Friday, June 14, 2013

Quebec's assisted euthanasia law

I truly believe that this is a good law. With many clients whom I have helped, I have not met more than a few who might have chosen to end their life. That said, there are many specific diseases whereby those who suffer would choose to end their lives and they should have that right. 

 These are situations in which there is no hope, they have made their peace with family and friends, and living with indignity is not an option. It is not a 'slippery slope' as some fearful, fear-mongering doctors proclaim. In fact, one of the best palliative training videos explain how one physician, with ALS, made choices about refusing a feeding tube, respirator, and signed DNR orders.
Assisted euthanasia is between a conscious, cognitive patient and their doctor; not the public, not the fearful right, nor lobby groups who fight for the disabled. It is a disease-specific, patient-specific issue, which is an important choice in this millennium. It is not for all doctors, many of whom fear death and dying. It is for a specific group of physicians who respect the will of a dying patient who is suffering the indignities, are a burden on family, and cannot endure any longer.

If you have met anyone on life support, perhaps with a feeding tube, you will understand.
My late father, I wrote about this in my book, was suffering with a brain tumour. I fought months with staff and the doctor to get him adequate pain medication. He was palliative, incontinent, aphasic, unable to use fork or knife, unable to communicate, and clearly in pain.
I have had clients whose last months were terrible. Imagine a 91-year-old weighing 60 pounds. I lifted her from commode to bed. Unable to walk or control her bowels, her life was hard on her caregiver family.
In some situations, people like this are not ready to give up. They have unfinished business: perhaps worrying about a loved one coping after they are gone. That is to be understood. This assisted euthanasia is for those who may choose to shorten a prolonged disease trajectory.

My favourite client, who became my friend, ended up losing her ability to swallow food, and eat. A retired nurse, mother, grandmother, great-grandmother at age 95. She had a feeding tube inserted, which sent her on a horrible downward trajectory. She had lost her sight, her hearing was beginning to fail, she was immobile and in bed, and was not living in dignity. If she had the option, and good information, I don't know if she would have chosen to end her life, but many of my clients speak to this concern. Life isn't worth living when you are virtually blind, unable to eat, sleep, or interact with others.
Imagine another client: WW II air force pilot, weighing precious little, unable to chew his food, subsisting on pureed food, living in a dirty retirement home, with inadequate care. I phoned his family to let them know that I thought his pneumonia had returned. The nurse on staff did not visit over the two days I sat by his bedside for 5 hours at a time. I had no chair upon which to sit. I bought a liquid diet supplement as he told me he was hungry. He was living in a converted storage room as the retirement home's elevator, which took him in his wheelchair up to his room, had broken.

Palliative care is a process in the caregiving continuum. Ask a doctor if they want lifesaving measures, and they will tell you. There are decisions to be made if you have all the information about your disease, and when doctors no longer are giving choices for you. The goal, for all clients, is to have managed care with treatment goals, treatment options and a plan with eyes wide open. This is what I wrote about in my book, when my father's doctor was inaccessible and unresponsive to our needs for pain management.

Many seniors suffer depression - the statistics are clear and predictable, and would be susceptible to choosing death over living. This is different from wishing suicide, to end a horrible life.
There are few hospices in Ontario. That said, most of my clients, if not all, wish to die at home, in the bosom of their family and the comfort of HOME.

Doctors are the ones that fail our system. They fail to explain what is the impact of, for example, a feeding tube. They fail to prescribe adequate pain medications. They fail to make the type of house calls that would ensure that a client's disease trajectory is understood. They fail to explain side effects of treatments or the possible outcomes or the likelihood of success for patients. Too many patients suffer from treatments that make life unendurable.

For more information:

'Society is ready for it,' says house leader of the end-of-life debate

People in Vermont, Oregon, Washington and Montana can have a doctor write a prescription for a lethal dose of medication. They can fill the prescription and take the medication at their own discretion.
If Quebec's proposed legislation gets adopted in the fall session of the national assembly, a doctor who receives the repeated consent of a patient could administer medication to cause death.
Hivon said this differs from palliative sedation, which is already legal in Quebec — patients on the cusp of death can be put into a medically induced coma, and have equipment such as a feeding tube and respirator removed.

For our seniors and frail elderly, what to ask your doctor, procedures to avoid

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