Wednesday, August 21, 2013

Dying with dignity –it is possible

Disability, illness, proximity to death. These are terms that hospice and respite workers, like myself, have begun to understand. Not all do. Here are summaries of two broadcasts, for and against physician-assisted suicide. One from a physician for legalizing it and the point of view from an activist who works with those with disabilities who is lobbying against and blocking the right to choose for us all.
The 'slippery slope' argument is wrong, based on what we now know and how this process works in many countries who have legalized suicides.

There are difference between disabilities, and new disabilities due to a chronic disease, and a predictable disease trajectory.

CMA demands a National plan

13th annual report card published by the Canadian Medical Association.
Canadians worried about how they'll be taken care of when they age. So say polls, and people not involved in caregiving or healthcare.
Canada falls short:
  • healthcare designed around acute care
  • Care that needs to be provided, best provided in home care or LTC, not hospital
  • Home & community care should be the keys, not hospitals
  • Healthcare transformation initiative: give right care to right patient, in the right setting

CMA proposes we restructure healthcare. Growing senior populations who may have chronic disease, e.g., diabetes, COPD. We should put resources into community-based care.
We need to invest in programs of homecare and build more LTC. Think about redistributing resources to save money.
Families: must deal with caretaker burnout. Need a lot of support, nurses once or twice a day, PSWs.
The costs:
$842/ hospital, $126/day in LTC, much less in the home.
But we lack enough well-trained PSWs to provide homecare and nurses and physicians who make house calls.

The case against physician-assisted suicide

We're hearing the case for and against legalizing physician assisted suicide in Canada. We heard the case against it, by Ruth Enns. (A radio broadcast.)

Q. "How can we trust the data?" It's data, pure, simple: more people are talking about this, the evidence is clear. Most of us do not need it. Only those who are sentient will participate in it, and all must state their wishes before they are part of the program.
Now - the case in favour. Arthur Schafer is Director of the Centre for Professional and Applied Ethics at the University of Manitoba.

He states that 20 years ago fears about the slippery slope were different. The safe guards in Oregon better protect vulnerable people. Doctors in those systems are more accountable.
It's time for a change: our human rights and freedoms trumps the decisions about when your life is so burdensome that you cannot tolerate it.
The state should not control this decision. There is no evidence that it harms those with disabilities, as some fear. It is different for those who are palliative, they are cognisant of their situation, and whose disease is terminal and cancer has metastasized. Dr. Schafer states:
  • 1/6 discuss physician-assisted suicide with family
  • 1/50 discuss physician-assisted suicide with doctor
  • 1/800 die by physician-assisted suicide. Hasn't changed much in a decade.
Disabled, frail, elderly, women, minorities have not been victimized by this. Most who would die within this program have metastatic cancer and are receiving hospice care, and are still suffering. Most are elderly white, affluent, men who can make choices and have input onto these decisions, with family members who support them.

Belgium study reports that some have strayed from the  guidelines. Sometimes people given assistance in dying or active euthanasia, if you can't swallow the lethal medications, a physician can assist. There are some cases where physicians have hastened the death, without going through the process.
The number of patients who die, those who haven't requested it, are the same as is currently found in larger society. Doctors have taken the initiative. This happens everywhere. Throughout western Europe.
Q. Has this practice increased? No, decreased with protocols in place.

Evidence is good that when you legalize it, make doctor accountable, regulate it, vulnerable patients are better protected.
Safeguards are in place.
Competence is examined, two doctors interview them without family present.
Q. Worry that patients coerced?
Every jurisdiction with legal physician-assisted suicide have various safeguards to assure that patients are not coerced, doctors have explained alternatives, and ensure process followed.

Society has allowed patients to make the decisions themselves, whether totally disabled or vulnerable, to refuse extreme measures, and we have allowed this for 30 years. Patients can refuse treatments and food and water, life support.

It's my body... can I die if I want to? Facing end of life choices

In April, Susan Griffiths said goodbye to her family in Canada and ended her life in Switzerland with the help of Dignitas, the assisted suicide organization. But before she left, Susan Griffiths spoke with us about her degenerative neurological disorder and how the thought of a slow and painful death became too much to bear.

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