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Friday, January 24, 2020

Medical assistance in dying.


If you are a Canadian, the federal government is seeking your input on legislative reform relating to a judicial decision that the current legislation contravenes Charter rights to liberty of the person.

And, although there hasn't been much publicity about this issue, nevertheless the on-line survey has evoked huge response.

A 1995 Supreme Court decision denied MAID by a narrow 5-4 decision.

A 2015 Supreme Court decision went the other way, requiring legislative amendment to permit MAID in certain circumstances.

But under political pressure, the 2016 legislative response to the 2015 decision went considerably further than the Supreme Court analysis, and stipulated that death had to be "reasonably foreseeable". Which meant that someone diagnosed with a serious illness -- progressive Alzheimer's, for example -- who did not want to end her life right now, could not sign an advance directive for MAID in the future after inevitable loss of capacity had occurred.

And then in 2018 a Quebec judge found that this legislative amendment was also unconstitutional, also infringing liberty of the person and imposing suffering, such that it required further amendment. And so: the request for input by means of the on-line survey.

The survey closes January 27.

Aristotle noted that law and social consensus evolve in tandem: with law sometimes leading social consensus and social consensus sometimes leading law.

More and more often, obituaries note that the deceased person chose MAID. Many people now know someone personally who chose MAID.

In my experience, going back to my three long summers of working as a ward clerk in a hospital for dying patients in the early 1970s, many people chose to end their lives: often foregoing daily pain relief and stockpiling prescribed medications until they had a sufficient dosage. While medical personnel looked the other way. Or pain medication would be administered in increasing dosages to alleviate pain with full understanding (not explicitly acknowledged) that the result would be hastening the end. Or a patient would decline treatment -- dialysis, for example -- understanding that doing so would result in death.

Difficult decisions.
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Member Comments About This Blog Post
    You got quite a nice discussion going on this. I so agree people should have the right not to suffer in their end days.
    25 days ago
    Very interesting. I didn't realize Canada was so progressive. As compared to the USA which at times is very provincial.
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    26 days ago
    Cont’d . into consideration. My husband and I differ greatly on this topic and so my take on MAID may pose problems. A difficult conversation looms ahead.
    26 days ago
    A friend, a physician told me about MAID ...we were away , out of touch. Since then I have done the survey, and offered a suggestion. Is is complicated. We have living wills, not parallel by the way, and I have taken my sons philosophical stances
    26 days ago
    26 days ago
    Difficult decision for sure, good blog thanks for posting
    26 days ago
    What an ethics-laden issue! As a nurse, I dealt with MANY patients who were in stages of end of life issues. It was not something taken lightly @ all. IN all situations, family was involved in discussions about what was appropriate to keep their family member comfortable. As a hospice nurse, we had/have guidelines about using Morphine to keep a patient comfortable. OF course, the dosage is medically prescribed by a physician. Never was an overdose prescribed, but it was unspoken that, in this weak, vulnerable population, it would eventually lead to respiratory arrest.

    I watched my Dad pass away first, in pain till I demanded Hospice involvement, and he was made comfortable. He and I had many discussions PRIOR to this point about how he wanted his 'ending of life transition' to be. He expressly said DNR (and I carefully explained the ramifications to him AFTER the physician had as Dad had questions). His main goal was to be comfortable. Had he been here @ home w/me, I am 100% sure he would have 'stockpiled' medications to do the job. But as it was, both he and Mom did live w/us for 2 yrs. but ended up in memory care, so that option was removed. In a way, I am grateful for that.

    Dad DID stop eating and drinking and refused all medications, except the morphine. I knew what he was doing, and it was hard to watch, BUT he did not fear death. He was 90. He wanted to be with my brother, who passed @ age 27 in 1982. So, though as a nurse I was aware that the Morphine probably hastened his passing, I didn't see it as a bad thing.

    He had the chance to say his good-byes to everyone, too. That is one thing I regret to this day for Mom. Due to her Alzheimer's that was not possible. A curse!

    Mom had Alzheimer's but . . . long before the signs appeared, we'd also had discussions about what she wanted @ the end of life transition. Her answer was the same . . . to be comfortable.

    Sad as it was to sit with Dad, then Mom thru their transition, they went exactly as they wanted . . . comforted, loved, taken care of.

    Outright administration of medications to sedate, stop the heart and stop breathing . . . I can see a place for it when extreme suffering pain. But then you get into the muddy waters of, for example, a teen who is depressed and seeks to 'end it all'. How do you handle that?

    Very thought-provoking question.
    26 days ago

    Comment edited on: 1/25/2020 10:38:45 AM

    thought provoking, for sure
    26 days ago
    Thanks for the link... I'm glad to know people are making their thought known. I filled out my survey days ago.
    26 days ago
  • DESIREE672
    I don’t have any personal experience with MAID or any medical knowledge, but I read the Canadian questionnaire and it seems to cover all bases.

    DNR is not the same issue, but I have had personal experience with it and it disturbs me when people think it is just common sense to have a DNR order in place. DNR is not uncontroversial and I do hope people will keep a questioning attitude and not accept anything as received wisdom, including MAID.

    It also worries me when dialysis is considered as something to be refused, unless other serious problems make it a rational decision to refuse it. It certainly reduces quality of life significantly but it is a lifesaving treatment.

    (Apologies for editing a couple of times, but I wanted to express my unease.)
    26 days ago

    Comment edited on: 1/25/2020 11:06:35 AM
    Whenever I visit my MIL, whose Alzheimer’s is rapidly progressing, I think about this issue. There is no doubt in my mind that she would prefer death to her present state. But she must go on as she is, and it makes me sad and frustrated. It’s hard!
    26 days ago
    Our state in Australia has just passed the MAID bill here. With many people having their say.The person must ask for it here. I am happy for my son and daughter to direct me if the time comes. Someone who knows me not a stranger :)

    I do feel for the Doctors, who may be taken to court etc, it is a tough one for all. I don't think a law is able to cover all eventualities.
    26 days ago

    Comment edited on: 1/24/2020 9:48:41 PM
    I am all for MAID, but in case of Alzheimer's it would be a difficult call. When would be the turning point at which i would want the help of MAID for myself?.
    26 days ago
  • ALICIA363
    27 days ago
  • PHOENIX1949
    Tough times.

    A few weeks ago a sister & I visited the first-cousin we lived next to when children. She survived breast cancer twice and had been in remission for ten+ years when it reared itself again and metastized throughout her body. She floats in and out of dementia and every other day they suction fluid out of her lungs along with plying her with multiple drugs that have severe side effects. This has been going on for about six months. As we left, my sister made the observation that she didn't fear death but did fear becoming immobile and dependent on others. One of my cousin's brothers and I were talking about how cruel and inhumane this was. He and his wife revised their medical directives because of this.
    27 days ago
    We have not evolved that much in the US and have a variety of laws in different sates but it seems like many doctors and hospitals respect the decision of patients and families and facilitate the inevitable.
    We made the decision to discontinue dialysis for my MIL as she was failing after years of suffering and decline and was spending more and more time in the hospital.
    My FIL made the decision himself ten years later, at 93, to refuse a recommended medication, refused to eat and asked for water and ‘comfort measures’ to help him through those last five days.
    They even had a nice big room for such patients so lots of family could come to say good-bye.
    It was so beautiful, really.
    He was long past done with living.

    27 days ago
  • no profile photo INCH_BY_INCH
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    27 days ago
    I attended a talk about MAID a couple of years ago. We have an update coming up on Feb. 5.
    27 days ago
    I am grateful I live in a state that allows doctor-assisted death. The opponents were afraid the passage would open the flood-gates but that never came to pass. The stories of the choices made have all stressed how nothing was decided by impulse but was well thought out and supported by friends and families.

    27 days ago
    Difficult decision for sure. I am interested. What happens north of us may influence what happens here. My family has had some experience that has influenced our current thoughts. We have seen opinions change due to personal experience, too. Thanks again for raising an important issue.

    27 days ago
    27 days ago
  • BJAEGER307
    In the States we have 10 states that have adopted the doctor assisted death policy. Meaning if you have a condition that is medically cannot be treated, you then have the right to medically end your own life if you so choose. I know you have to go through many hoops to get approval for this, but it can be done. Many are appalled at this, but working for a doctor and see patients suffer, I totally agree with this. I know my religion does not condone this, but to me it is not humane to let a person suffer the way one can. It is all a personal decision that cannot made be hastily.

    Touchy subject for most.

    27 days ago
    A tricky question. For each of us. And yes, been through it with loved ones, although US law is nowhere near MAID, at least not in this very "red" state (and I'm not talking about the football team).
    27 days ago
    Thank you Audrey Parker. With stage 4 breast cancer that had spread to her brain she had been granted MAID. The catch of course was that in 2018 the law required the "patient" to be of sound mind in the hour before assisted death, to be able to sign yet another paper saying that they were fully cognizant of their decision. She had no guarantee that the cancer would not prevent her from doing just that so she moved the date forward. Audrey died Nov. 1, 2018 on her own terms surrounded by friends and family.
    27 days ago
    Very difficult...
    27 days ago
    Personal decisions like this don't deserve governmental intrusion is my belief...but of course we need laws because a lot of people make 'bad choices'. This is not one of them, but I certainly support a person's right to choose. This extends to other areas in our lives as well.
    27 days ago
  • GABY1948
    It is difficult for sure
    27 days ago
    Fascinating discussions! I can imagine the controversy around this subject!
    27 days ago
  • NANCY-
    Difficult subject and difficult personal decisions, indeed.
    27 days ago
    A very difficult decision to make.
    The Liverpool pathway is often employed here (not giving sustenance to a loved on the final journey)
    I am SO angry at the way we are left to "allow death" in such a long lingering undignified manner.
    I am Pro all the way, we treat suffering pets better and with more dignity.
    I've been through this misery with both my parents.
    27 days ago
    It's interesting how different jurisdictions deal with this issue. DH and I have talked about it, given that we've had friends who had serious illnesses and eventually passed away, but who did not choose what in the US we call medically assisted suicide. A number of US states allow this, provided that the illness or condition will lead to death within a relatively short time, and with the signature of a specified number of doctors (usually 3) attesting to the fact that the patient does have a terminal illness or condition.

    What I find fascinating is the concept that someone with a long-term condition, such as Alzheimer's or other dementia, could make such a decision long before they are at that point of being close to natural death, and that they have that constitutional right. It definitely is a valid issue to be raised.

    And what of advance medical directives? If someone has specified a DNR, or asked for no heroic measures, is that enough? Does the advance medical directive now need to specify that in the event of such a situation where death is inevitable, the person requests that MAID be administered?

    My aunt, in her 80s, had a major illness recur, to the point that death would be inevitable within the year. She was living in Switzerland, where they have their own version of MAID. I remember my father telling me that she chose that option, and he was glad that it was available for her, so that she didn't need to be in excruciating pain for the last several months of her life. While we can intellectualize about the concept of euthanasia, having a family member choose that option makes it much more important, as well as understandable.

    27 days ago
    I'm totally pro-euthanasia. We do it on animals to avoid their suffering, yet we cannot choose it for us, humans. My dad legally refused dialysis when he was left with no kidneys. And yes, there are tons of cases in which medical personnel look the other way (thank goodness) to alleviate someone with prompting death when there's no other option.
    27 days ago
    Such a personal decision.
    Been through it with family members.
    27 days ago
    Yes, it is a difficult decision. Interesting blog.
    27 days ago
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