Saturday, November 07, 2009

Life, Suffering and Death

I recently attended a lecture given by Dr Jose Periera. The lecture was called Euthanasia and Assisted Suicide: A Pandora’s Box?
Dr Pereira is a prominent professor of palliative care. He actually worked at a hospital in Switzerland which allowed doctor assisted suicide.
definitions: Euthanasia is a doctor( or others) actually doing something to cause the death of another ostensibly at their request.
assisted suicide is giving someone the means to take their own life.

I am opposed to euthanasia and assisted suicide. I think in most cases if suffering is relieved most people want to live. I agree with Dr Pereira and Barbara Kay who responds toHM Minister Stephen Fletcher.
Dr Pereira is also strongly opposed to euthanasia and assisted suicide. He spoke at the hearings on Parliament Hill on bill C-384. the lectured encompassed most of those comments. You can read these comments below. He believes there really is a slippery slope. In some studies as many as 14% of people who are euthanized have been clinically depressed. It is now being done without express consent in Europe. It weakens the therapeutic alliance between patient and doctor. Safeguards are not usually adequate.
Palliative care doctors deal with relieving suffering and death for a living. Palliative care is a wonderful way to embrace life and relieve suffering. Most palliative care health professionals are opposed to assisted suicide and euthanasia. Let's relieve suffering and these laws become unnecessary.

Dr. José Pereira

I have seen many people die and worked together with colleagues from different disciplines, nurses, social workers, chaplains, therapists, to alleviate the suffering of these persons as best as possible.

For the last 14 years I have worked as a palliative care physician, medical teacher and researcher. I have had the privilege of caring for thousands of people with incurable illnesses as a member of palliative care teams. I have seen thousands of patients dying with dignity, after receiving good palliative care. I have witnessed first-hand many dignified deaths. I have also witnessed some difficult deaths.

Caring for these patients has taught me two important things; good palliative care can make a big difference and research into a better understanding of these persons’ needs and improving their care is worthwhile.

I have another unique experience; for almost three years I worked as a palliative care physician in Switzerland, a jurisdiction that allows assisted suicide. These experiences bring me here today because I feel now - more than ever, that the best way to help dying patients is to improve their care, not to terminate it.

There are several serious flaws in Bill C-384.

The bill is not limited to patients with a terminal illness. It allows any person with physical or mental pain to receive euthanasia or physician-assisted suicide. This means that even a young adult with depression or an elderly person who is tired of living or feeling alone may be euthanized.

It allows people to refuse appropriate treatments that would alleviate their suffering, opting to be euthanized instead. This is particularly alarming when we know that depression is treatable.

The bill does not define what is meant by terminal illness. I have seen many people who, when diagnosed with cancer for the first time, feel as though their world has fallen apart around them and that all hope is lost. During this time of intense fear and anxiety they may ask to be euthanized, even though current treatments could either cure their cancer or control it for many years.

Moreover, we as health professionals are very inaccurate in predicting how long someone has to live. One of the first persons, for example, that we admitted to a new palliative care unit that we opened in Calgary a few years ago was a man with advanced prostate cancer. He was admitted for us to control his pain. He thought that he was dying. We were able to control his pain and he went on to live for several more years. He would occasionally come to visit us on the unit and celebrate the added time he had with this family and loved ones.

The bill states that persons who “appear to be lucid” have the capacity to request euthanasia. It is open to abuse and misinterpretation. It would not even meet current standards for persons to sign consent to have an operation, receive treatment or participate in research.

Legalizing euthanasia and assisted suicide places the most vulnerable at risk, particularly the elderly and disabled. In the Canton of Vaud in Switzerland, the pro-assisted suicide movement is initiating a referendum that, if accepted, would force long-term care facilities and nursing homes to allow assisted suicide within their walls or lose their accreditation status. Elderly persons living in these facilities, especially the lonely or those who feel they are a burden to their families and to society, will, over time, feel obliged to request assisted suicide.

Consider the implications of this, particularly in the context of significant needs that our aged will continue to experience in the future, recently highlighted by the Senate special committee co-chaired by the honourable Senator Sharon Carstairs on the Care of the Elderly in Canada.

Therefore, there are many loopholes in this bill, loopholes which put many other people at risk. But my concern, based on what I have witnessed and have studied, is that it is impossible to develop foolproof safeguards to prevent abuse of laws legalizing euthanasia or assisted suicide.

Foolproof safeguards in these laws are almost impossible.

Let me give you some examples.

One of the main criteria established by the University Hospital of Lausanne when they allowed, under exceptional circumstances, assisted suicide within the hospital, was the presence of a terminal illness. Yet one of the first patients referred to the process was a patient with depression.

In the Netherlands, within only a few years of legalizing euthanasia and assisted suicide on the basis that it would be limited to terminally ill persons from the age of 12 years and upwards, the Groningen protocol was established that allows severely handicapped young children to be euthanized.

In Belgium, within three years of legalizing euthanasia, again on the basis of being limited only to terminal illness, it was broadened to include persons with dementia.

In the Netherlands, 500 to 700 people are euthanized annually, without the appropriate consent that is required by law.

In Oregon, people seeking assisted suicide have to be assessed by a physician as a safeguard to ensure that only those with intolerable suffering access assisted suicide. However, the assisted suicide lobby group facilitated 53 out of 60 assisted suicide deaths by referring the person to a physician who supported assisted suicide.

Legalizing euthanasia and assisted suicide therefore places some people at risk.

The Social Slippery Slope

Although data from Oregon and the Netherlands would indicate that there is no significant increase in the number of persons being euthanized or receiving assisted suicide; over time when these practices are allowed, I have observed a slippery slope in other forms - a slippery slope that Dr. Noella Kenny, a Canadian ethicist, calls a social slippery slope.

In Geneva, within a few months of the University Hospital allowing assisted suicide within its walls for exceptional cases, the community-based palliative care service was disbanded. The number of palliative care physicians was also reduced. The broadening of criteria to include non-terminally ill persons, including, those with depression and dementia, is another case in point as is the hundreds of persons in the Netherlands being euthanized without clear consent.

In Switzerland, only a handful of cantons have integrated palliative care formally within their health care systems - yet assisted suicide is available in all of them. Most of their private health insurances do not even cover palliative care.

None of the five medical schools in Switzerland offers adequate palliative care education and the hours available falls very short of the recommended European standards.

We therefore need to ensure that all Canadians have access to good palliative care.

Nine years ago, a senate subcommittee chaired by the honourable Sharon Carstairs, made several recommendations to ensure that every Canadian had access to quality end-of-life care.

While we have made significant strides, and have shown international leadership in several areas, many gaps still remain. Resources are sometimes not available to adequate trained nurses, social workers, chaplains, psychologists and therapists.

In some parts of our country, dying patients have no choice but to be cared for in acute care hospitals, at very high costs, instead of dying at home or on palliative care units and hospices because of a shortage of these facilities. Several important medications to alleviate the burden of symptoms are still not covered. We lack a national strategy with sufficient funding.

Such a strategy could be tasked to inform Canadians about palliative care and their rights, including the right to withdraw futile treatment that is unnecessarily prolonging their lives. It could be used to address the many misperceptions that exist about palliative care, including the misperception that morphine shortens peoples life which has been proven to be untrue.

We have seen how projects such as the Pallium Project, has developed Canadian homegrown educational programs for doctors, nurses and pharmacists to learn together.

Addressing intolerable suffering

We cannot ignore our fellow citizens with terminal illnesses who experience intolerable suffering. How then can we better relieve their suffering?

Canada has an international reputation for leadership in palliative care. Now is the time for us to step-up again and respond to calls for legalizing euthanasia and assisted suicide, not by legalizing these acts, but by investing in the research that will improve our care. I am positive that we can do this.

I firmly believe that we have not reached the limits of what palliative care can offer. We need to respond by increasing our efforts to find better and more effective treatment through research and training and adequate resources.

Where I worked in Switzerland, a middle-aged man with advanced lung cancer was admitted to our hospital experiencing severe pain. He was a member of the pro-assisted suicide society and asked that we give him access to assisted suicide as it was his right. We convinced him to allow us to try and control his pain. Within a day it was controlled. He rescinded his request for assisted suicide and went home a few days later.

We need to improve the care we provide, not terminate it.

In closing, this bill brings to our attention the burden of suffering in our country. We need to respond not by terminating care through euthanasia or assisted suicide, but rather by improving care.

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