Thursday, August 14, 2008

An International Review of Hastened Death

Wednesday, July 30, 2008

An International Review of Hastened Death

Monday, July 21, 2008(Hopefully not a recurring feature)*Please read disclaimer at the end of post*The New York Times #6 most emailed article today is about the underground practice of hastened death via the procurement of barbiturates in Tijuana, where the medications are intended for euthanizing animals, not humans. It is interesting this practice fits under neither commonly used terms for hastened death by medical means:"euthanasia" - the administration by a medical professional (or other person) of a prescribed medication with the intent of causing a hastened death"physician-assisted suicide" - the self-administration of a medication prescribed by a physician with the intent of causing a hastened deathThis article describes people obtaining the medication without a doctor's prescription, therefore 'physician-assisted' is a disqualified descriptive. They merely need to show a picture of the medication they want at the Mexican veterinary stores. So I guess this is simply 'suicide?' Although I think 'suicide' is too broad to define the particulars about a situation where someone is in the terminal phase of a condition versus someone suffering from a severe depression but no terminal illness. But to label this 'terminal suicide', 'hastened death in the terminal phase' or some other contortion feels clumsy and is bound to cause even more confusion.Regardless of the term used, the issue has been made more relevant with a couple high profile cases of medicine and hastened death.In Australia, Exit International and Philip Nitschke have been making the papers and TV (and are featured in the NYT article) with a public campaign to legalize euthanasia including You Tube Videos, film screenings, book promotions (attempts at banning it are underway in Australia and New Zealand), workshops and political initiatives. More focus has been on Mr. Nitschke and his group since the recent manslaughter conviction of a woman who gave a barbiturate to her partner who had Alzheimer's. Another recent case is also being featured of a woman who was depressed but not terminally ill who supposedly relied on information form Exit International's materials to kill herself.In Germany, a lawyer/politician advised, and videotaped a 79 year old woman who prepared and self-administered a 'lethal cocktail.' The woman was not terminally ill but chose hastened death because she did not want to go to a nursing home. The politician, Roger Kusch, was inspired by Dignitas, a pro-euthanasia organization based in Switzerland who has many people from Germany requesting its services.In Scotland, a Member of Scottish Parliament, Margo MacDonald has filmed a documentary with the BBC and proposed legislation to adopt the euthanasia and assisted suicide laws similar to The Netherlands.In Italy, a case eerily similar to Terri Schiavo and Nancy Cruzan is being discussed publicly and was recently covered in TIME magazine. A 20-year old woman in a car accident (in 1992) now comatose and with a feeding tube that her father wants to have removed (and has fought for since 1999) was allowed by Italian courts to stop her artificial nutrition via feeding tube despite much opposition. The case is now pending appeal despite already having gone to the Italian Supreme Court in 2002.In Canada, Samuel Golubchuk, an 84 year old man whose family fought hard to continue aggressive life-prolonging measures died 9 months after doctors initiated discussions about end-of-life decisions. He died on full life support measures. If his life support was withdrawn it would have been illegal since a court ordered physicians and the hospital to continue partly based on the family's belief of hastening his death would be a sin under Orthodox Jewish law. The case was to be heard by a full court in September. Doctors refused to care for him, likening his medical treatment to 'torture.'In England, a man who was refused Sutent, a prostate cancer drug, by the National Health Service suffocated himself.So why is this all important to palliative care?Because guess who thinks about these things:your patientstheir familiesmedical professionals who consult youthe publicand they may never bring it up with you for a multitude of reasons. Or they may hint at hastened death, but never start an open discussion. Or they may make a sly joke about it, waiting to see how you respond. Or they may assume what is good standard palliative care is really euthanasia.Good hospice and palliative care practices can help people discover hastened death does not have to be the easy way out. If the lines are too blurred between the legal and illegal our field has significant trust to lose with the public and our peers. Being educated and aware of the public debate over hastened death is a responsibility for palliative medicine to ensure the safe, ethical, and legal care of the patients and families entrusted to us.(My Standard Disclaimer: Pallimed, Dr. Sinclair and his current and former employers and states do not endorse or practice euthanasia or physician-assisted suicide, but do encourage the open, non-judgmental discussion of these topics for educational and ethical discourse about this controversial area of medicine. Links do not represent endorsement.)Posted by Christian Sinclair, MD Labels: , , , , , ,


Mary Walsh said...

I like your article, Killing them is that isn't it. Not rudely racked with pain but rather a quiet lullaby.

In Australia we are very lucky to have two active doctors who support choice and dignity in dying. Philip of course wants his own little white pill (euphemism - could be three red ones!) and Dr Rodney Syme, author of A Good Death, wants legislative change.

Personally I don't think we'll get either any time soon but we can keep on trying to change the conservatives.

As of next week the Victoria Parliament will debate Physician Assisted Dying and already the Right to Life use Nazi Germans exterminating the unwanted in society as their war cry.....They keep talking about the value of a life, but are yet to determine what value is a life spent with intolerable pain.

It is heartening to know that throughout the world some of us continue to promote choice as an alternative to dogma!

Mary Walsh

CJ said...

Mary, of course I am for VOLUNTARY euthansia, that is, as long as the decision was "knowingly, intelligently and voluntarily" made. However, what this blog is about is IN-VOLUNTARY or "backdoor" euthansia, that is, when the care-giver allows the patient to die or "hastens" their death without their EXPRESS CONSENT or knowledge. It happens more often we would like to know. Death is generally, but not always, hastened by the withholding of necesary foods, fluids or nutrients. The patient doesnt even know it, but they are starved to death through malnurishment. They die NOT from their disease but through lack of BASIC life-sustaining care. This type of "euthansia unawares" is ALWAYS illegal, as it should be, but is done "in-secret" or through "the backdoor." Very hard to prove, especially when there is a living will, where the tendency by caregivers is to just let them die.. My next post will be about "The Dangers of Living Wills."