Quebec doctors open door to euthanasia

[future_doc]

http://www.cbc.ca/news/canada/montreal/story/2013/01/15/montreal-dying-with-dignity.html

 

Quebec to proceed with 'dying with dignity' legislation

A legal panel recommends province allow doctors to help some die

CBC News Last Updated: Jan 15, 2013 8:28 PM ET

 

The Quebec government says it will proceed with so-called "dying with dignity" legislation aimed at allowing doctors to help some terminally ill patients end their lives.

[Mourning Cloak]

Aye, there's the rub:

 

"Ménard said the decision on whether to comply with a patient's request would be left to doctors to judge, on a case by case basis."

 

I wonder who this is going to fall to. It sounds like marijuana and methadone - most MDs avoid these morally / legally complicated situations like the plague. Are there going to be "death docs" who spring up to become specialists in choosing who qualifies for physicians assisted suicide? (You might think of the palliative care docs, but the palliative med guys and gals around here would - I think - be absolutely opposed to this.)

 

Thoughts?

[future_doc]

Quebec seems to be ahead of the curve on this one. Seems like they will let each doc decide and leave it at that with no repercussions.

[rmorelan]

Aye, there's the rub:

 

"Ménard said the decision on whether to comply with a patient's request would be left to doctors to judge, on a case by case basis."

 

I wonder who this is going to fall to. It sounds like marijuana and methadone - most MDs avoid these morally / legally complicated situations like the plague. Are there going to be "death docs" who spring up to become specialists in choosing who qualifies for physicians assisted suicide? (You might think of the palliative care docs, but the palliative med guys and gals around here would - I think - be absolutely opposed to this.)

 

Thoughts?

 

I know our geriatric medicine group here is worried about the consequences of this - they have been worried that the work they have done to increase the resources to geriatric care and research to make things better will be shifted if things appear. That has happened in other countries when the laws changed. Subtle and not so subtle pressures to end things rather than push through to recovery I guess, and why fund something to prolong things etc.

 

Gah what a messy question.

[aaronjw]

People living in a crap quality of life should be able to have solutions to end their lives when they lose physical/mental capacity to do so.

 

My father in law is a perfect example of this. If you told him 10 years ago how his health would deteriorate he'd of killed himself then when he had the chance. Now he has no mental or physical capacity to do that.

[future_doc]

Move to Quebec where docs are progressive.

 

You don't have a father-in-law, just a father of your s.o.

[aaronjw]

Move to Quebec where docs are progressive.

 

You don't have a father-in-law, just a father of your s.o.

 

How do you figure?

[future_doc]

If I recollect correctly, you have said you are not married and live with your significant other. In my books, this means no father-in-law - unless you married, never divorced and technically have one.

 

Will you move to Quebec in old age?

[aaronjw]

If I recollect correctly, you have said you are not married and live with your significant other. In my books, this means no father-in-law - unless you married, never divorced and technically have one.

 

Will you move to Quebec in old age?

 

That's what I have said in the past yes. Does not mean it is true today

 

And no. I won't be moving to Quebec in my old age. Lol

[future_doc]

That's what I have said in the past yes. Does not mean it is true today

 

And no. I won't be moving to Quebec in my old age. Lol

 

Ah, games.

 

Hope you are never terminally ill. We are the only sanctuary in Canada.

[futureGP]

i don't particularly agree with euthanasia

 

but i think having an option is good for the patients and not surprisingly it's Quebec who proceeds with this

 

It'd be nice to have a province in Canada where euthanasia is legislated so people don't have to go abroad to get what they want

[future_doc]

I doubt that euthanasia tourism within Canada will happen. Doctors will deal with their own patients.

[Satsuma]

I find it hard to believe that there was never a discussion with the family regarding end of life issues. It is one of the first things that gets done on admission to ICU, and often it is even done in the ER.

 

Note that this discussion does not have to take place with the entire family. Just to substitute decision maker and it is up the them to communicate with the rest of the family. If say the spouse did not discuss with a child and that child called, well, maybe the child was not in the loop.

 

Sometimes you may come up with a plan to say, give the pt a 1 week go and if things don't get better then plan for a 1-way extubation. But maybe all family members were not in the loop.

 

Alot of what is done in the ICU is for the benefit of the family not the patient. And in fact, in my opinion, often the cost of benefit to the family is resulting harm to the patient.

 

In any case, it is difficult to comment on the example given and there are alot of details missing.

 

As for the situation re: Katrina. This was completely different. People were murdered, yes murdered, there is no other way to put it. People that expressed their desire to live were given lethal doses of narcotics. Family members that came to pick up patients were not allowed to take them if they had a DNR status. DNR status was not allowed to be reversed when asked to do so. People did not understand what DNR meant!! Sure you may not wish to have CPR when your heart stops, doesn't mean you want to be left with no food or water, or given lethal doses of medications, or not be allowed to go home with family who will care for you, or not allowed to have a say in your care.

 

And I assume you are mostly referring to Dr Anna Pou at Memorial/Life care. She is an ENT and was trying to manage a disaster situation. This is not part of an ENTs training and there should have been someone better able to manage a disaster managing the whole thing. She was put in a difficult situation and made some bad decisions, but they were not at heart malicious. There are so many issues with that case - the hospital had a disaster plan that nobody knew about, different management for memorial vs life care, a helipad that was built in a ridiculous and largely inaccessible place etc. Anyway, there is no doubt in my mind that patients were murdered. But I also think Dr Pou had good intentions. I think she was in over her head. And I don't think those cases parallel a non-disaster situation in a typical ICU/hospital setting.

 

I get your point about not providing care that is medically futile.

 

However, once commenced, is it ethically and legally proper to pull the plug? The theoretical harm in this case was the hastening of the death of a patient who would have died very soon in any event. Sensitivity of family is an entirely other matter, although issues could have been joined had, for example, the family registered a formal complaint with the hospital, doctor, College and/or police.

 

Would the physician and nurse who implemented his orders have a valid defence if charges were brought or they were brought before their respective licencing authorities? I recall the extreme case of Katrina where patients could not be removed to higher ground as water was rising, decisions were taken for the compassionate deaths of the patients and criminal charges were laid. Physicians should not be placed in such positions by society or b y virtue of their own decisions.

[future_doc]

I find it hard to believe that there was never a discussion with the family regarding end of life issues.

 

Truth is stranger than fiction. There were two adult children, one lived in Montreal. One lived abroad and flew in. The doctor did not consult the children, he simply ordered the plug be pulled without consulting either family member. Then again, this was in Quebec.

[rmorelan]

Truth is stranger than fiction. There were two adult children, one lived in Montreal. One lived abroad and flew in. The doctor did not consult the children, he simply ordered the plug be pulled without consulting either family member. Then again, this was in Quebec.

 

ahhhh what? Was there end of life care plan in that case? Why wouldn't he talk to the family - often they would want to be there etc(?)

[future_doc]

ahhhh what? Was there end of life care plan in that case? Why wouldn't he talk to the family - often they would want to be there etc(?)

 

No end of life care plan. He could have obtained the agreement of the family had he only asked. This was at a McGill teaching hospital. Exactly - the family simply would have wanted to be there. I have no idea why the doctor did not consult the family and he was wrong. He may have been under pressure as undoubtedly, patients needed that bed. Whether this was a one off oversight or his routine, I do not know. The family never discussed this with the doctor after the fact, there was no point, they were not trying to create trouble for the doctor, they were just deeply disappointed that they got no advance call and were not consulted.

[future_doc]

http://www.cbc.ca/news/canada/montreal/story/2013/06/12/montreal-quebec-palliative-sedation-assisted-suicide-dying-with-dignity-legislation.html

 

Quebec tables bill on medically assisted death

'Society is ready for it,' says house leader of the end-of-life debate

CBC News Last Updated: Jun 12, 2013 11:05 AM ET

 

The Quebec government this morning tabled its controversial bill on medically assisted death.

 

Junior Health Minister Véronique Hivon's introduction of bill 52 around 10 a.m. ET Wednesday received a standing ovation from fellow members of the national assembly.

 

Hivon said she was honoured to introduce the bill, saying “this legislation is intended for people at the end of their life to die with autonomy and dignity.”

 

The bill is meant to address assisted suicide, palliative (terminal) sedation and some forms of euthanasia.

 

Stéphane Bédard, Quebec government house leader, underlined the importance of a non-partisan approach to the topic of end of life.

 

"Our desire is quite simple. We want to make the debate something all of society can engage in. A non-partisan issue," he said.

 

"I believe we are capable of holding this debate at this time. Society is ready for it."

[future_doc]

News Conference by one doctor, Dr. Saba, representing a coalition of physicians, presently on CBC TV, calling it homicide, opposing assisted death bill - which is expected to become law by the fall.

 

He says government is in financial crisis and asking hospitals to shorten stay of patients and asks would you trust such a government?

[future_doc]

http://www.cbc.ca/news/yourcommunity/2013/06/should-medically-assisted-suicide-be-legal-in-canada.html

 

Should medically assisted suicide be legal in Canada?

Last Updated: June 12, 2013 1:33 PM

Categories:Community

 

The Quebec government introduced a bill Wednesday permitting medically assisted death, saying it would address "excessive suffering" of dying patients. It would, if passed, be the first of its kind in Canada.

 

Should Canada have legal physician-assisted suicide? (CBC)

The province's junior health minister, Véronique Hivon, tabled Bill 52 addressing medically assisted and other end-of-life issues in the national assembly.

 

"I believe we are capable of holding this debate at this time. Society is ready for it," said Stéphane Bédard, Quebec government house leader.

 

Since 2009, the Quebec legislature has been studying the issue of medically assisted death, which is currently prohibited by the Criminal Code of Canada.

 

The bill is meant to address assisted suicide, palliative sedation and some forms of euthanasia with explicit consent of the patient. It would be a Canadian first, but four states have "dying with dignity" legislation: Oregon, Washington, Montana and, most recently, Vermont.

 

The federal government has made it clear it has no intention of changing the law, announcing last summer it would appeal a June ruling by British Columbia's Supreme Court that partially struck down a ban on assisted suicide. The Quebec government has said that medically assisted suicide is a health-care issue and, therefore, a provincial matter.

 

As well, a report released in January by a panel of legal experts led by Jean-Pierre Ménard argued that people's decision-making autonomy should prevail over the interests of the state.

 

But the issue is emotionally charged and many people - including some doctors - say that causing another person's premature death is and should be a crime.

 

"As human beings, we know that if you commit an act to make a person to stop breathing, for the pulse to stop, you've killed at person. To feel easy about taking a life is a scary situation for anyone to be in," said Dr. David Bacon on CBC Montreal radio morning show Daybreak.

 

But proponents of the law say some end-of-life procedures are already being performed and the law gives health-care providers protection of a legal framework.

 

Dr. Marcel Boisvert, a retired palliative-care physician also speaking on Daybreak, said the law would also contain safeguards for patients, as outlined in the Ménard report.

 

"When the team agrees at the patient's request that it's time for terminal sedation because nothing else works, you have all the conditions to proceed if it is the patient's wish with physician-assisted dying," said Boisvert.

[dazzle]

quote:

 

"But the issue is emotionally charged and many people - including some doctors - say that causing another person's premature death is and should be a crime.

 

"As human beings, we know that if you commit an act to make a person to stop breathing, for the pulse to stop, you've killed at person. To feel easy about taking a life is a scary situation for anyone to be in," said Dr. David Bacon on CBC Montreal radio morning show Daybreak. "

 

 

There is no absolute right and wrong. These are things we cling to traditionally. Killing is not always wrong. One of these times is when a patient's life is horrible and asks to be put to death. Physicians who oppose these kinds of things annoy me. They should first take philosophy classes and do their intellectual duties before participating in public debate.

[future_doc]

Bacon is just trying to raise the heat by using this word, but he is spitting in the wind.

[Steward Leader]

The definition of killing is " an act of causing death, especially deliberately."  Dr. Bacon was right in his definition.  He is not "spitting in the wind", but rather advocating for life.