Quebec legislators are reportedly within days of passing a law that would permit euthanasia for competent adult patients with incurable disease which causes constant and unbearable physical or mental suffering. The euthanasia-related portion of Bill 52 (an English-language copy of which can be download here) seem modeled on euthanasia laws in Europe, in that it requires a diagnosis of incurability rather than of terminality, and explicitly ties access to euthanasia to suffering. A person is eligible to receive a physician's aid in dying only if he or she "suffer[s] from an advanced state of irreversible decline in capability; and suffer[s] from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable." The term "aid in dying" is not actually defined in the bill, presumably in order to leave methodology in the hands of physicians.
Euthanasia is illegal according to Canadian national law, and it's not clear that the Quebec provincial law's alternative reference to "aid in dying" will skirt that national prohibition. Parti Quebecois officials are reportedly thinking of simply asking Crown officials not to prosecute euthanasia within Quebec after the law passes.
The bill covers a great deal of ground in addition to the euthanasia innovation. It creates a provincial commission to gather information on end-of-life care, establishes a regime for the creation and registration of advance directives, and addresses the provision of hospice and palliative care.
The bill has attracted a fair bit of high-profile opposition from groups of physicians, from the Catholic Church, and from some bioethicists. Here's a piece on the slippery-slope argument ("Soon we'll be killing children and the demented, just like in Belgium") being advanced by prominent conservative Canadian bioethicist Margaret Somerville.
Showing posts with label end-of-life care. Show all posts
Showing posts with label end-of-life care. Show all posts
Tuesday, February 18, 2014
Saturday, September 28, 2013
Melissa Harris-Perry Appearance: My Not-Quite-15 Minutes of "Fame"
Here I am on Melissa Harris-Perry's MSNBC show, talking with a very sensible panel about end-of-life care. The two segments below do an excellent job of introducing audiences to my nascent bald spot. Plus I say some stuff; and a number of other people say some stuff too. I pretty much endorse all the stuff they say. Comment on how said stuff was received willl follow shortly.
Wednesday, May 15, 2013
Vermont Legislature Passes Physician-Assisted Suicide Law
The Vermont legislature has passed a new physician-assisted suicide law and is sending it to Governor Shumlin, who supports it and is expected to sign. The Oregon-style legislation will be the third such state law in the country and the first adopted by a legislature, as opposed to via popular referendum. The strange feature of this law, though, is that while it begins by mandating (in section 5283) a number of Oregon-like anti-abuse measures to make sure that the program doesn't help the wrong people to die by mistake (two different oral requests, 15 days apart; a written request for self-administered lethal medication signed by two disinterested witnesses; findings of terminality and capacity entered into the chart; and so on), most of these requirements sunset in 2016 in favor of the much shorter section 5289, which says only:
"A physician with a bona fide physician–patient relationship with a patient with a terminal condition shall not be considered to have engaged in unprofessional conduct under 26 V.S.A. § 1354 if:
(1) the physician determines that the patient is capable and does not have impaired judgment;
(2) the physician informs the patient of all feasible end-of-life services, including palliative care, comfort care, hospice care, and pain control;
(3) the physician prescribes a dose of medication that may be lethal to the patient;
(4) the physician advises the patient of all foreseeable risks related to the prescription; and
(5) the patient makes an independent decision to self-administer a lethal dose of the medication."
A subsequent section immunizes any physician from civil or criminal liability for any actions performed in good faith compliance with the law.
The legislators's assumption, according to press coverage, is that physicians will have developed adequate professional standards for physician-assisted suicide by 2016. I wonder whether the law's repeal of safeguards will really last, or whether the Vermont legislature will re-think the matter in the next year....
And I know, I'm supposed to say aid-in-dying, not physician-assisted suicide. But I'm an academic, not an advocate, and even though the term "suicide" scares some folks, and others argue that it's not really suicide if you're dying of a disease you didn't choose, my own view is that if you give a terminally ill person some pills with which she can kill herself faster than her underlying disease would have, you're assisting in her suicide. (Wow! On that one verbal point, I actually agree with Wesley Smith! Though, unlike him, I approve of physician-assisted suicide with appropriate safeguards, and think that the Oregon safeguards are appropriate. And I'm not a fan of slippery-slope arguments.)
"A physician with a bona fide physician–patient relationship with a patient with a terminal condition shall not be considered to have engaged in unprofessional conduct under 26 V.S.A. § 1354 if:
(1) the physician determines that the patient is capable and does not have impaired judgment;
(2) the physician informs the patient of all feasible end-of-life services, including palliative care, comfort care, hospice care, and pain control;
(3) the physician prescribes a dose of medication that may be lethal to the patient;
(4) the physician advises the patient of all foreseeable risks related to the prescription; and
(5) the patient makes an independent decision to self-administer a lethal dose of the medication."
A subsequent section immunizes any physician from civil or criminal liability for any actions performed in good faith compliance with the law.
The legislators's assumption, according to press coverage, is that physicians will have developed adequate professional standards for physician-assisted suicide by 2016. I wonder whether the law's repeal of safeguards will really last, or whether the Vermont legislature will re-think the matter in the next year....
And I know, I'm supposed to say aid-in-dying, not physician-assisted suicide. But I'm an academic, not an advocate, and even though the term "suicide" scares some folks, and others argue that it's not really suicide if you're dying of a disease you didn't choose, my own view is that if you give a terminally ill person some pills with which she can kill herself faster than her underlying disease would have, you're assisting in her suicide. (Wow! On that one verbal point, I actually agree with Wesley Smith! Though, unlike him, I approve of physician-assisted suicide with appropriate safeguards, and think that the Oregon safeguards are appropriate. And I'm not a fan of slippery-slope arguments.)
Monday, January 9, 2012
Online Advance Directives
Virginia has recently decided to create an advance directives registry which, when it goes live sometime this spring, will permit patients to upload their own living wills. The plan is eventually to integrate the advance directives information into the state's health information exchange, so that physicians will be able to access their patients' documents without needing to know their login information. The hope is that physicians will then be able to act on their patients' previously-expressed wishes without having to locate and contact surrogate decision makers.
Friday, December 2, 2011
NHS: Disclosing "Death Pathway" Use
The NHS's "Liverpool Care Pathway"--known to some in the press as the "death pathway"--is a palliative care pathway designed to reduce burdensome end-of-life medical interventions including, controversially, artificial nutrition and hydration. Tens of thousands of patients annually are put onto the pathway in the last days of their lives. But a new report claims that in a quarter of hospital trusts, one in three families are never informed that their loved one has been placed on the Liverpool Care Pathway. In one trust, fully half of families weren't informed. The good news is that doctors do discuss the issue with families in 94% of cases overall--a sharp improvement over the 2008-09 audit figure of 75%, even though twice as many patients are put on the protocol now than then.
Thursday, December 1, 2011
Globe and Mail on End-of-life Care
I'm grateful to Thaddeus Pope for drawing my attention to the Globe and Mail's amazing current series on end-of-life care.
There are two current important cases on end-of-life care pending in Canada. I blogged earlier about Gloria Taylor's case rising from British Columbia, which is challenging, for the first time since the Rodriguez case in 1993, the constitutionality of Canada's law against assisted suicide. The second case is that of Hassan Rasouli, a patient in a permanent vegetative state in Toronto. Rasouli's medical team wants to discontinue aggressive care and begin palliative care, but the patient's family disagrees. Lower courts held for the family, but the doctors have now appealed to the Supreme Court.
There are two current important cases on end-of-life care pending in Canada. I blogged earlier about Gloria Taylor's case rising from British Columbia, which is challenging, for the first time since the Rodriguez case in 1993, the constitutionality of Canada's law against assisted suicide. The second case is that of Hassan Rasouli, a patient in a permanent vegetative state in Toronto. Rasouli's medical team wants to discontinue aggressive care and begin palliative care, but the patient's family disagrees. Lower courts held for the family, but the doctors have now appealed to the Supreme Court.
Monday, November 28, 2011
Bioethicsy Stuff at Yale
Our Animal Ethics group will hear Charles C. Camosy (Theology, Fordham) on the topic of Ethics and Other Animals: Common Ground Amidst Difference, on December 1 at 1pm.
Our Jerome Medalie End-of-Life Issues group will host Helen Stanton Chapple, PhD, RN, MA, CCRN, MT (Center for Health Policy and Ethics, Creighton) on December 6 at 5:30.
Our Technology and Ethics group will hear Aimee Vanwynsberghe (PhD Candidate in Philosophy, University of Twente) on A Framework for Integrating Ethics in the Design of Care Robots on December 7 at 4:15.
Locations and other details on all of these events are here.
Our Jerome Medalie End-of-Life Issues group will host Helen Stanton Chapple, PhD, RN, MA, CCRN, MT (Center for Health Policy and Ethics, Creighton) on December 6 at 5:30.
Our Technology and Ethics group will hear Aimee Vanwynsberghe (PhD Candidate in Philosophy, University of Twente) on A Framework for Integrating Ethics in the Design of Care Robots on December 7 at 4:15.
Locations and other details on all of these events are here.
Thursday, November 17, 2011
Challenge to Canada's Assisted Suicide Law
The Royal Society report I blogged on earlier today may end up having an impact on an important case which has just begun in British Columbia. It's a new challenge to the constitutionality of Canada's law criminalizing assisted suicide. The case aims to overturn the 1993 Rodriguez case, in which a 5-4 split Supreme Court upheld the criminal law by affirming that it did not interfere with the rights to liberty and security of the person affirmed by the Canadian Charter. The Royal Society report includes extensive discussion of contemporary Canadian attitudes toward euthanasia and assisted suicide--attitudes which have changed substantially since 1993. Such changes in national climate--plus a number of intervening cases interpreting "security of the person"--may leave Rodriguez vulnerable to reversal.
Royal Society of Canada: Assisted Death
Have a look at this report from the Royal Society of Canada on end-of-life care. It's headline-grabbing recommendation is that both assisted suicide and voluntary euthanasia should be legally available; but the full report, with its overview of current Canadian public opinion and law on end-of-life options, is well worth reading.
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