Canada Assisted Dying Shitshow

[antelopevalley]

Anyone else been following what is happening in Canada around assisted dying? Lots of issues with mentally ill and depressed people being helped to kill themselves and assisted dying in some cases being pushed on disabled people. Below is a screenshot from the latest awful story.

This is what worries me about assisted dying, how it is implemented in practice. I remember how awful the Liverpool Pathway was that was supposed to make dying patients' last days more comfortable, and instead led to people who may have recovered being starved to death.

@hopeisathingwithfeathersx firstly, it isn't up to the report to 'call' for anything - it simply presents the facts. There's no guarantee that specialist pain clinics will result in a 100% painless death hit rate.

Secondly, your position is still about refusing people choice and autonomy. What if you don't want to be in a hospice drugged to the eyeballs and unable to manage basic self care? You want to force people down that route.

Lastly, not all pain is physical. You would deny people with other issues the choice of ending their lives safely, thereby pushing them down the suicide route, with all the associated trauma for their loved ones.

There is no compassion in saying assisted dying should not be legislated for.

If you listen to Palliative care doctors though, they do not want to be compelled to participate in the deliberate killing that you suggest. They want protection from this accusation for their profession and also protection for their most vulnerable patients from coercion, assumptions that they are a burden etc.

www.theguardian.com/society/2005/oct/12/health.homeaffairs

The main problem with assisted suicide is the assisted bit, which doesn't just involve one individual's personal choice.

And even if we can imagine a hypothetical situation where an individual doctor and patient both freely consent, there are societal impacts on other more vulnerable people, whom the law currently protects. In this way, I see it similarly to the debate around surrogacy.

This really is a debate about choice. Surely, people with say Alzheimer's should be allowed to die naturally over a long period of time, much of it where they are unable to talk, doubly incontinent, unable to feed themselves and bed ridden, if they want to die this way. Alternatively, if they want to be helped to die, in a peaceful and dignified manner, they should be allowed to do this too. In other words people should have choice.

For me too, it is about choice and I believe the stage we are at in this, is similar to pre abortion law debate. The details will come later but note that in Scotland we are only currently talking about terminally ill patients.

I agree that no doctor should be compelled to carry out an assisted suicide if they do not wish to do so. The rest of your argument about the societal impact on vulnerable people is the usual 'slippery slope' argument, and it holds no water. It's about forcing people to suffer because other people are afraid and that is not acceptable. That is what the regulatory framework is for.

There is no 'hypothetical situation where doctor and patient freely consent'. In the countries where assisted dying is legal, there is simply the actual situation where doctor and patient freely consent. My grandmother freely consented. Do not pretend otherwise, you were not there.

But there are people in this very thread arguing that euthanasia should be extended beyond people that are terminally ill. If it's all a matter of choice, how can you possibly justify denying assisted killing to anyone that requests it? I think this is a legal protection and an ethical principle we give up at our peril.

Despite supposed protections and informed consent in other countries, we still have people:
-who believe that an assisted suicide is guaranteed to be less painful, more dignified and less distressing than a natural death, which is evidently not the case
⁃ we have 23 year old young people with normal physical life expectancy being killed instead of offered safe effective psychiatric treatment
⁃ We have dementia patients being held down and killed despite insisting they are happy with their life and protesting they don’t want to die
⁃ We have doctors who initially agreed to participate in this practice becoming weary and traumatised with the patients they are being asked to kill, and advising them to kill themselves if they must, but don’t put the responsibility and guilt of that personal choice onto the doctor
⁃ We have assisted killings being carried out on people due to a fear of future pain or intolerability of life, rather than their current condition, and the experience of palliative care specialists in the UK is that the vast majority of patients who ask for this at an early stage go on to report that, in the end, their condition wasn't as they had feared.

I think everyone would agree anyway that it's vital that we fund access to high quality hospice and palliative care for all who want it, and establish a specialist pain service to help those who are suffering.

@hopeisathingwithfeathersx there are so many wrong headed assumptions in your post that it makes me dizzy, but OK.

Despite supposed protections and informed consent in other countries, we still have people:
-who believe that an assisted suicide is guaranteed to be less painful, more dignified and less distressing than a natural death, which is evidently not the case
We also have people who believe that palliative care guarantees a painless and dignified death, which is evidently not the case. No medical intervention is 100% safe and effective. People need to learn this.

⁃ we have 23 year old young people with normal physical life expectancy being killed instead of offered safe effective psychiatric treatment
We have one instance of this happening. One. I would reiterate the question I asked earlier in the thread: how long do you think someone with mental illness who has a wish to die should be made to live? How long should it be before the carrot called 'hope of recovery' becomes a stick we beat people with? Why is 6 years not long enough? Would you feel differently if this person had been 45 rather than 23? Do you truly believe that there is such a thing as 100% effective psychiatric treatment?

⁃ We have dementia patients being held down and killed despite insisting they are happy with their life and protesting they don’t want to die
I agree that this should not happen. The regulations should be changed to say that if consent is withdrawn at the moment of intervention, that withdrawal of consent should be taken at face value and the advanced directive struck down. And the patient should not be able to then make any further changes.

⁃ We have doctors who initially agreed to participate in this practice becoming weary and traumatised with the patients they are being asked to kill, and advising them to kill themselves if they must, but don’t put the responsibility and guilt of that personal choice onto the doctor
No doctor should be compelled to participate in an assisted suicide and any doctor should be able to withdraw from the practice when they feel they can no longer engage in it. However, do not assume that all doctors end up feeling this way. That is presumptuous.

⁃ We have assisted killings being carried out on people due to a fear of future pain or intolerability of life, rather than their current condition, and the experience of palliative care specialists in the UK is that the vast majority of patients who ask for this at an early stage go on to report that, in the end, their condition wasn't as they had feared.
In Oregon, patients are given medication which will end their lives. Over 90% end up not using it. Just having the choice gives them the strength to cope with what they are suffering, because ultimately they have autonomy. This is what we should be striving for. We should not be denying choice. It is as far as I am concerned a gold standard option.

I get it, you are opposed to assisted dying. We will never agree. But put away the arrogance and the certainty and listen to people who have seen assisted dying in action, and also have experience of what happens when that option is not there.

Surely, it's unethical to force someone who wants to die, to instead knowingly put them through a natural long drawn out death where they may not be able to speak, smile, eat, walk and are doubly incontinent for a long period of time. This is not just about pain. We have the means to allow people to die peacefully and with dignity before these things happen so why not give them that choice.

My views have been formed by listening to palliative care specialists, as well as my own personal experiences of illness and bereavement, like all of us. I totally understand that those who want assisted dying are motivated by care and compassion, as we all are. That's why we are here, taking the time to think carefully about these things.

I'm currently reading Kathryn Mannix's book, as recommended by a PP. It is such a wonderful, important perspective she has about the end of life. By turns beautiful, powerful, moving, comforting. An amazing book, not focused on this particular topic but about all aspects of death and dying, through stories of her experiences. Glad to have found it through participating in this discussion.

What about people who aren't terminally ill, like the 23 year old with PTSD?

Pointy things thinks people like that should have access to assisted dying too.

Kathryn Mannix’s book is excellent and gives comfort to many. But many palliative care specialists do think there’s a place for assisted dying. At the very least, give those of sound mind, who are terminally ill and in unrelieved pain or suffering that choice. To do otherwise is inhuman. They may not use that choice, as pp said, but to have it there as available is important.

Pp said upthread about sedation and patient expectations about what that actually means. There’s an interesting article here from anaesthetists about palliative care and anaesthesia, explaining the disconnect.

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15459

@hopeisathingwithfeathersx I think if someone has a psychiatric disorder and there have been efforts made to treat them with medication and therapy over a long period of time (say, 10 years), and they continue to find life unbearable, then they should be offered assisted suicide as an option. That is the ethical thing to do.

Thanks for the article. It strongly suggests that there could be a greater role for anaesthesia in end of life care, which is not prohibited by UK law, but rarely used here. Interesting that this is more often done in France and is framed as a right to unconsciousness.

It sounds like anaesthesia could be a means of addressing the current levels of unrelieved pain in terminal patients that was highlighted earlier.

What about if they want it after 1 year? Why do you get to decide that they must spend 10 years in suffering? It's their choice to die now.

@hopeisathingwithfeathersx are you suggesting that one year is enough time to exhaust all treatments, I would have thought ten years would be better but I am no expert. I think we are in danger of getting sidetracked by an outlier here so won't comment further on this specific scenario.

If you want to allow assisted dying for some types of people, but prevent other types of people from accessing it, you need to have a way of distinguishing between these people.

The argument (as I understand it) for allowing it for a terminal patient applies equally to a person with mental health problems of 10 years. and it applies equally for a person with mental health problems of 1 year. If you want to distinguish between these people then you need some basis for doing so.

"Availability of other treatments" doesn't work, because the original argument also included the idea that patient choice is absolute, and they must be allowed to decline any treatments.

What about people who aren't terminally ill? Pointy things and lucky dip think people with mental health problems, no physical pain and decades of life ahead of them should also be assisted to kill themselves.

I feel that the time has come for me to give a little more personal information on why I am in favour of assisted dying.

Specialist had given 12-18months final stage diagnosis. In the 5 months since the diagnosis, DH had been in hospital for very short periods about 3 times, so when he was admitted for the 4th time, we saw no reason to suspect this time would be any different.

DH had complained of feeling very weak and unwell so we saw the GP who advised that I phone the specialist nurse in charge of his treatment, to arrange immediate admittance to kidney ward as doc can only advise A&E.

It's NYE (Hogmany in Scotland) but it's still early afternoon so we wait for nurse to return my call. Hours later after no call back we eventually decide to go to A&E but DH wants to shower and shave first before going - the dignity thing. He is so weak that he barely manages the shower, no shave, and has to rest afterwards. Two hours later we are on our way to A&E at last, but it takes another 4 hours for DH to be admitted to kidney ward as blood tests have to be done first so he is in A&E bed.

Five days later, doctor is updating me and says (after I asked because DDs live abroad) that it's time to call the family home. DS had already quit a job abroad to work in UK, when he realised how ill his dad was and as he came to Scotland when DF entered hospital, is already here.

Now it's a mad scramble for DDs to fly home. One DD with the shorter 6 hr journey takes a taxi directly from airport to hospital. After greeting her, I leave the room to give her some time alone with her dad. Within 5 minutes she comes frantically crying to the family waiting room, "I think dad just died!".

Minutes later I get a call from other DD (9 hr flight) who is on her way with 2 DGC, saying that she is still at Heathrow as her plane had a fault and had to turn around but she would be on the next connecting flight. I have to tell her, on the phone, that DF had just died. She starts crying. There is nothing we can do. We all feel helpless.

DS had gone home to rest after being at DF's beside throughout the night, so in the end, only 1 family member had been there to say a final goodbye. We all wished we had been there together.

We should not forget the potential impact on the loved ones left behind when we debate this issue. Just imagine how differently it could have been if DH had been given the opportunity to choose his dying. Perhaps he would not have used it, but this very personal experience, is exactly why I want to be able to have the choice for myself. It's for my family's sake too.

What about people who aren't terminally ill? Pointy things and lucky dip think people with mental health problems, no physical pain and decades of life ahead of them should also be assisted to kill themselves.

Doesn't it depend on the actual mental health assessment made by the medical professional? How do we distinguish between the strength of physical and psychological/mental pain? Is it possible to say one is worse? Who determines what constitutes a "good" quality of life? Can someone tell another what they can and cannot bear?

I don't have answers for these questions and don't forget the "all things being equal" caveat, but isn't true choice about having options and the capacity to make decisions?

The article makes the point that 88% of people state that they want to be unconscious as they die. Also, whereas general anaesthesia is seen as a normal patient request for dental treatment, for example, even if normal pain relief would be adequate, general anaesthesia is unavailable for those suffering unrelieved extreme pain at the end of life. Currently, there seems to be no standard sedation level that is on offer for palliative patents - some are sedated to the level where they can still talk, others are virtually unconscious. What you get varies, and not just because of patient need. The point is made, again, that currently some patients do suffer pain, delusions, etc, under current practice because the medications on offer do not work. It may be that if general anaesthesia was on offer -the right to unconsciousness, as in France - some people might choose that instead of assisted dying. However, it’s not on offer. Bearing in mind anaesthetics are regularly used elsewhere in medicine, it’s bizarre that they are not in palliative care.

@hopeisathingwithfeathersx the way you put it, you make it sound as if @Luckydip1 and I think that it should be possible to just walk into a euthanasia clinic and say 'Hey, I'm a bit depressed and have been for a while, please euthanise me'. I certainly don't think that way - but as @logicisall says, how do you define unbearable suffering? I think it is shortsighted to assume that suffering not involving physical pain must by its nature be less unbearable. I think that someone with a serious and enduring mental illness should have the same choice about living or not living that the rest of us have, subject to mental capacity. How long the duration of their illness 'should' be will probably need to be assessed on a case by case basis using contact with the patient's treating clinicians, studying their case notes (with consent, obviously) and with assessment from clinicians who do not know the patient. Just because this would be difficult to do that does not mean it should not be available for patients who don't have a terminal physical illness. Your phrasing suggests you seem to think this is appalling. I think it is appalling to rule out people with a mental illness.

What we need is a system that provides excellent palliative care, including specialist pain treatment and full anaesthesia if wanted, as well as a dignified way to end life if that is what is wanted. This must not be a zero sum game.

Relieving suffering isn’t only at the time of death. Take someone with Huntington’s who is left with no quality of life, unable to care for themselves, unable to communicate, unable to engage or interact in any meaningful way. What is to gain by keeping someone in that state for years awaiting death? It is psychological torture. If they want to die sooner, why can’t they have that option?

Suffice to say, the issue of people with mental health problems being helped to kill themselves cuts particularly close to home. And yes I do think it the case of the 23 year old with PTSD is appalling.

I think most people who are in favour of assisted dying in the UK are imagining a terminally ill patient, not a 23 year old with PTSD.

I think it's useful to point out to anyone reading who thinks that this law can be restricted to terminally ill patients: as soon as you give up this legal protection for the terminally ill, there will be people like those on this thread calling for euthanasia to be extended further to people with mental health problems, people with disabilities etc.

This isn't any kind of a slippery slope, or euthanasia gone wrong, it's simply a logical application of the same argument. Unfortunately, it would be a cheaper and easier way to deal with people with mental health problems and disabilities, so make of that what you will.

100% agree

@musingsinmidlife You are assuming their life is not worth living. Lots of people with very severe disability do still want to live. It is able bodied people who see their life as worthless, but many very disabled people have a different view of life.