Where Do the Dead Go in Our Imaginations?

My friend was gone. I needed to do something to honor the person she was.

By Anakana Schofield

In the west of Ireland, in County Mayo, where my mother lives, there’s a lovely tradition of attributing words or phrases to people. If they are dead, you add an acknowledgment after their name along the lines of “May the Lord have mercy on their soul.”

I love how this reignites the spirit of a deceased person you may or may not have known. You can build an entire sense of someone you never met from hearing their expressions. And for those who knew them, that person can live again in the utterance of those sayings.

From a young age, I’ve had to contemplate death. Early childhood loss of a parent will do that to you. My father died when I was 6. Since then, I’ve been trying to understand the cumulative nature of grief. The resounding question of my life has been, Where do the dead go in our imaginations? Increasingly as I age, I’ve wondered where I will go in people’s imaginations. Will anyone remember me? Will I still matter to anyone once I am dead?

After all, as time passes, people can become the subject of their exit. My friend who was hit by a car. My friend who had an asthma attack. My friend who took her life. After the pandemic we will also have to decide how we will talk about the lives of those who were taken by Covid-19: Will the lives they lived be overshadowed by the fact that it was Covid-19 that extinguished them? Will their years of living be reduced to the name of a virus that wiped them out in a matter of days or weeks?

These questions confounded me even before the pandemic. Five years ago this month, one of my oldest friends died by suicide (though it is so tempting to say that she “died suddenly”). A lifetime of loss would not prepare me for the way this buckled me in half. I would see my friend in the T-shirts my son put on, every time I picked up a tea towel or made a cup of tea, because this friend was so incredibly generous, she wallpapered my entire life with that generosity and love. It wasn’t about the objects as much as the thought that at the time she picked out the tea towel or the many tea tins that line my cupboard, she did so because I was on her mind. I was alive for her even though I was absent. In that moment she chose to remember me. How can I return this gesture now, when she is no longer here?

In a way, my friend’s endless generosity has kept her alive for me, but inevitably, whenever I experience small mercies or achievements or special moments, her devastating absence is felt as large as it ever was. I can become overwhelmed by the thought that I failed as a friend, since I never sufficiently demonstrated how important she was to me and now it is too late.

My beloved friend was not just generous; she was an extremely effective and reliable health care professional with boundless empathy and patience who did not take shortcuts. I know this because I watched her work through lunches and weekends to fill out charts, and rarely take sick days. I know she was someone who saw and heard patients in all the ways we need to be heard and seen.

In time, I decided that the only way for me to consistently keep this particular person alive in my imagination was to try to do something that would put me into the precise spirit of who she was. But what that something would be was not yet clear.

As it happened, while researching my novel “Bina,” which explores female friendship and the right to die, I began an email exchange with Dr. Sue Hughson, who was volunteering for Dying With Dignity Canada. She asked if I would be interested in becoming a volunteer witness for the organization. It seemed that this would be something my friend might do and that I might be able to keep her spirit alive by being a compassionate witness to others in their dying. I agreed.

Medical assistance in dying or MAID, which was previously known as voluntary euthanasia, is legal in Canada. All applicants require two witnesses to sign the paperwork to commence the application process to MAID. As volunteer witnesses, we cannot be involved in the care of the dying or be beneficiaries of their wills. We go in pairs. We read aloud (or have patients read) a series of statements confirming that they understand the nature of the request they are making, that they have had all their treatment options explored and explained to them and that they are free to change their minds at any time in the process.

The visit is generally not long — roughly 20 to 40 minutes — yet in those moments we enhance our humanity by helping strangers’ requests for their end-of-life choice be heard and considered. “Choice” is an important word: I have never been in any situation where I was in any doubt that the person had absolute clarity and full understanding of what they wanted, because if I had been, I would not have been able to sign the form. The next step involves assessment by two doctors independent of each other to determine whether the patient qualifies for MAID. Once the form is completed, there’s usually palpable relief from the patient and always enormous gratitude to us for volunteering our time.

In such brief interactions there can be unexpected, profoundly moving exchanges and experiences. There can be laughter and humor. There is nothing I have seen more beautiful than patients supported at this moment by their siblings, children or friends, nothing more loving and compassionate than family members or dependents who are struggling visibly through silent tears, yet stay to support and comfort their loved ones.

Occasionally parents become aware their son or daughter is distressed and spontaneously give a soliloquy to all present; they announce that their child is a good son or a good daughter and plead gently, “Don’t be sad. It is time.” Once a man asked us to turn on Ozzy Osbourne’s “Mama, I’m Coming Home,” and we rocked out to it around his bed.

Every time I have the privilege of witnessing in this way, I feel the presence of my beloved friend in that room with me. Her spirit, her patience and her willingness to hear people live in this act. Every day it’s a struggle for me to imagine she is with us no more, and I find myself pondering, “Where can she be? How can she be gone? How is this possible?” I have concluded she lives now in my ability to imagine her right there with me in the room when I witness, for she was brave and nonjudgmental, kind and honest, warm and supportive, which is the truth of what takes place in these interactions.

Recently, I decided to take a full-time job at a nearby lab receiving and processing specimens for coronavirus tests. At the end of the first week, I was exasperated and exhausted and feeling quite useless. I am older than most of the workers, and slower and more easily flustered. The one thing I held on to was the knowledge that my friend would have been proud of me for working in that lab.

So this is where the dead go in our imaginations: They continue to live with us in the moments when we are sad and terrified. They cheer for us. They give us unbelievable strength and the courage we lack to carry on in situations. They coax us through. They lead us where we need to be, to experience the joy and capability that was them. They who have been with us in life manage to teach us how and where in death we can listen for them and find their voices and essence again.

Complete Article HERE!

Does grief depend on how the loved one died?

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Is the grief experience different for individuals who have lost a loved one by medical assistance in dying (MAiD) compared to natural death with palliative care (NDPC)?

Philippe Laperle examines this sensitive issue in a recent article published in the Journal of Death and Dying, based on his Ph.D. research under the supervision of Marie Achille of the University of Montreal’s Department of Psychology and Deborah Ummel of the Université de Sherbrooke’s Department of Psychoeducation.

Previous research suggests that following the medically assisted of a loved is no more challenging or complex than grief in other dying contexts, including sudden natural death or suicide. Some studies have even concluded that it may be easier.

Comparing two groups of bereaved individuals

To date, however, no one has compared bereavement following the loss of a loved one by MAiD and by NDPC, considered the “gold standard” in in end-of-life care and death preparation.

Laperle recruited 60 subjects who had been bereaved for at least six months. Twenty-five of them had lost a loved one by MAiD and 35 by NDPC. In the majority of cases (48), the cause of death was cancer.

The 51 women and 9 men first completed two questionnaires assessing different aspects of grief, symptoms of distress and the presence of prolonged grief disorder requiring professional psychological support. This quantitative component was followed by in-depth interviews with 8 members of each group.

No overall differences, but a diversity of experiences

Contrary to his initial hypothesis that grief would be easier after MAiD than after natural death, Laperle did not observe any significant differences in intensity or distress between the two groups.

The low scores for distress symptoms indicate that “these two contexts tend to make grief easier in certain respects,” said Laperle, “although some bereaved individuals still reported a more difficult grief experience characterized by depression and guilt.”

The interviews showed that the experiences of the bereaved were diverse and, sometimes, mixed in both groups. And that the traces, or “imprints,” left on the bereaved individual by their loved one’s final moments and the separation brought by death could be painful, comforting or both at the same time.

“When preparation for death and acceptance of its coming unfold at a similar pace in the dying person and their loved one, the two arrive at the same point mentally and emotionally at the time of death, which makes the subsequent grieving process easier,” explained Laperle. “But if one of them accepts the impending death while the other remains in denial, this leaves imprints that are more difficult to overcome.”

But regardless of whether the loved one passed away by MAiD or naturally under palliative sedation, in which case the person gradually slips into unconsciousness and death, some bereaved individuals felt the process was rushed. In general, those who were in synchrony with their loved one experienced the death more serenely and felt it came at the right time.

Differences were also found n the subjects’ memories of the loved one. In the case of MAiD, some of the bereaved remembered the departed as a “hero” who embodied values of freedom, control, courage and/or immortality. In the case of NDPC, the departed was more likely to be remembered as the embodiment of a beauty that never fades completely although it withers. Others felt left behind by their hero, which created a even greater void after their passing.

“It’s important to remember that every grieving process is different and that not everyone will be left with the same imprints,” said Laperle. “In general, imprints fluctuate over time, arising momentarily to then dissipate and even transform. Other factors also impact grief, including the person’s relationship with the deceased and degree of involvement during the illness. These factors can increase or decrease the effects of the imprints left by MAiD or NDPC.”

Complete Article HERE!

What Oncology Nurses Should Understand About Medical Aid in Dying

Lisa Vigil Schattinger, MSN, RN, discusses her experience with medical aid in dying, and what oncology nurses need to understand when supporting patients at the end of their lives.

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For patients with cancer who are at the end of their life, being afforded the same level of autonomy in death as they experienced is life can be a vital component in providing quality care for the patient and their family, according to Lisa Vigil Schattinger, MSN, RN.

Schattinger is the founder and Executive Director of Ohio End of Life Options, a nonprofit organization that advocates for and provides education on medical aid in dying laws. In addition to being a nurse advocate, she also brings a unique personal perspective to her career.

Schattinger’s stepfather electively chose medical assistance in end-of-life care under Oregon’s Death with Dignity Act1 after he received a myelodysplastic syndrome diagnosis and learned he was not eligible for blood marrow transplant. He opted not to start chemotherapy but enrolled in hospice and received palliative packed red blood cell transfusions before electing to pursue a medically assisted death.

Her stepfather’s death was incredibly peaceful and in accordance with his wishes: he was able to walk himself into his room, sit down on the bed, and be surrounded by family as he took the medication.

“He felt empowered,” she recalled, noting that the family was grateful that the state of Oregon had allowed them this option.

At that moment, Schattinger and her mother, who is also a nurse, recognized that this option is potentially groundbreaking for certain patients and their families. As a result, they decided to learn more about the processes in place and to share their own personal experiences. Recently, the duo presented on the topic at the 47th Annual Oncology Nursing Society Congress , specifically on the role of oncology nurses in end-of-life care and the key components of medical aid in dying (MAiD) or dying with dignity laws.

In an interview with Oncology Nursing News®, Schattinger provides a quick overview of her presentation and key takeaways for nurses seeking to provide quality care.

Oncology Nursing News®: Please provide a brief overview of medical aid in dying.

Schattinger: Medical aid in dying is a law that allows terminally ill and mentally capable adults the ability to request a prescription that will hasten their imminent death. The process is patient directed; it is a voluntary process that has multiple safeguards. It is for an [individual] who understands that they are at the end of their life, understands that they are dying, and wants to determine the time and the place and [the company present] at the end of their lives.

Each state can determine if they are going to pursue the process of passing an aid [with the establishment of a] dying law or medical aid in dying law. The first one that [was passed] was in Oregon, and it is called the Death with Dignity Act. I always consider that one as kind of a baseline. As other states passed [similar] laws, they put their “thumbprint” on that law— they made it work for their state.

Currently it is legal in Oregon, Washington, California, Hawaii, Colorado, New Mexico, Vermont, Washington, DC, New Jersey, and Maine. [In addition], there was a Montana State Supreme Court decision that allows [MAiD], but it is not exactly the same as in places that have actual laws.

[To qualify], patients have to be capable of making decisions. If there is any concern that the person is not capable of making decisions, then they can be referred for a mental health evaluation. Then there are timeframes in place [these vary by state, as well]. A patient also needs a written request that is witnessed by 2 people, of whom at least 1 cannot be related to or benefit in any way from the person’s death. Then, after qualifying for the prescription, they must wait 48 hours before filling. Patients must also be able to self-administer the medication.

Anybody involved in this process can opt out at any time, physicians, pharmacists, nurses, [or] any other care provider can opt not to participate [in the process]. Of course, the patient themselves can change their mind at any time and stop the process as well.

It is also important to note that when a physician gets this request, they must inform the person of all [available end-of-life options], including hospice care.

[Interestingly] we have learned that [approximately] a third of the [individuals] who get this prescription never end up taking it. There are a combination of things going on there. [Some] say that they can relax knowing that they are able to determine if [and when] their suffering becomes too great. Others, [unfortunately,] do decline in health. And [those] who are not able to self-administer, are no longer capable of making that decision.

Should oncology nurses only be familiar with these laws if they live in a state where it is legal? How might nurses support a patient who wants MAiD, yet lives in a state where it is not an option?

The American Nurses Association put out a statement saying that because so many people now have access to this option at the end-of-life that they feel nurses are ethically bound to be knowledgeable about it. This means being able to have non-judgmental conversations about MAiD, and to be able to [inform individuals] about what end of life options are available [including hospice care and pain management].

So if, as a nurse, you live in a state without a [MAiD] law, and someone asks you about it, [best practice] is taking a moment to really focus on that person and that request and ask: What does this mean to you? What does that request mean to you? Do you understand what all your options are for care at the end of life, and that we live in a state that does not have a law?

Then, if [end-of-life medical assistance] is important enough to patient, they [might consider if they’re willing] to move to a state with a law? This is a very big question. At the end of a person’s life, that is a really big step: to decide to pull out roots from their community, their community of support, and their healthcare community of support, and move to another area, to go through the process of establishing residency–depending on where you’re living—and finding 2 doctors who will participate in this program [is a big commitment].

However, some will decide that it is important enough to them and they do want to do that. But others [will not] and so everyone needs to understand what end-of-life care options are available to them. It is important to have that full conversation to understand that their personal beliefs, values, and goals are, and to see what types of care match their needs, as well as what is available in their community.

What are some misconceptions or things that nurses may not understand about MAiD that makes it difficult for them to support it?

A lot of times [individuals] do not understand [how it is] a self-directed process. This is the patient who wants this and it is vital that they determine what the end of their life looks like.

I remember a person who said, “When I got this diagnosis years ago, I knew that my treatment options would probably run out at some point. So, I became a partner with my health care team in making medical decisions moving through the course of my illness—I made decisions on what type of treatments [I took], what surgeries, and everything else that was possible.” When it came time for [the health care team] to say, there are no longer treatments for you, [the patient] said, “I made all of those decisions as a partner up to that point, why would it change?”

Please elaborate on the ethical value of medical aid and dying and the impact that it does have on the patient.

I think that concept of autonomy and self determination to some [individuals] is paramount. Its who they are. They want partners in their health care [team] who will work with them to provide that care. Some health care providers also believe that providing compassionate care is one that meets the [patient’s] goals.

Ultimately, the concept of suffering is for the patient to determine, not for us to judge.

Until we get to know these [individuals] and fully [understand] why they are making these requests [we cannot fully understand their needs]. Whatever a patient’s definition of suffering is, compassionate care means granting their requests to manage it.

Complete Article HERE!

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

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Voluntary assisted dying is now lawful in all Australian states. There is also widespread community support for it.

Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so.

As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue.

So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end.

The many ways to block access

While voluntary assisted dying legislation recognises the right of doctors to conscientiously object to it, the law is generally silent on the rights of institutions to do so.

While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including:

  • restricting staff responding to a discussion a resident initiates about voluntary assisted dying
  • refusing access to health professionals to facilitate it, and
  • requiring people who wish to pursue the option to leave the facility.
  • Here’s what happened to ‘Mary’

    Here is a hypothetical example based on cases one of us (Charles Corke) has learned of via his role at Victoria’s Voluntary Assisted Dying Review Board.

    We have chosen to combine several different cases into one, to respect the confidentiality of the individuals and organisations involved.

    “Mary” was a 72-year-old widow who moved into a private aged-care facility when she could no longer manage independently in her own home due to advanced lung disease.

    While her intellect remained intact, she accepted she had reached a stage at which she needed significant assistance. She appreciated the help she received. She liked the staff and they liked her.

    After a year in the facility, during which time her lung disease got much worse, Mary decided she wanted access to voluntary assisted dying. Her children were supportive, particularly as this desire was consistent with Mary’s longstanding views.

    Mary was open about her wish with the nursing home staff she felt were her friends.

    Sick elderly patient in hospital bed, nurse wearing gloves holding fingertips
    Mary’s condition worsened so she requested voluntary assisted dying.

    The executive management of the nursing home heard of her intentions. This resulted in a visit at which Mary was told, in no uncertain terms, her wish to access voluntary assisted dying would not be allowed. She would be required to move out, unless she agreed to change her mind.

    Mary was upset. Her family was furious. She really didn’t want to move, but really wanted to continue with voluntary assisted dying “in her current home” (as she saw it).

    Mary decided to continue with her wish. Her family took her to see two doctors registered to provide assessments for voluntary assisted dying, who didn’t work at the facility. Mary was deemed eligible and the permit was granted. Two pharmacists visited Mary at the nursing home, gave her the medication and instructed her how to mix it and take it.

    These actions required no active participation from the nursing home or its staff.

    Family and friends arranged to visit at the time Mary indicated she planned to take the medication. She died peacefully, on her own terms, as she wished. The family informed the nursing home staff their mother had died. Neither family nor staff mentioned voluntary assisted dying.

  • Staff are in a difficult position too

    There is widespread community support for voluntary assisted dying. In a 2021 survey by National Seniors Australia, more than 85% of seniors agreed it should be available.

    So it’s likely there will be staff who are supportive in most institutions. For instance, in a survey of attitudes to voluntary assisted dying in a large public tertiary hospital, 88% of staff supported it becoming lawful.

    So a blanket policy to refuse dying patients access to voluntary assisted dying is likely to place staff in a difficult position. An institution risks creating a toxic workplace culture, in which clandestine communication and fear become entrenched.

  • What could we do better?

    1. Institutions need to be up-front about their policies

    Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place.

    2. Institutions need to consult their stakeholders

    Institutions should consult their stakeholders about their policy with a view to creating a “safe” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting.

    3. Laws need to change

    Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying.

    There should be safeguards in all states (as is already legislated in Queensland), including the ability for individuals to be referred in sufficient time to another institution, should they wish to access voluntary assisted dying.

    Other states should consider whether it is reasonable to permit a resident, who does not wish to move, to be able to stay and proceed with their wish, without direct involvement of the institution.

Complete Article HERE!

Claiming a monopoly on truth and decency is no way to win the assisted dying debate

Arguments for and against helping someone die were rehearsed in the House of Lords last week – echoing debates unfolding across the world

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A man is standing on the parapet of a bridge. He is about to jump. What should you do? Most people would agree that the moral act would be to talk to him to try to persuade him not to. Most people would also agree that giving him a push because “that’s what he wanted” would be committing murder.

Your grandmother is dying. She is in great pain, has only a few days to live and wants you to end her life now. It’s unlikely that most people could bring themselves to do that. But most would probably understand if you did accede to her wishes, however tormented you felt. And even more were a doctor to give her sufficient painkillers to allow her to die in peace.

The debate about assisted dying is one in which there are no simple answers; a debate in which we need to acknowledge that truth and moral decency lie on both sides and in which context is particularly important in judging what is right and wrong. On Friday, the House of Lords debated Baroness Meacher’s assisted dying bill, which would allow terminally ill adults assistance to end their life. It’s unlikely to become law, but the debate will undoubtedly continue.

The Lords debate was respectful, often moving. Much of the wider discussion on the issue, however, is mired in bad faith assumptions: on the one side, the idea that opposition to assisted dying is driven primarily by religious obscurantism and on the other that supporters are tantamount to murderers and “not to be trusted”. Those are not good places from which to start a hugely significant yet highly sensitive public debate.

I am broadly in favour of decriminalising, in a limited fashion, acts of assisted dying but I also understand the force of the arguments from opponents and partly agree with them. This is a terrain to be carefully negotiated.

The first, critical argument is about the sanctity of life. This is more than a religious argument. Most of us, religious or irreligious, place special meaning on human life, recognising that we are not merely machines or slabs of meat, but persons, moral agents to whom we accord dignity and respect by virtue of being human.

Few, however, view the sanctity of life in absolute terms. Many who oppose assisted dying support the death penalty. Most would defend the taking of a life in self-defence or accept killing other humans in a war they think is just or necessary. Again, context matters.

The philosopher Ronald Dworkin observed that we value life through three lenses: subjectively (treasuring the inner life of the individual); intrinsically (insisting that a human life is valuable in and of itself); and instrumentally (gauging people through their usefulness for society and other individuals). Opponents of assisted dying rightly stress the intrinsic value of life and worry that in expanding the legal capacity to end life we may be drawn to viewing human worth in more instrumental ways. One of the ironies, though, is that in stressing the intrinsic, we may implicitly downgrade the subjective aspect of being human. We can end up giving priority to the state of being alive – of breathing or being conscious – over an individual’s moral sense of what life means to them. Yet it is that capacity for subjective evaluation that truly makes us human.

A second key argument is that of the “slippery slope” – the belief that one step towards any form of assisted dying would irrevocably lead to a world in which we accepted the culling of the old and the infirm.

There are few spheres of life in which slippery slope arguments have not been deployed. In the late 1960s, a Times leader warned that the new technique of IVF could lead to a race between nations, each “breeding a race of intellectual giants”. Any attempt to decriminalise marijuana becomes a downward path to smack being sold in the corner shop. And, for many, gay marriage is “a slippery slope to polygamy and bestiality”.

It’s a metaphor whose power derives from imagining social developments as though they were natural and inevitable, just as a ball rolls down a slope under gravity. What shapes human laws and conduct, however, are not invisible natural forces but political debate. There is nothing inevitable about social change and taking one step does not mean a slide all the way to the bottom.

Many critics point to developments in the Netherlands as an example of a slippery slope. In 2002, assisted dying was legalised for people with incurable illnesses facing “unbearable suffering”. Over the past decade, there has been a debate over extending the law to all those over 75 who feel they have “completed” their life. This, indeed, would be a calamitous move. The problem, though, is not the mythical slippery slope, but that critics have not yet convinced proponents that their proposals are dangerous and wrong. This, as much as any other contentious issues, from Brexit to immigration, should be worked out through public debate, not fear-mongering about slippery slopes.

Linked to slippery slope arguments are fears that assisted dying laws will devalue the lives of old or disabled people. Many might feel they are a burden on their families or on society and so feel a pressure to die. These are important issues and a primary reason the proposed expansion of the law in the Netherlands is so troubling. Society should view the elderly and the vulnerable as people to whom we have obligations, not as inconveniences weighing us down.

The real issue, though, is less the law than wider social attitudes towards elderly and disabled people. During the Covid pandemic, there have been abuses of “do not resuscitate” orders, apparently given to care home residents and those with learning difficulties without regard for their wishes or welfare. The stories are shocking, but few would argue that the solution lies in getting rid of DNR notices. The same logic should shape the assisted dying debate, too.

There are many other questions – from the need for improved palliative care to the relationship between individual choice and the common good – with which to wrestle in this debate. Too often, though, these get entangled in a common refusal to see the significance of the argument from the other side. Compassion and moral righteousness don’t belong in bunkers.

Complete Article HERE!

‘Quick and painless death’: easier said than done

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The central goal of right-to-die organisations has not changed much over the past 150 years. In 1872 a British writer, Samuel D. Williams, wrote a book advocating the use of the novel anaesthetic chloroform to give patients “a quick and painless death”. In 1931 the British eugenicist Dr Killick Millard proposed legalisation of euthanasia “to substitute for the slow and painful death a quick and painless one”.

Now that legalisation has arrived, however, doctors have realised that a Q&P death is easier said than done.

Writing in a recent issue of The Spectator (UK) Dr Joel Zivot, a Georgia physician, expresses his doubts about whether lethal medications are the way forward. He studied the autopsy reports of more than 200 prisoners executed with lethal injections and found that many may have died in great pain.

“The death penalty is not the same as assisted dying, of course. Executions are meant to be punishment; euthanasia is about relief from suffering. Yet for both euthanasia and executions, paralytic drugs are used. These drugs, given in high enough doses, mean that a patient cannot move a muscle, cannot express any outward or visible sign of pain. But that doesn’t mean that he or she is free from suffering.”

Dr Zivot believes that pentobarbital, which, it seems, is used in Oregon in 4 out of 5 assisted suicides, caused pulmonary oedema – the lungs fill with liquid secretions and the person can die in agony. “Advocates of assisted dying owe a duty to the public to be truthful about the details of killing and dying. People who want to die deserve to know that they may end up drowning, not just falling asleep,” he writes.

Nor is death necessarily quick.

In Oregon, where statistics are gathered about the mode of death, the median time to death throughout the 23 years of the Act is 30 minutes but the maximum time is 4 days and 8 hours. The median time for people to fall unconscious is 5 minutes, the maximum is 6 hours.

At least in the United States, doctors who participate in assisted suicides are aware of these issues. Dr Lonny Shavelson, a California physician who specialises in this novel field, has helped to organise the American Clinicians Academy on Medical Aid in Dying. This provides a forum for doctors to establish a best-practice for helping people to die.

It turns out that the very diseases from which the patients suffer can make the drugs less effective. Dr Shavelson spoke with Medical Xpress last year about some of the difficulties:

“Shavelson and [his colleague retired anesthesiologist Dr Carol] Parrot have identified which patients are more likely to linger, and can recommend adjustments. People with gastrointestinal cancer, for example, don’t absorb the drugs as well. Former opiate users often have resistance to some of the drugs. Young people and athletes tend to have stronger hearts and can survive longer with low respiration rates.

“We’re learning. Hypothesis, data and confirmation. This is what science is,” he said. “Our job is to stop the heart; that’s what they want us to do.”

Complete Article HERE!