5/26/15 Euthanasia and Assisted Suicide:! Speaking from the Evidence Disclosure: Margaret Cottle, MD I have no personal relationship Vancouver, BC, Canada with any commercial interest. “In the tender compassion of our God The dawn from on high shall break upon us, significance of photos… To shine on those who dwell in darkness and the shadow of death And to guide our feet into the way of peace.” Song of Zachariah Luke 1 Anne of Green Gables Disclaimer: “Smorgasbord” Disclaimer: “…and although I say far too much, Lots of text: yet if you only knew for reference later & language help how many things I want to say and don’t, you’d give me some credit for it.” Resources annotated and another list at end Anne to Marilla Note what is most compelling for you in Anne of Green Gables By L. M. Montgomery Think about your own stories & experiences 1 5/26/15 Thank you for inviting me my views are based on 26+ years of caring for I don’t mind dying...I just don’t want to be there when it happens. seriously ill patients and their loved ones Woody Allen Know their vulnerability and that complete autonomy is a myth— We’re all connected...and that’s a good thing! Acknowledge diverse opinions & backgrounds Everyone makes decisions based on a set of philosophical principles. Vast majority who favour these options do so on grounds of compassion Respectful, civil discourse is hard to find Complex issue--not simplistic While religious and philosophical ideas should —need nuanced, civil discourse be perfectly acceptable as part of public discussions in a democracy, Many good reasons to oppose these practices: this is seldom the case at present. Evidence from scientific studies Experience in other jurisdictions Need to attempt to “speak the language” Some faith-based considerations of our fellow-citizens and colleagues 2 5/26/15 E/PAS are NOT: Euthanasia and Assisted Suicide: Definitions: 1) Withholding or withdrawing medical treatment that is useless (futile) burdensome or extra-ordinary. Assisted Suicide: “prescribing the pills” 2) The proper use of large doses of pain killing drugs (providing the means for person to take his own life) to relieve suffering. Euthanasia: “pushing the syringe” 3) The proper use of sedation with a regimen of drugs (directly & intentionally ending the person’s life) to relieve the suffering of a person. 4) “Aid in Dying,” or “Assisted Death”--palliative care Significance of “intent” in our legal system can be aid in dying. “Aid in Dying” and “Assisted Death” are euphemisms created by the euthanasia lobby. Carter et al. Decision at Supreme Court of Canada (SCC) Carter et al. Decision at Supreme Court of Canada (SCC) No requirement for “terminal” dx Used right to life, liberty and security of person “irremediable condition” (includes disability) as rationale “Intolerable suffering” (specifically includes psychological suffering) NB: individual “competent” at time of PAS/E Not amenable to treatment acceptable Would exclude dementia patients—for now to that individual Gave Parliament one year to attempt legislation Who do you say “no” to & on what basis? (Also note: Parliament did act multiple times) Still illegal now 3 5/26/15 May be compelled to refer or even do it SCC said nothing in the ruling would compel physicians to participate, but left it to the Either referral is integral part of the process regulating bodies to “balance” the rights of & therefore referring makes one complicit patients and physicians. OR patients can self-refer & therefore do not need a referral Not encouraging with events in Ontario and Saskatchewan colleges (provincial licensing Canadians do not “refer” for capital punishment bodies for physicians) Also rejected capital punishment because of concern for even one “wrongful death” Justice Lynn Smith in original decision: Justice Lynn Smith in original decision: Admitted some collateral damage: Her analysis of witnesses & evidence Like any other “medical procedure” e.g. Hendin vs Battin Said there is no difference between killing SCC used her analysis and allowing to die Irish High Court concerned by other Felt Canada could do better than other jurisdictions and reached opposite conclusions jurisdictions 4 5/26/15 E/PAS: Some form legal in: Carter et al. Decision (SCC) AS: Oregon, Washington and Vermont in US; Big change in Canadian Law (“limbo” in Montana & New Mexico) E: The Netherlands; Belgium; Luxembourg; First time all lives are not protected First time the court says some lives are not Switzerland worth living, that death would be better than living that life, and that the government will Quebec: Euthanasia bill—awaiting law help those people to die either by providing means for them to kill themselves, or by Germany: policy of non-prosecution directly killing the person through state- In addition: multiple governmental hearings world-wide sanctioned programs plus ballot initiatives & legislative debates E/PAS in the news everywhere: E/PAS public discussions focus on: Massive media attention Autonomy —much of it very friendly to the “pro” ideas Individual “rights” Avoiding suffering “Don’t ask so you don’t have to tell!” Disability as “indignity” Seldom ask the hard or probing questions --especially about what is happening where these practices are legal. 5 5/26/15 Two important themes in civic arena: Public safety Public safety Preserving our social heritage of caring Vulnerable people at risk Protected by being risk averse Problems & expansion where already legal Public safety problems are more obvious Hubris of simplistic thinking But…need to understand ethos of society Societal Ethos Societal Ethos Need to reclaim terms.. This is not about “autonomy” or “independence” Language has been high-jacked: in a battle against “medical paternalism.” People (Thanks to Dr. Tom Koch for these insights) are free to autonomously refuse care. People are free to commit suicide, a choice we may lament Supporters of E/PAS say: but cannot always prevent. Rather it is about the “end of life decision making” desire of some for us to accept their judgment but mean “deciding to end life” that life is not worth living, embrace and facilitate their deaths through medical interventions It is not about “aid in dying” approved by the state and supported by it. but about termination (the term the Dutch use) 6 5/26/15 Societal Ethos Dr. John Wyatt It is not about “dignity,” but rather hubris. Disability lawyer-activists like Harriet McBryde- What the “compassion” of these practices Johnson and Diane Coleman repeatedly point is really saying: this out. Equating the need for help with indignity assumes only the purely independent “I care about you so much that I am willing to kill are worthy of continuance. you or to provide the means for you to kill yourself” So it is not “whose life is this?” but “what life will we support, as a people, and what deaths will we encourage through our programs?” No such thing as a death that only affects the See also Bill Peace’s blog post Dec 24, 2013: person who died. My recent experience in Boston testifying in opposition to H1998 helped me understand where proponents of such legislation have gone wrong: they have turned the debate surrounding the end of life Also, already limit autonomy in many ways: into a public policy question. At no point are the larger cultural No smoking implications of assisted suicide legislation considered. This reduces the Speed limits debate to be about individuals rather than about the social forces that drive one to conclude their life has no value and death is preferable Prohibit drinking and driving to life. To me, this is a socio-cultural tragedy not an individual failure Quarantines for Ebola and other diseases or issue of choice. More to the point, lives are at stake. This was on full display symbolically in Boston. Proponents of assisted suicide wore Prohibit use of pesticides on private property blue stickers that read “My life. My Choice. My death”. This slogan is Limit animals in the city wrong. Simply put, no human being dies in a social vacuum. Death is never about an individual alone. Goal: community protection http://badcripple.blogspot.ca/2013_12_22_archive.html (the entire post is excellent) 7 5/26/15 What kind of social world do we want to leave Why now? for our grandchildren? http://www.ottawacitizen.com/debating Are we being good stewards of our cultural +euthanasia/2134980/story.html heritage of respect for life? “Why we're debating euthanasia now?” Margaret Somerville “Not one of the bottom-line conditions usually linked with calls for “…I suggest it's profound changes in legalizing euthanasia -- that a person is our post-modern, secular, western, terminally ill, wants to die and we can democratic societies, and their kill them -- is new. These factors have interactive and cumulative effects. been part of the human condition for To make wise decisions about whether as long as humans have existed. And or not to legalize euthanasia, our capacity to relieve pain and we need to identify and understand suffering has improved remarkably. So, these changes.” is some other cause the main one?... 8 5/26/15 Public safety Being Risk Averse is Prudent!# Prudent to be risk averse Vulnerable people at risk --results not known for decades or centuries# 10-20 years is a short time!# Problems & expansion where already legal --cannot know all outcomes or ramifications# Hubris of simplistic thinking (e.g. introduction of the starling in Central Park# or the mongoose in Hawaii)# NB: Lots of information in this section since this information can be hard to find NB opposition to nuclear power, pipelines & fracking# through the media --potential harm is enough for opposition # February 2015 Possible difficulties for palliative care services: The Canadian Society of Palliative Care Physicians (CSPCP) promotes access to high quality palliative care for all Canadians.