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Friday, October 8, 2010

Blog Submission from a Member

We welcome any members to write in and share your story or opinion with us. One member wrote the following piece, sparked by an earlier blog post "We've Still Got a Lot of Work to Do...

REVIEW OF "THE QUALITY OF DEATH" -  Economist Intelligence Unit
Commissioned by the LIEN FOUNDATION,  2010
By: John A. Thomson   MD  DPH

It was pleasing to note that the discussion of these subjects has reached an impressive level on a global basis - a discussion long overdue. The principal Canadian expert consultant was Sharon Baxter, Executive Director, Canadian Hospice Palliative Care Association.

I have become accustomed to reading medical scientific papers, and the methodology employed in this EIU paper may not meet usual rigorous scientific standards in all respects, but given the limitations of sources available the results are still quite impressive. It is hoped that in Canada a more detailed presentation may eventually become available to guide those in need of help and those engaged in planning, investigations in a milieu where essential details for sources are forthcoming.

The vexing Hippocratic Oath so often quoted in the popular press is as usual not specifically identified, but no doubt its reference in the paper is to some more recent revision of the original oath. (Wikipedia explains).

There seemed to be a considerable bias in this paper in favour of government involvement in distributing services, but in Canada we find that comprehensive national medical care has obviously serious shortcomings and apparently will soon run out of funds. I agree with a later comment in the paper that the movement for hospice and palliative care needs to stay close to government essentially to change legislation or the administration of it to favour improved relief for problems of pain. At least we should be able to return to the patterns of patient care which existed prior to “The War on Drugs“.

The opioids question is attacked on page 28 quite well. In Canada deficiencies in this respect are almost as severe as in less fortunate countries. Some of my own experiences and those of friends with younger physicians indicate a considerable physician ignorance about opioids. To correct it we need to look carefully at universities to discover why this phase of teaching has become so reduced. Some debates become quite irascible, where one side may accuse others of being “junkies”, or the opposite side may consider their opponents as “sadistic monsters”. There are numerous references to various opioids in this paper, but it needs to be understood that some medical conditions are beyond the reach of opioids and require other techniques.

On page 13 for example, the fact that “in Canada hospitalisation is 100% funded by the state” is presented as if it would be an advantage rather than have the usual retardant effects we so frequently see. So that if we are looking for niche types of problems and solutions, I would expect answers to arise from the private sector first, then eventually be developed by the government when political decisions direct action.

In scientific medical papers it is now quite refreshing to note the addition of ethical considerations such as liens with or support by pharmaceutical firms or tendencies of some physicians to create iatrogenic diseases - quite blunt approaches to these issues compared to the past. More discussion about these patterns may have been perhaps added to the cultural issues section (2) or the economics of health care (3) insofar as the general health care industry is concerned - an expansion perhaps of Dr. Kevorkian’s original complaints about what is “good for business” or “bad for business”. 

*** Note: The opinions and views above are those of the author, and do not necessarily reflect the opinion, stance or mission of Dying With Dignity Canada, it's staff or volunteers.***

Sunday, October 3, 2010

Doctors and nurses launch campaign for right to help terminally ill to end their lives

Dr. Ann McPherson
Leading doctors who endorse assisted dying for the terminally ill will this week launch an unprecedented campaign to change the law on the right to die.

Healthcare Professionals for Change, a group of doctors, nurses and allied health professionals, says it wants to challenge bodies such as the British Medical Association, which opposes any change in the law that would allow others to help terminally ill people to die.

The group is the first professional body of its kind to be set up with the explicit aim of changing the 1961 Suicide Act, which forbids such assistance.

The group will be chaired by Dr Ann McPherson, a GP and fellow of the Royal College of General Practitioners and of Green College, Oxford, who is dying of pancreatic cancer.

Read more....

Friday, October 1, 2010

What is human dignity?

The Quebec National Assembly hearings on Dying with Dignity have, of course, been met with the opposition of many people and groups, the latest one being the Ordre des infirmières et infirmiers du Québec (the nurses association). (See the Montreal Gazette for 28 September 2010.) The argument, as usual, pertains to palliative care.

In a news release, before its testimony, order president Gyslaine Desrosiers said the risks of legalizing medical means to ending life are very real.
"It would be premature to legalize euthanasia and assisted suicide when there remains so much to do in the area of end-of-life care," Desrosiers said. "Protection of the dignity of people is a daily task.

"Euthanasia and assisted suicide are acts which must remain exceptional."

It is important to note that the idea that "protection of the dignity of people is a daily task" is taken directly out of the Roman Catholic moral play book. It neglects the most important question: What is human dignity? In what does human dignity consist?

The Roman Catholic Church holds that human dignity pertains merely to biological human life. Therefore, in Roman Catholic theology, the embryo has as much dignity as a woman who has lived, faced challenges, made decisions, developed a plan of life, has hopes, fears and aspirations, etc. ... Therefore, even if a woman's life is in danger, the Roman Catholic Church forbids abortion. It excommunicated the medical team and the mother of a 9 year old Brazilian girl who was raped by her step father, and made pregnant with twins, because they had participated in aborting the 9 year old's foetuses. It excommunicated a nun in the United States because she had permitted an abortion (at a Roman Catholic hospital) rather than let a woman die.

When we are talking about human dignity, it is important to bear in mind just what the Roman Catholic Church means by this term. It has nothing to do with individuality, with personal decision or the capacity for personal decision. It is simply a matter of biological human life. It is a brutally inane concept, deeply immoral, with tragically immoral consequences, and should be seen to be so. It should not govern our laws, and no one should be held hostage to it. If Roman Catholics want to vest dignity in the simple fact of biologically life, they are welcome to do it, but it should not be forced on anyone else.

Aside from this Gyslaine Desrosiers' argument is empty. Of course, we should make sure we have the best end-of-life care possible, but we know, too, that there will always be more that we can do. Suggesting that people should not be permitted to choose assistance in dying because our end-of-life care is not perfect is laughable. It never will be perfect, and even if it were, individuals should still have the right to choose.

The further claim made by Gyslaine Desrosiers that "the risks of legalizing medical means to ending life are very real" is simply false. It is one of those run-of-the-mill scare tactics that opponents of assisted dying always use. But there is absolutely no reason to believe it to be true. Certainly, the law must ensure that any law enabling assisted dying cannot be used for the purposes of murder, so there must be clarity about consent and the ability to consent; but is this not already required in cases where patients choose not to undergo treatment, or to have treatment withdrawn? Opponents will use every dirty trick in the book, and this is one of them.

The important questions are: What is human dignity? How can the dignity of persons be best preserved and enhanced? Is refusing to assist a person to die in a way and at a time of their own choosing compatible with respecting that person's dignity?