Should physician-assisted death be legalized in all countries?

[Choppy]

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?

 

[Sophia]

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.

 

[Greg Bernhardt]

I fully agree that a mentally healthy adult has a moral right to decide if he wants to live in such situations.

I agree

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.

How do the countries (I think some Scandinavian?) structure it?

 

[gjonesy]

I fully agree that a mentally healthy adult has a moral right to decide if he wants to live in such situations.

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.

 

[berkeman]

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

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).

 

[wolram]

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%

 

[gjonesy]

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).

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 want to 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.

 

[berkeman]

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 want to 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.

Very sorry to hear that. What a difficult situation.

 

[gjonesy]

Very sorry to hear that. What a difficult situation.

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 want to 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.

 

[berkeman]

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%

Are those the guidelines that Canada is using now?

 

[PeterDonis]

2 there must be no one that gains from the patients death

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.

 

[PeterDonis]

The Oregon statute is here:

https://public.health.oregon.gov/Pr...onResearch/DeathwithDignityAct/Pages/ors.aspx

 

[newjerseyrunner]

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.

 

[berkeman]

The Oregon statute is here:

https://public.health.oregon.gov/Pr...onResearch/DeathwithDignityAct/Pages/ors.aspx

I think I need the Cliff's Notes version...

 

[Sophia]

I agree
How do the countries (I think some Scandinavian?) structure it?

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.

 

[ZVdP]

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 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.

 

[jim hardy]

I am 99% sure that if he could have spoke up he would have and made a different decision for himself.

reason enough to learn Morse Code.

 

[Psinter]

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.

 

[russ_watters]

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).

Also very different from assisted suicide, in which the person is conscious when s/he makes the decision!

 

[Tsu]

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).

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.

 

[berkeman]

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.

Yikes, I did not know that. Why would the doctor's office keep it on file if the doctor hadn't signed/approved it?

 

[OmCheeto]

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.

Technically, according to a video I just watched, "euthanasia" is still illegal in all 50 states. In Oregon, the patient is prescribed a lethal dose of medication, and they are required to take the medicine themselves.

 

[OmCheeto]

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.

Are there other DNR forms other than the POLST form?

POLST (Physician Orders for Life-Sustaining Treatment)
...
A POLST Form requires a signature from an MD, DO, PA, or NP to be valid and should only be filled
out and signed after an in-depth conversation between the patient and health care provider about the
patient’s goals of care
...

 

[256bits]

Are those the guidelines that Canada is using now?

There has been no law yet passed in Canada to legalize euthanasia. It is still a criminal offence to provide assistance or to kill an individual.
Some exceptions have come about, as a result of the following legal bypass of being criminally responsible for the death of an individual.
What happened is that a court case for assistance for dying found its way up to the Supreme Court of Canada. The Supreme Court, in its infinite wisdom, struck down the prohibition on assisted death, by reason that it violated a section of the Charter of Rights and Freedoms. They gave the government of the day ( Harper ) 6 months to produce a new law conforming to said charter, or if having failed to do so, the ban on assisted death being a criminal act would become null and void.
A new law was not passed due to an election. After which the newly formed government ( Trudeau ) asked for an extension to draft a law to the summer of 2016.
Consultations with the provincial governments, health agencies, and interested parties is ongoing. Exceptions were granted to Quebec and doctors (and related ) who would play a role in assisting someone to die before the government of Canada drafted and passed the law making euthanasia a non-criminal act.

In the meantime, actually previously , a doctor assisted law was passed by the provincial government of Quebec in 2014, and became effective the end of 2015.
Presently, Quebec is the only province that has provisions to enable assisted euthanasia within Canada.

Canada will only change the section whereby euthanasia will not be a criminal act, as that is their constitutional jurisdiction.
( does it act on the old, young, feeble, healthy, sick, children, terminally ill, mentally ill, etc. )
The separate provinces will have to draft their own laws regarding euthanasia, as health is a provincial jurisdiction.

With the consultations, it would seem to be that a consensus is to form a basic framework across the land somewhat consistant.

 

[russ_watters]

Technically, according to a video I just watched, "euthanasia" is still illegal in all 50 states. In Oregon, the patient is prescribed a lethal dose of medication, and they are required to take the medicine themselves.

Again, I'm reasonably certain that euthanasia and assisted suicide are totally different things*. The OP was about assisted suicide, but someone else brought up euthanasia...which then led to DNR.

Beyond that, I think euthanasia is the wrong word in many of the cases people are using it: euthanasia refers to killing a person on purpose (giving them drugs that kill them) whereas a DNR is about letting them die by withholding treatment.

*[edit] According to the wiki, most states do not make a distinction between euthanasia and assisted suicide, but then that would be because assisted suicide is illegal, so there is no legal difference. Assisted suicide is legal in Oregon, which therefore establishes the legal difference. Morally, I think the difference should be obvious: it is about who makes the choice.
https://en.wikipedia.org/wiki/Euthanasia#Legal_status

 

[256bits]

Draft laws were presented to the Senate and House of Commons, but died due to the change in government.
http://www.parl.gc.ca/HousePublicat...Language=E&Mode=1&DocId=6811259&File=27&Col=1
http://eol.law.dal.ca/wp-content/uploads/2014/03/Bill-C-581.pdf

The new federal law will probably have similar criteria for Physician Assisted Euthanasia to become NOT a criminal offence.

They may or may not decide to follow a slippery slope ( as someone mentioned in a previous post ), and allow the extension of the health care service of assisted euthanasia beyond to just the consenting terminally ill, to children and/or the mentally ill, either in the first draft of legislation, or develop methods to allow such in increments over several years.

Canada will only change the section whereby euthanasia will not be a criminal act, as that is their constitutional jurisdiction.
( does it act on the old, young, feeble, healthy, sick, children, terminally ill, mentally ill, etc. )
The separate provinces will have to draft their own laws regarding euthanasia, as health is a provincial jurisdiction.

In reality, the federal and provincial separation of jurisdiction in law regarding health is not as clear as mentioned above and is somewhat vague and overlapping; in practice the above is just a simplified general statement on how health care is provided in Canada.

 

[256bits]

Again, I'm reasonably certain that euthanasia and assisted suicide are totally different things*. The OP was about assisted suicide, but someone else brought up euthanasia...which then led to DNR.

Beyond that, I think euthanasia is the wrong word in many of the cases people are using it: euthanasia refers to killing a person on purpose (giving them drugs that kill them) whereas a DNR is about letting them die by withholding treatment.

*[edit] According to the wiki, most states do not make a distinction between euthanasia and assisted suicide, but then that would be because assisted suicide is illegal, so there is no legal difference. Assisted suicide is legal in Oregon, which therefore establishes the legal difference. Morally, I think the difference should be obvious: it is about who makes the choice.
https://en.wikipedia.org/wiki/Euthanasia#Legal_status

Yes, the terminology is confusing.

Euthenasia would be the act of ending someone's life to relieve their suffering.
Voluntary euthanasia would be the act of ending someone's life to relieve their suffering with their consent.
Assisted suicide would be the act of providing assistance to end someone's life.

As far as I know, in Canada, the term Medical Assistance in Dying refers to voluntary euthanasia with the assistance of a health care teams.
Assisted suicide will likely remain illegal, ( but not physician assisted suicide ) so that not just anyone can go about claiming that they helped end another person's life at their request as a legal defence.

 

[wolram]

Are those the guidelines that Canada is using now?

I am in England berkeman, those are my guidlines.

 

[OrangeDog]

Ive seen people so sick that healthcare does nothing but prolong suffering. Thus, I support assisted suicide. I think end of life care is a waste of money, but maybe I won't think that when I am old. From what I have seen though, dying in a hospital sucks. Id rather just go home, chill with my friends and family, and drop dead on the couch.

 

[gjonesy]

A DNR is usually employed in situations where a person has a terminal illness and simply doesn't want anyone to attempt to save them if they go critical and the heart stops beating. I completely understand and agree with that. If a person is being kept alive by machines and conscious and can indicate YES I want this life saving equipment taken off of me. Then YES I agree they have that right. BUT at that point its more of an assisted suicide. In some cases like my brother he couldn't make a choice and they fell back on a comment he made in conversations (I never heard him say any such thing) before he ever got sick. They consulted the family and asked us and each person got to say what they wanted but in the end a hospital administrator produced a document my brother had signed that allowed them to treat him and in that document it said in the event you are unable to make critical decisions about your care who do you want making those decisions He wrote down his "common law" wife's name. He basically told us she had control and final say. So our wishes wouldn't have mattered anyway. I was under the assumption that the hospital had to try everything they could to save his life, but as it turns out no they don't. They told us we can take the leg and give him dialysis and try to get the infection under control with no guarantee he'll survive, or we can take him off the ventilator and make him comfortable. Myself and his daughter said take the leg, everyone else said its up to his wife.

 

[PeterDonis]

"euthanasia" is still illegal in all 50 states.

Yes, you're right, "euthanasia" was not the correct term for me to use.

 

[berkeman]

I am in England berkeman,

I know that -- I can tell it from your accent...

I was just wondering if the Canadian rules were similar to your thoughts.

 

[Sophia]

A DNR is usually employed in situations where a person has a terminal illness and simply doesn't want anyone to attempt to save them if they go critical and the heart stops beating. I completely understand and agree with that. If a person is being kept alive by machines and conscious and can indicate YES I want this life saving equipment taken off of me. Then YES I agree they have that right. BUT at that point its more of an assisted suicide. In some cases like my brother he couldn't make a choice and they fell back on a comment he made in conversations (I never heard him say any such thing) before he ever got sick. They consulted the family and asked us and each person got to say what they wanted but in the end a hospital administrator produced a document my brother had signed that allowed them to treat him and in that document it said in the event you are unable to make critical decisions about your care who do you want making those decisions He wrote down his "common law" wife's name. He basically told us she had control and final say. So our wishes wouldn't have mattered anyway. I was under the assumption that the hospital had to try everything they could to save his life, but as it turns out no they don't. They told us we can take the leg and give him dialysis and try to get the infection under control with no guarantee he'll survive, or we can take him off the ventilator and make him comfortable. Myself and his daughter said take the leg, everyone else said its up to his wife.

Was what they did even legal? How could they even allow discussion about turning the ventilator off if there is still a chance of saving him?
In such cases, doctors are surely responsible for doing everything they can and ask about euthanasia only if there is absolutely no chance of helping.


I know this will not bring your brother back but did you consult with a lawyer?

 

[OmCheeto]

...Morally, I think the difference should be obvious: it is about who makes the choice.
...

And, according to that "60 Minutes" episode, the people who made the choice, still had a choice.

"Since 1997, more than 1,500 prescriptions have been written in Oregon -- over a third who requested it, never took the medication".
​

Like most things in life, and death, there are 7 billion ways to go.

Personally, I'm pro-choice.

As I've pointed out before, my father, who lived in Arizona, who didn't have a choice, chose to put a bullet through his head, to end his suffering.

That was about 10 years ago.

To this day, I wonder, if the last thing I want to hear in life, is a gunshot, or, just peacefully going to the long sleep.

Tough question.

 

[Tsu]

Are there other DNR forms other than the POLST form?

I filled out an Advance Directive and did not need a physician's signature.
http://www.oregon.gov/DCBS/insurance/shiba/Documents/advance_directive_form.pdf