ancient duchy of Normandy, is a conservative place (its politics are characterised by “inertia”, notes one politician). Only in 2015 did all shops gain the right to trade on a Sunday, for instance, and its narrow lanes are dotted with churches. All this makes it an unlikely location for the trailblazing introduction of a controversial policy.
Nevertheless, in May the island’s parliament, the States of Deliberation, will vote on whether to legalise assisted dying. If its 40 members come down in favour, a working party would examine issues like whether to restrict the right to those with terminal illnesses, and how doctors’ approval might work, before returning with a fleshed-out proposal in 18 months. Such a vote would set Guernsey on the path to becoming the first place in the British Isles to legalise assisted dying—and, in doing so, raise thorny constitutional questions.
More...
https://www.economist.com/news/britain/ ... m=20180410
Coming out in favour could put the island on course for a constitutional clash with Britain
PEOPLE used to joke, “Welcome to Guernsey, please put your watch back 50 years,” recalls Tony Lee, who moved to the island in the 1970s to work as a doctor. The British crown dependency off the coast of France, formerly part of the ancient duchy of Normandy, is a conservative place (its politics are characterised by “inertia”, notes one politician). Only in 2015 did all shops gain the right to trade on a Sunday, for instance, and its narrow lanes are dotted with churches. All this makes it an unlikely location for the trailblazing introduction of a controversial policy.
Nevertheless, in May the island’s parliament, the States of Deliberation, will vote on whether to legalise assisted dying. If its 40 members come down in favour, a working party would examine issues like whether to restrict the right to those with terminal illnesses, and how doctors’ approval might work, before returning with a fleshed-out proposal in 18 months. Such a vote would set Guernsey on the path to becoming the first place in the British Isles to legalise assisted dying—and, in doing so, raise thorny constitutional questions.
More...
https://www.economist.com/news/britain/ ... m=20180410
Why David Goodall, 104, Renowned Australian Scientist, Wants to Die
David Goodall, 104, an accomplished Australian scientist, isn’t terminally ill, but he wants to die.
Mr. Goodall says his quality of life has deteriorated so badly that he has no reason to live, and he would like to end his life through assisted suicide. But he can’t do it in his own country, where the practice is banned.
So on Wednesday, he took what was expected to be his last flight, bound for Europe, to accomplish his goal — and his quest has renewed a debate in Australia about the right to end one’s life and what role others should play.
Mr. Goodall left his home in Perth to fly to an assisted-dying agency in Basel, Switzerland, a country where assisted suicide has been allowed for decades.
Though nations like Belgium, Canada, Colombia, Luxembourg and the Netherlands (along with some American states and the District of Columbia) permit euthanasia or assisted suicide, Switzerland is the only country with centers that offer assisted-suicide services to foreigners if the person assisting acts unselfishly.
More....
https://www.nytimes.com/2018/05/03/worl ... 9877220504
David Goodall, 104, an accomplished Australian scientist, isn’t terminally ill, but he wants to die.
Mr. Goodall says his quality of life has deteriorated so badly that he has no reason to live, and he would like to end his life through assisted suicide. But he can’t do it in his own country, where the practice is banned.
So on Wednesday, he took what was expected to be his last flight, bound for Europe, to accomplish his goal — and his quest has renewed a debate in Australia about the right to end one’s life and what role others should play.
Mr. Goodall left his home in Perth to fly to an assisted-dying agency in Basel, Switzerland, a country where assisted suicide has been allowed for decades.
Though nations like Belgium, Canada, Colombia, Luxembourg and the Netherlands (along with some American states and the District of Columbia) permit euthanasia or assisted suicide, Switzerland is the only country with centers that offer assisted-suicide services to foreigners if the person assisting acts unselfishly.
More....
https://www.nytimes.com/2018/05/03/worl ... 9877220504
Was a Scientist’s Death Murder or an ‘Act of Mercy’?
Excerpt:
Then, one evening this month, Ms. White was found dead. She was 92. Several days later, her daughter was charged with murdering her.
The accusations have stunned people who knew Ms. White and her family, as well as Bundanoon, the small town where neighbors remembered an attentive daughter who would take her mother to the salon for haircuts and stop in the cafe across the street. Many insist that whatever happened must have been motivated by compassion and love.
“It would have been done as an act of mercy,” said Jenny Goldie, a friend who had known Ms. White for 30 years. “There wouldn’t have been any malice attached to it at all.”
The case has saddened and confused Ms. White’s friends. But it has also tapped into the broader debate in Australia over euthanasia and assisted dying, which has been renewed in recent weeks as Parliament considered a proposal to overturn a two-decade-old ban on the practice in the nation’s territories.
The legislation ultimately failed, but last year, the state of Victoria became the first in Australia to legalize assisted dying, allowing someone with an incurable illness and limited life expectancy to obtain a dose of a lethal drug, and other states are considering their own legislation. (The Victoria law requires that a patient be mentally sound enough to make the request on his or her own, preventing relatives or caretakers from applying on an ill person’s behalf.)
More...
https://www.nytimes.com/2018/08/28/worl ... 3053090830
Excerpt:
Then, one evening this month, Ms. White was found dead. She was 92. Several days later, her daughter was charged with murdering her.
The accusations have stunned people who knew Ms. White and her family, as well as Bundanoon, the small town where neighbors remembered an attentive daughter who would take her mother to the salon for haircuts and stop in the cafe across the street. Many insist that whatever happened must have been motivated by compassion and love.
“It would have been done as an act of mercy,” said Jenny Goldie, a friend who had known Ms. White for 30 years. “There wouldn’t have been any malice attached to it at all.”
The case has saddened and confused Ms. White’s friends. But it has also tapped into the broader debate in Australia over euthanasia and assisted dying, which has been renewed in recent weeks as Parliament considered a proposal to overturn a two-decade-old ban on the practice in the nation’s territories.
The legislation ultimately failed, but last year, the state of Victoria became the first in Australia to legalize assisted dying, allowing someone with an incurable illness and limited life expectancy to obtain a dose of a lethal drug, and other states are considering their own legislation. (The Victoria law requires that a patient be mentally sound enough to make the request on his or her own, preventing relatives or caretakers from applying on an ill person’s behalf.)
More...
https://www.nytimes.com/2018/08/28/worl ... 3053090830
Could I Kill My Mother?
I am not a doctor. I am not very brave. But I want to do what she wants.
Excerpt:
Lung cancer is a frightening illness. In its final stages, it can make you feel as though you’re drowning, or suffocating. A formidable pharmacological stew of medications can help to suppress the symptoms, but no pill can take away the pain of waking up each day and remembering all over again that you are about to die.
I know what I’m supposed to do, because she has told me many times. One of the stories passed down as gospel in our tiny family is about how my late father, a doctor, helped his own mother — my grandmother Cecilia, whom I never met — at the end of her life. Her cancer was unbearable. “So he gave her a big dose of morphine to stop the pain,” my mother has always told my brother and me, as if reaching the end of a fairy tale. “It had the side effect of stopping her heart.”
As it happens, I have a big dose of morphine right here in the house. I also have some hefty doses of codeine, Ambien, Haldol and Ativan that I’ve cunningly stockpiled from the hospice service, like a squirrel hoarding for winter. In my top drawer, next to Mom’s passport, are more than 100 micrograms worth of fentanyl patches — enough to kill her and several passers-by.
But I am not a trained assassin. I am not a doctor. I am not very brave. I’m just a person who wants to do the most important thing that her mother has ever asked of her. I’m also a resident of New York State, where assisted suicide is illegal.
More...
https://www.nytimes.com/2018/08/31/sund ... 3053090901
I am not a doctor. I am not very brave. But I want to do what she wants.
Excerpt:
Lung cancer is a frightening illness. In its final stages, it can make you feel as though you’re drowning, or suffocating. A formidable pharmacological stew of medications can help to suppress the symptoms, but no pill can take away the pain of waking up each day and remembering all over again that you are about to die.
I know what I’m supposed to do, because she has told me many times. One of the stories passed down as gospel in our tiny family is about how my late father, a doctor, helped his own mother — my grandmother Cecilia, whom I never met — at the end of her life. Her cancer was unbearable. “So he gave her a big dose of morphine to stop the pain,” my mother has always told my brother and me, as if reaching the end of a fairy tale. “It had the side effect of stopping her heart.”
As it happens, I have a big dose of morphine right here in the house. I also have some hefty doses of codeine, Ambien, Haldol and Ativan that I’ve cunningly stockpiled from the hospice service, like a squirrel hoarding for winter. In my top drawer, next to Mom’s passport, are more than 100 micrograms worth of fentanyl patches — enough to kill her and several passers-by.
But I am not a trained assassin. I am not a doctor. I am not very brave. I’m just a person who wants to do the most important thing that her mother has ever asked of her. I’m also a resident of New York State, where assisted suicide is illegal.
More...
https://www.nytimes.com/2018/08/31/sund ... 3053090901
British doctors move to end their opposition to assisted dying
But the circumstances have provoked accusations of a stitch-up
IN THE HALF-MILLENNIUM since it was founded the Royal College of Physicians has seen plenty of squabbles, including the storming of its building in the 18th century over its exclusion of non-Oxbridge graduates, and a long battle over whether to admit women (which, after four centuries, it did). The latest row is over one of the most fundamental medical questions of all: should doctors help willing patients to die?
The college is surveying its 35,000 members on whether to back changes to the law on assisted dying, which is illegal in Britain. Five years ago 44% of them voted against and 25% in favour (the rest were neutral). Under the rules then, the plurality of votes against changing the law was enough to carry the day. This time, the college has decided that a supermajority of 60% is needed for either side to win. Since neither the pro nor anti doctors are expected to reach this threshold, the organisation looks likely to default to a neutral stance.
More...
https://www.economist.com/britain/2019/ ... sted-dying
But the circumstances have provoked accusations of a stitch-up
IN THE HALF-MILLENNIUM since it was founded the Royal College of Physicians has seen plenty of squabbles, including the storming of its building in the 18th century over its exclusion of non-Oxbridge graduates, and a long battle over whether to admit women (which, after four centuries, it did). The latest row is over one of the most fundamental medical questions of all: should doctors help willing patients to die?
The college is surveying its 35,000 members on whether to back changes to the law on assisted dying, which is illegal in Britain. Five years ago 44% of them voted against and 25% in favour (the rest were neutral). Under the rules then, the plurality of votes against changing the law was enough to carry the day. This time, the college has decided that a supermajority of 60% is needed for either side to win. Since neither the pro nor anti doctors are expected to reach this threshold, the organisation looks likely to default to a neutral stance.
More...
https://www.economist.com/britain/2019/ ... sted-dying