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Physician-Assisted Death

  1. Mar 16, 2016 #1

    Choppy

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    Where do you stand on the issue of physician-assisted death?

    In Canada this issue has been a leading news story over the last year or so. See for example: Alberta Doctors Prepare for 'Culture-Shift' Created by Physician Assisted Death.

    Physician-assisted death is where a competent person makes the conscious decision to end his or her life under the supervision of a physician. Generally it occurs in cases where the patient is terminally ill, or faced with a chronic debilitating and/or painful condition for which there is no foreseeable cure.

    Some of the issues that this brings up:
    1. Is it better to die with dignity under one's own control, or should a person live life to it's natural conclusion? What defines a natural conclusion?
    2. How should the decision be made? Who should be involved? If you need a board or committee to meet, and the approval of two physicians, will this draw the process out for too long?
    3. Are there any risks associated with physician-assisted death? Could a wealthy parent be pressured into requesting that her life be ended by a greedy son or daughter? Could a person feel pressure because he or she feels like a burden to a struggling family?
    4. While medical doctors may be in a position to administer lethal drugs and pain control medications, are they the appropriate professionals to be ruling on whether a desired death should proceed?
    5. What about costs to the healthcare system? In Canada, with socialized healthcare - this may have a different response than in the US? But will it ultimately cost more through legal fees, consulting, board meetings etc. for a person to end her or his life, than to live through compassionate hospice care?
     
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  3. Mar 16, 2016 #2
    I fully agree that a mentally healthy adult has a moral right to decide if he wants to live in such situations. On the other side, I very much doubt that it is practically possible to create such a law that would take into consideration all possible factors and that such a law could not be misused. This matter is so delicate.
    I would most probably choose PAD if I knew I and/or my family would suffer and nothing could help (pain can be treated very well today but what about dementia, paralysis from neck down or suffocating slowly?)
    At the same time I feel that if PAD became a common practice, greedy heirs would sure become a huge problem.

    If there was a list of diseases that allow this option, what about other patients who wish to fight till the end? How would they feel if they knew that society decided people in their condition should not wish to live anymore?

    Than there is slippery slope argument. What if more and more people are killed this way for less serious reasons and what if it eventually leads to refusal of treatment by insurance companies as people with certain conditions would be judged as sentenced to death? I don't know if it is true but about half a year ago I read that in the UK people over 65 admitted to hospital who do not pass certain test will not be given treatment but will be sent home to die (please PF members from the UK tell if that is true or not. I read it in printed magazine and don't remember details or the name of this new policy).

    To sum up, i understand all people who wish to choose this option. I would never judge a doctor who does this if the patient asks. But I feel that the negatives of allowing such practice legally could potentially have more negative effects than positives. However, if someone wrote a really good law and if no pressure by the heirs could affect the patient, than I would agree. It should be paid by insurance (they will save lot of money) and the patient would have to be assessed by a psychologist and at least 3 or more highly qualified doctors (preferably from different hospitals) should evaluate his condition and fully explain the prognosis to him. Than it would be up to the patient to decide.
     
  4. Mar 16, 2016 #3
    I agree

    How do the countries (I think some Scandinavian?) structure it?
     
  5. Mar 16, 2016 #4
    That's more reasonable then the U.S. option which is a DNR. And if you so happen to be in a position that renders you unable to speak then you change your mind, barring someone intervening legally you can basically be euthanized. And there is no legal recourse of action if a relative signs over power of attorney to someone. Then they can sign the DNR for you and you are toast. I have witness that personally.
     
  6. Mar 16, 2016 #5

    berkeman

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    Not resuscitating someone who has a valid DNR is very different from euthanasia. A DNR has to be signed by a physician, who has presumably discussed the issues of the DNR with the patient, and gone over the various options (if available in that state).
     
  7. Mar 16, 2016 #6

    wolram

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    I have strong feelings that euthanasia should become law, if the patient wants it , but there must be iron clad rules
    1 the patient must be of sound mind
    2 there must be no one that gains from the patients death
    3 the patient should be in such a condition that life is intolerable
    4 switching off life support must be decided by at least 2 doctors and a solicitor
    5 the relatives point should be only 25%
     
  8. Mar 16, 2016 #7
    In my brothers case he never read or signed a do not resuscitate order, his common law wife had power of attorney so she was able to make that decision for him. By the time they realized he was critical he no longer had the ability to speak, they had to tie his arms down cause he kept tying to get out of the bed....he wasn't ready to go! He was on a ventilator and they called us all into a room and told us his prognosis, gave us one option that would give him a chance and made it seem as though death were the inevitable out come......myself and his daughter objected, everyone else stated that if he told his wife he didn't wanna be on a machine then it was her decision to make. Within the hour they removed the ventilator and pumped him full of morphine. Basically I got out voted.
     
  9. Mar 16, 2016 #8

    berkeman

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    Very sorry to hear that. What a difficult situation.
     
  10. Mar 16, 2016 #9
    I am 99% sure that if he could have spoke up he would have and made a different decision for himself. So do not ever make a casual comment like ( I don't wanna live tied to a machine, that's so "cliché" anyway and some people will take you at your word) and besides you never know what might happen. The only reason he was on the machine was because of sever septic shock, kidney and liver failure. He was still conscious and lived 30 minutes after the machine was cut off. By that time the tube had damaged his throat to the point he couldn't speak.
     
    Last edited: Mar 16, 2016
  11. Mar 16, 2016 #10

    berkeman

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    Are those the guidelines that Canada is using now?
     
  12. Mar 16, 2016 #11

    PeterDonis

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    This one would be hard to meet; most people have at least some assets that will go to someone when they die.

    In Oregon's Death with Dignity Act, a written request to be euthanized must be witnessed by at least one person who is not a relative, a beneficiary of the requester's estate, an owner or operator of a health care facility serving the requester, or the requester's attending physician. This is at least an attempt to ensure that the requester is not being coerced for the personal gain of someone else.
     
  13. Mar 16, 2016 #12

    PeterDonis

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  14. Mar 16, 2016 #13
    I see that this thread is about two different things: euthanasia: where someone else makes the decision for someone who's bod or mind has failed to the point where they can't really function on their own, and doctor assisted suicide, in which a person chooses to end their life to avoid future pain and suffering. I have different thoughts on each.

    For ending someone else's life, who has not signed a living will, but can't communicate themselves, I would think that the doctor and the family should be in agreement. The doctor should access any possibility of recovery and only suggest euthanasia in the case where there is no hope for recovery, but only with the will of the family. Some people have religious objections to euthanasia and I think that should be respected, that's why the family should have final say. Then again, the doctor must sign off that the damage is permanent and irreversible now or in the foreseeable future, to prevent a rich kid form pulling the plug on his parents prematurely.

    As for suicide, I think everyone has the right to self determination. I see no moral issue with killing oneself at all, I believe it's a remnant of western religions that has no basis on reality. Some people's lives are just miserable and they should be able to decide whether or not it's worth living. When you bring people who are took sick to be able to self-determinate into the mix, I think doctors should be able to take the life of a patient if asked. I'm fairly certain that if I was in enough pain to ask a doctor to kill me, if they refused, I'd probably find a way to do it anyway. I'd hate to be an oncologist knowing that all you can do for certain people is just watch them die in agony.
     
  15. Mar 16, 2016 #14

    berkeman

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  16. Mar 16, 2016 #15
    I don't know, haven't read about Scandinavia.

    In the Netherlands and Belgium even euthanasia of children is allowed.

    At least in one case, euthanasia for a person with depression was legally approved in Belgium. That is unacceptable in my opinion.
     
  17. Mar 16, 2016 #16
    I never considered the difference. In Dutch (Belgium) we only use 'euthanasie'. It's legal, but can only be requested by the person in question. So that would correspond with what you call doctor assisted suicide.

    I think Belgium and the Netherlands were one of the first countries to legalise euthanasia, or doctor assisted suicide depending on the terminology and it seems to be widely accepted by the population. I have seen very little opposition. Recently the Christian Democratic party proposed to investigate the criteria for euthanasia after a seemingly questionable case where someone non-terminally ill requested and received euthanasia, but didn't find much support.

    More people did have questions when a couple of years ago the government (which included the Christian Democrats) proposed to remove all age restrictions. The opposition mainly came from the Catholic church, for what they are still worth, but also from a couple of child psychiatrists. In the end the law was passed without much further fuss. In Belgium itself at least. Some reader's comments on American online news sources compared Belgium to Nazi Germany as if we were going to kill all ill children and babies without their consent. In any case the child has to be deemed able to understand the consequences, the parents cannot decide this on their own.

    Without wanting to generalise, it looks like most opposition in the US comes from the religious side, which in North-Western Europe has very little influence in politics or ethical discussions. (I wouldn't even know which members of the Christian Democrats are actually religious, I think to mention that during elections would almost be political suicide.)

    The current requirements are that you have to suffer from unbearable pain (physically or mentally) that cannot be properly relieved and there is no medical chance of improvement or suffer from a terminal illness.

    You can also sign a document where you appoint someone else to decide the moment of euthanasia in case where you are not able to make the decision, i.e. when you are in a coma.
    The main problem with this declaration is, in my opinion, that it is not valid for cases such as progressed Alzheimer's, where the patient is still conscious, but unable to make a informed decision. In this case, as is the case of my grandmother, euthanasia is impossible. If you have been diagnosed with dementia, you can only request and receive euthanasia if you are still mentally competent, which means you have to do it well in advance at a moment when you are still able to live normally, which is a very difficult decision to make for most people I think.

    In all cases, two doctors have to review your situation and give their approval after you have made a written request (every doctor can refuse to perform euthanasia on moral grounds and hospitals can prohibit all their doctors to perform euthanasia, although that last one was up for discussion a while ago IIRC).
    When the patient is not going to die in the near future, a psychiatrist also has to be consulted.

    All in all, I'm quite pleased with the liberal ethical laws in Belgium, one of the few things I'm proud of my country. I would still like to see dementia included as a possibility to appoint a guardian. Luckily for myself dementia seems to run mostly in the female part of the family, but I still wouldn't want to see my mother deteriorate, bit by bit, until there is little left of the person you once knew, as is the case now for my grandmother.
     
  18. Mar 16, 2016 #17

    jim hardy

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    reason enough to learn Morse Code.
     
  19. Mar 16, 2016 #18
    Long post ahead, sorry.

    I don't know if I agree or disagree. There are still a whole lot of things I must first understand. I must study a lot in a lot of fields before coming to a conclusion. However, regarding my country, this is what I think that should happen before a law regarding the subject at hand be passed:

    Before passing the law, have a group of university professors. Half of them strongly agree and half of them strongly disagree (such that possibilities of them being bribed are greatly reduced). Separately they are biased, but together the bias is 50/50. The professors will give an exam to all the congress person that will vote for the bill. Any congress person that doesn't fully understand the bill will not be allowed to vote.

    Why fully? Because you cannot have them only partially understanding it and be ignorant of the consequences specific parts may carry if they are going to vote either in favor or against.

    In the end the ratio of voting persons must not change to that of the ordinary voting ratio when no exam was taken.

    And the exams and results of the evaluation must be published to the general public on their entirety. That is the whole exam and answers from each congress person as well as the evaluation each professor made on each exam. Along with a defined standard of what in the exam is considered as 'the person understands' and 'the person does not understand'.

    Some congress persons may refuse to do this because if it results they don't fully understand it they can argue their public image will be stained, but I don't care. They are tasked with the job of deciding important rules of a country that affect present and future people, if they don't have understanding of what they are doing they shouldn't be there in the first place. You don't decide laws on gut feelings or beliefs, you decide laws because you have a deep understanding of them. A lot of people will be affected by your decisions.

    Of course this is just a resume of everything. Other conditions may apply (like the chosen professors must also pass a scrutiny test). This method is not foolproof as I can point out some cons on it, but it is by far better than what they have now at my place in the sense that right now congress persons vote and you don't know if they understand what they are voting for or not. I can point out some cons and I'm sure other people who better understand law passing can identify more cons. But it can be discussed with the people of the country, experts at each area and improved.

    Where the money to make all that comes from? My taxes. I pay a lot of taxes, it's about time they do something good with it.
     
  20. Mar 16, 2016 #19

    russ_watters

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    Also very different from assisted suicide, in which the person is conscious when s/he makes the decision!
     
  21. Mar 16, 2016 #20

    Tsu

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    In Oregon, a DNR doesn't have to be signed by the doctor. It just needs to be on file at your Dr's office OR your local hospital.
     
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