Tag: Assisted Dying

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A ‘sacred moment’: Brockville doctor talks about why he helps people die

By Joanne Laucius

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Dr. Gerald Ashe has assisted in four deaths since Canada’s new law passed.

Dr. Gerald Ashe has seen the kinds of things people do if they can’t get help in dying.

A couple of his patients have taken their own lives. Some have told him they are hoarding sleeping pills “just in case.” He says he has seen too many cases of terminal delirium, a condition where an agitated and confused dying patient survives through five to seven days. The patient will die, it’s just a matter of how long it will take.

“It’s common and it’s nasty and it requires palliative sedation. If given the choice, most people would say: ‘I’ll take the five- to 10-minute plan, not the seven-day plan.’”

Ashe has been a family physician for almost 40 years. He offers palliative care in Brockville and is a member of the physicans’ advisory council at Dying With Dignity Canada. He says his support for assisted dying came as the result of many years of “watching people die, helping people to die and watching them suffer and coming to the realization that we can’t relieve all suffering.”

Since assisted dying legislation passed on June 17, Ashe has assisted in the deaths of four patients, and another patient has permission. “They’re content to know they have permission.”

When a patient dies, it’s a “sacred moment,” he says.

“None of us really want our patients to do this. We understand it. We honour their request and their autonomy. We would prefer to provide relief in another way. I have a contract with a patient. I am with you until you die. I am not going to send you off when things get tough.”

Physicians still feel ambivalent about helping patients die. At the Brockville General Hospital, where Ashe works, a survey of the medical staff found about three-quarters agreed or strongly agreed that people should have a right to assisted death, and almost two-thirds felt it should be offered at the hospital. But only 30 per cent pf physicians would be willing to provide assisted death — with proper training — while 43 per cent would not, with the remainder neutral. About three-quarters said they would refer patients, while 13 per cent said they would not refer. The remaining respondents were neutral.

Ashe believes that only a small subset of people will seek assisted dying. In Oregon, laws permit qualified terminally ill adults to request a prescription for a medication to hasten death. With a population of four million people, about 150 permissions for physician-assisted suicide are sought every year in Oregon. Interestingly, only two-thirds of those who request the prescriptiom actually take it.

“Knowledge is empowering. People won’t make that decision because it is available,” says Ashe. “They will choose it because that’s what they want.”

He was nervous at first about going public with his support for assisted dying. In December 2014, he spoke out after a terminal cancer patient in his care shot himself. This summer, he spoke about helping an ALS patient die at home. But feedback from family and colleagues has been gratifying, he says.

“To live through this era and see this come to fruition has been an amazing experience. That we can allow someone to die peacefully, painlessly, speaks volumes abut how far we have come as a society and as a profession.”

Ashe believes the current legislation doesn’t go far enough. He would like to see other patients have access, including people with severe mental illness and competent children. People with mental health problems suffer terribly and Ashe said he can see no reason why they shouldn’t qualify. People over the age of  18 qualify, but not those who are 17. That’s arbitrary, he argues.

“The beauty of dying where and when you want and with whom is pretty amazing,” he says. “One of the reasons why I have been advocating for this isn’t altruistic. I would like to live in a world where this is possible for myself.”

Complete Article HERE!

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More than 65 B.C. patients choose doctor-assisted death since June

by  Jeff Nagel

So far 66 B.C. residents have ended their lives through physician-assisted death.
So far 66 B.C. residents have ended their lives through physician-assisted death.

More than 65 B.C. residents have legally ended their lives with the help of a doctor since federal assisted death legislation took effect June 17.

Fraser Health officials confirm some of those deaths have been within this region, but referred requests for detailed numbers to the B.C. Coroners Service.

“Our first request was two days after the federal legislation was put in place,” said Lisa Zetes-Zanatta, Fraser Health’s executive director for palliative care, home care and residential care.

“A number of requests have come in and some have completed the service.”

Coroner Barb McLintock said it’s too soon to provide a regional or other breakdown on B.C.’s assisted deaths, which she said stood at 66 as of Wednesday.

The most high profile case so far made public has been that of author W.P. Kinsella, who lived in Yale and invoked Bill C-14’s assisted dying provisions Sept. 16 at Fraser Canyon Hospital.

The Catholic Church’s Vancouver Archbishop Mark Miller urged Fraser Health in an open letter not to mandate assisted dying as an option in palliative care wards, calling it a “cruel dilemma” for those vulnerable patients.

And Miller said it’s a “terrible conflict of interest” for palliative caregivers who may be compelled to offer “an economically expedient shortcut in the form of lethal injection” contrary to their ethical principles.

Zetes-Zanatta acknowledged that not all doctors or nurses are willing to participate, but said that has not been a barrier to finding sufficient volunteers.

“We’re very clear, as is the provincial and federal legislation, that conscientious objection is absolutely respected,” she said. “I would never force any of our staff into doing anything not consistent with their own moral, ethical or spiritual beliefs.”

Doctors can perform the assisted death injection independently if nursing staff who would normally assist are unwilling, she said.

Zetes-Zanatta noted the World Health Organization definition of palliative care is to protect and alleviate the suffering of patients until they reach a natural death.

“The number of palliative care physicians providing this service is less than other disciplines because it’s not aligned with their philosophy of care. That being said, there are palliative care physicians who are providing this service.”

More of the requests for assisted death come from people in the community than in hospices or palliative care settings, she added.

“We try to give the service where the patient is,” Zetes-Zanatta said. “They’re usually in intolerable suffering and so to move them is really difficult. We try to make this very much about the patient.”

Under the federal legislation, patients must be at end of life with death expected within the next six months to a year.

Only they – and specifically not youth or psychiatric patients – can make an initial request leading to more information on the assisted death option.

Usually those requests go through a family doctor, Zetes-Zanatta said, but Fraser Health will assign physicians to respond to patients who don’t have one.

“We ensure that they have had access to palliative care services and pain management services to see if we can alleviate their suffering prior to them making a formalized request for this.”

After the information provision stage, two doctors must conduct independent assessments, after which there is a 10-day waiting period before the patient can finally make the choice to die.

She said Fraser Health is now legally required to comply when patients qualify.

“Regardless of where people sit on this we have to recognize that there are patients requesting this. And we have to understand what that patient must be going through to put in a request like this.”

The legislation passed by the Justin Trudeau government came after the Supreme Court declared it unconstitutional to prevent suffering Canadians from getting medical assistance to hasten death.

Complete Article HERE!

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My patient ended her life at Dignitas to avoid a slow, undignified death

Her courage showed me assisted dying should be legal in the UK so the terminally ill can have some control

By Anonymous

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I gained great insight into the courage and tenacity it takes to go to Dignitas.

Some years ago, while working as a district nurse at a GP practice, one of the receptionists came to tell me she had just taken a phone call from the son of a patient to say he had returned from the Dignitas clinic in Switzerland. His mother, who had recently been diagnosed with a neurological condition that would kill her slowly, and with loss of dignity and independence, had taken her life there.

The reception staff were shocked. I was shocked. My team was shocked. I was dismayed that this lady, who I had known for a number of years, had to go to another country to receive the care she wanted and to die earlier than she should have.

The following day her GP asked me what Lily* had been up to over the past few days. You can tell from this perhaps that Lily was a lady who made demands on the surgery team. The GP was upset when I told her what had happened, and contacted Lily’s son.

I had known this lady for a number of years and looked after her husband when he returned from hospital after surgery. Lily would turn up at the surgery immaculately dressed and would not leave until she obtained what she thought would help him. I would sometimes receive a phone call from the surgery asking me to come back from my house calls to see her. I was not the only person at the surgery with whom she could be quite insistent. Yet even as she frustrated us all, I found it noble the way she fought for what she thought was best for her husband.

After he died I saw her only occasionally. A few years later her health deterioriated and I became involved in her care. Occasionally I found it frustrating when, in the middle of a clinic or housecall, I would be contacted to say Lily wanted to see or speak to me. Many a day on my way home I would have to call into her house to reassure her or deal with a problem.

After her diagnosis she was matter of fact as we discussed plans for her care and how to deal with her condition. She was living on her own and had no intention of “burdening” her children. Despite the fact that she could be difficult, I found her likeable with a very dry sense of humour and fun.

I found out later that before she died she had bought a new outfit to travel in, and been to a favourite view she and her husband used to visit and to a favourite restaurant.

The point of telling this story is that I gained great insight into the courage and tenacity it takes to go to Dignitas and that there should be a way of assisting someone who is of firm mind to take their own life in these circumstances. Perhaps if she had felt she would have had control of the situation in this country Lily would not have found it necessary to take her own life at all; certainly she would have had a longer life. I feel privileged to have known a very brave woman, even if she could drive me to distraction.

Complete Article HERE!

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Let Me Die My Way

As a D.C. Council committee prepares to vote today on a death with dignity bill, a terminal patient urges passage.

By Mary Klein

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I do not know how long I have to live. I have aggressive ovarian cancer that has spread throughout my body. I want to live, and I’m doing everything possible to continue living, including surgery that took 42 industrial strength staples to stitch me back together and chemotherapy that has life-threatening side effects and has caused nerve damage, which limits my ability to walk.

Despite these efforts, my cancer cannot be cured. It is terminal. Intolerable, constant pain is a real possibility I must confront.

When I have only a few months left to live, I would like the option to obtain medication that I alone could decide to take to peacefully leave this world. I might decide not to take it, but it would bring me great comfort to know that it is available.

The “Death with Dignity Act” would provide this option to me.

The D.C. Council’s Health and Human Services Committee is scheduled to vote today on whether to approve this legislation for consideration by the full D.C. Council.

Some people fear that the bill would lead to abuses, but those fears have proved unfounded. Oregon and four other states with medical-aid-in-dying options, have not found any incidents of abuse.

The legislation only provides the option to a terminally ill person who has six months or less to live, who personally requests the medication from two doctors and is found to be of sound mind and is acting independently. The patient must take the medication herself, but is under no obligation to take it.

The qualification requirements in the bill, which is modeled after Oregon’s nearly 20-year-old death-with-dignity law, include verification of the patient’s diagnosis and mental competency by two physicians.

A terminally ill person should not have to endure needless suffering in her or his final days. I ask that my choice to have a peaceful death be respected in the same way as other medical decisions made privately with one’s doctor.

I urge the D.C. Health and Human Services Committee and the full Council to approve the Death with Dignity Act and Mayor Muriel Bowser to sign it into law, so terminally ill DC residents like me do not have to worry about dying in agony.

Complete Article HERE!

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Assisted death was ‘incredibly positive,’ says family of Alberta’s first patient

By Shawn Logan

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[A]t the end, Hugh Wallace still remembered there were 43,560 square feet in an acre.

Surrounded by family on April 19, just before a lethal cocktail was administered to legally end his life, making him the first Albertan to do so in this province, his son asked him the question he feared he may one day not be able to answer.

“Hugh always said if he got to the point where he couldn’t remember how many square feet were in an acre, he didn’t want to go on,” said his widow, Evie.

“At the end, he scored the winning goal in the last second of play.”

Alberta Health Services this week revealed 31 Albertans have so far been granted physician-assisted deaths, two dozen of those coming after the federal government lifted the legal prohibition against the practise in June, following a 2015 Supreme Court ruling.

Wallace, who at 75 had endured a quarter-century of multiple sclerosis before contracting aggressive lung cancer, was an engineer, and at his heart an uncompromising pragmatist, said Evie, who has since become an advocate for assisted death, speaking around the province.

“He wanted to go out with his brain intact,” Evie said.

“He didn’t want to go out in a coma, with a catheter and wearing Depends. That wasn’t him.”

Wallace, like a handful of trailblazers before him, had gone before the courts earlier this year seeking an exemption against the law outlawing assisted death in the Canadian Criminal Code.

In February, Hanne Schafer became the first Alberta woman granted the legal right to take her own life, but, after struggling to find a doctor in her own province, had to go to B.C. for the procedure. A second Alberta woman also went to B.C. to have a doctor assist in her death after a ruling in May.

But Wallace was able to find an Alberta doctor willing to help him die on his own terms, opening the door to others seeking the same release. As of Tuesday, the lead for medical assistance in dying preparedness for AHS, Dr. James Silvius, said two to four patients a week are taking advantage of the service, numbers he admits are somewhat surprising.

Evie said though her husband was suffering in the waning days of his life, he found some comfort in being able to have some control of how he passed on.

“It was an incredibly positive experience,” she said. “He was able to say his goodbyes to everybody and the doctors were fantastic. They were amazing human beings.”

Evie added the doctors involved in his care had meetings with both family and Wallace privately to ensure there were no signs of coercion before he underwent the procedure.

While her family’s experience was positive, the 73-year-old widow noted those who choose assisted death need to make sure everybody’s on the same page, and there are no lingering issues to resolve.

“It’s something for people to really look at their family dynamics before they go through with this,” Evie said.

“If there’s a lot of unfinished business in a family, it’s fertile ground for explosions.”

After 51 years of marriage, Evie said she is left with wonderful memories of the man she deeply loved, and not a shadow of regret about watching Hugh end his own life.

“At the end, we didn’t have any tears left in us. It was a good day.”

Complete Article HERE!

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Will People Of Color In California Use The Aid In Dying Law?

By Ja’Nel Johnson

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Death was a topic that wasn’t discussed in Adrienne Lawson Thompson’s home growing up. The Los Angeles native says it was such a taboo topic, that her own mother didn’t even reveal what illness she was stricken with before she died.

“She didn’t want to disclose things to me because ‘Oh, you’re young. I don’t want to be a burden to you. You have your children, recently married.’ And we don’t look at it that way, as being a burden,” Thompson says.

She believes not talking about death is pretty prevalent in the African American community. And when faced with death, many African Americans lean on their faith.

“Trust in your faith that if God will heal you, he will heal you,” Thompson says.

And it’s that trust that may lead many African Americans not to participate in California’s End of Life Option Act.

“Very few have used the law that are Hispanic, Asian or Black,” says George Eighmey, president of Death with Dignity in Oregon. He says requests are generally made by people who are white and highly educated.

Demographics of Oregon's Death with Dignity Act Recipients.
Demographics of Oregon’s Death with Dignity Act Recipients.

In Oregon, between 1998 and 2015, 97.1 percent of participants were white, according to the Oregon Health Authority.

Last year in Washington, 98 percent of participants were also white, according to the Washington Department of Public Health.

But while Oregon and Washington have largely white populations, California’s demographics are much different. Latinos are 39 percent of the population and Asians and African Americans make up 15 percent and 6 percent of the state’s population, respectively.

“Our demographics are really, very different and we don’t know yet who is going to be asking about this option with the intent of participating,” says Lael Duncan, medical director of consulting services at the Coalition for Compassionate Care of California.

Britta Guerrero, executive director of  Sacramento Native American Health Center, says when members of her community face terminal illness, trust in their culture and their own healers is also important.

“We would seek maybe to see a medicine person and try to receive doctoring from a cultural perspective, a spiritual perspective,” Guerrero says.

In addition to these cultural and spiritual differences, there’s also the country’s history of using people of color for medical experiments.

Between 1973 and 1976, the US government sterilized 3,406 American Indian women without their permission.

“I think we have a long-term distrust for the medical and health care system,” Guerrero says.

CynthiaPerrilliat, executive director of Alameda County Care Alliance, says trust in the health care system is also a major issue in the African American community due to medical experiments like the Tuskegee Study of Untreated Syphilis in the Negro Male.

“Black men that had syphilis not being treated, the role that the government, quote, unquote, had to play in that, the role of the health system in that,” Perrilliat says.

It’s too early to tell whether this dark history will affect minority participation in the End of Life Option here in California.

The Department of Public Health will release a report on participation in the law, including a racial and ethnic breakdown, next summer.

Complete Article HERE!

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A publicly funded hospital can’t refuse assisted death

By Ottawa Citizen Editorial Board

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[D]uring the bleakest, most vulnerable period of their lives, terminally ill patients should be able to count on top-notch care and generous doses of compassion. But in one key area, Canada’s Catholic hospitals are letting them down.

At St. Paul’s Hospital in Vancouver, a dying 84-year-old patient who had requested a medically assisted death was required to go to another hospital, and his last day was pure agony as an ambulance shuffled him between institutions. St. Paul’s would not even permit him to be assessed for assisted death on its premises.

Catholic health providers across the country have said that while medically assisted dying is now legal, their faith does not allow them to participate. “These organizations neither prolong dying nor hasten death, and that’s a pretty fundamental value for them,” says the president of the Catholic Health Alliance of Canada.

We have argued before that individual choice must be the over-arching principle behind assisted dying decisions. While, in accordance with strict legal rules, a patient should be able to request assisted death, individual medical practitioners should not be forced to provide it against their own ethics.

But individual rights don’t apply to publicly funded institutions. If no individual health care expert in a Catholic hospital will personally support a medically hastened death, the publicly funded institution itself must still find a qualified practitioner who will. Forcing those in pain and mental distress to leave the site in order to obtain even an end-of-life assessment is simply inhumane.

In Ottawa, the situation is particularly complicated for Bruyère Continuing Care, a Catholic facility. Although organizations that support Catholic health care don’t want even a conversation about assisted dying to take place there, the Bruyère is the only publicly funded, complex palliative-care option in this region. To its credit, it appears to recognize that it must be more flexible.

A Bruyère administrator told the Citizen that if a patient requested information, the facility would be bound to acquiesce. If the patient were too ill to be assessed off-site – which is likely in palliative cases – the assessment, at least, could be done without moving the patient.  Still, the person would have to transfer elsewhere to actually obtain a medically hastened death.

Provincial governments must step in – yet in Ontario, at least, regulations aren’t expected until 2017. Why should a publicly funded institution be permitted to refuse a service to the dying that is legal and that could be performed on its premises with considerably less agony than exiling the patient?

Force individual medical practitioners to end a life? No. Tell institutions to follow the law? Yes. A dignified ending shouldn’t be hostage to institutional beliefs.

Complete Article HERE!