Physician Assisted Dying

Yesterday I attended a full day conference regarding “Physician Assisted Dying.” I have been looking forward to this as soon as I heard about it. Parking was frustrating at $18.00 for the day especially since it would not accept my credit card and so paying cash, I never received a receipt. I am going to claim it as a business expense anyway. However, aside from one other detail which I will not bore you with, the day was exceptional, informative and another learning experience. I did ask for the slides which I still do not have and will not bother to wait for. It is a pet peeve of mine when there are important discussions, that we do not have copies of relevant points. But that is ok, I took notes and as I write for you, I write for me because our memory falters with time and so while things are still fresh in my mind, here goes. My day began as I left my home and saw my neighbour. Since I was going downtown I offered him a ride. He has a Masters in Theology though he has gone into the financial world where money exists. He is Orthodox Catholic and when I told him where I was going, he asked where the Catholic stance was. I replied that taking a life was not sanctioned by the Catholic church. He asked about letting a person die without artificial means of keeping them alive. That is ok, I replied. He then wanted to know about the Hebrew stance on that. “I don’t know.” I replied. But I was going to find out. Our first speaker was Peter Allatt, an Ethicist, who had great slides which I am sure I will eventually get them for my own file. He said that Assisted Physician death is still illegal at this point of time. There is no legislation at this time. Parliament doesn’t even exist yet. (That was yesterday) If there is no request for extension before Feb 16, the law will come into effect. If anyone out there does not know we had an election and there was a change of government from Conservative to Liberal. He explained that it was determined that the Criminal Code of Canada which indicates that suicide or helping someone commit suicide in section 241 is illegal (sorry my copy of the Criminal Code is in my office and I am not there). This was found to be unconstitutional and against human rights. And so a law was passed to support Assisted Physician death (it was not that fast. They researched it). He spoke of Oregon, USA where the law is in effect, that patients requesting end of life, are encouraged to tell families but are not obligated to do so. One person from the audience spoke out that in Quebec, one hospice is refusing “Physician Assisted death” and subsequently have been refused funding. There was discussion about the possibility of conscientious exemption clause which exists in Switzerland and Oregon, USA that no one is forced to participate. What about other Health providers? What about nurses? What about spiritual care providers? Is there a duty to refer to others who are willing to participate? There was some discussion regarding how this will be handled in small areas where there may be only one physician who may object. How are we going to support those physicians and nurses? Multifaith representatives discussed concerns of what was being raised. One spoke of how Wisconsin, USA who has had this law implemented for some time requires a second opinion from a physician. Our second speaker, First Nations Michael Robinson, at Thunderbay we could see by satellite along with other members from the hospital there. I got to wave at a previous school buddy of mine. He said that the elders need more time to process this change, before they speak on this matter. He has however interviewed different members of the Native community driving 300 miles or so to obtain feedback. He said that there is an epidemic of high suicide rates and subsequently there is some fear of condoning young natives. He explained that the community supports the family at the time of end of life. Some are Christians and other Native Spirituality. There is a rise in teenage suicide. It is believed that natives will be opposed to this law. He also spoke that there are language differences. For example they have no translation for cancer and so to help the patient understand they refer to cancer as a spider. It is important to understand the meaning of Physician assisted suicide. He compared the Native with the Roman Catholic that values suffering. Our third speaker Rabbi Ronald Weiss, spoke about life being precious and of infinite value. He spoke of pain control and the rarity of when a patient cannot get relief. The numbers are very few. He discussed how this affects everyone though it pertains to few. There is a concern in the community of how is going to play out in the hospital and community. He spoke of twisted logic and discrimination because an able body person can commit suicide and a person who cannot do should be able to be helped to do so. Our next speaker is a Buddhist, Dr Anne Low. She spoke that Buddists refrain from killing, they are none harming, believe in non violence and being kind to all. (I later told her that my favourite professor in undergrad was a Buddhist. I didn’t tell her that if Prof Yawney did not die from cancer I would have probably changed my discipline from psychology to anthropology to work under her direction. She was that amazing a person) Dr Low continued that our actions, thoughts impact our present life and that a Buddhist may have some issues with heavy sedation at point of end of life. One must prepare from our journey to the next. There has to be an awareness of transitions from one plane of existence to another. A calm and peaceful mind is crucial for a good birth. “While life must never be intentionally destroyed, there is no obligation to preserve it at all costs.” Our fifth speaker was Mary who works at a Palliative Hospice. I am not revealing her last name, professional status or where she works because she began to tear when she spoke of her dying patients and I want to keep that private out of respect for her. I know how attached one may become working with patients, I have shed my own tears. Palliative Care is where one goes when a cure is no longer possible. Relief of suffering is based on the individuals and family wishes. The focus is on life and journey of life to death. Not everyone dies. Some improve, regain their quality of life and are transferred to long term care or other. The focus is to improve the quality of life. Most people have palliative care are in their own homes, due to physical, emotional or cultural reasons. Mary spoke of how people have died and how the team discusses. They have a procession when someone dies and light a candle as the patient leaves the hospital. They will go as a group to the exit. This helps them (tears). Question: Physician Assisted Death - How is it going to affect Palliative Care? Don’t know. The goal is quality of life. We are going to learn how this is going to impact us. Quality and maintaining respect and dignity is most of what occurs in the family home and the few into hospice. The morning was very interesting and we had a small talk within our own tables, for a set of questions. However, I ignored the questions wanting to take advantage of picking the Ethicist’s brain who happened to be sitting at my table. One woman who sat near me was quite perturbed after listening to the Rabbi speak. She thought that it was too religious. I asked her if she was a social worker, forgetting that I was at a Spiritual Care conference and not my other ones. She replied that she was a clinical spiritualist. She wanted to know my view about assisted dying was I pro or against. “I’m against” I replied. I didn’t see her again after that. She asked. I didn’t tell her that just a month ago I saved a wasp from drowning in the pool. I didn’t tell her that I stopped eating meat after I saw my neighbour kill a rabbit and I noticed that the rabbit was struggling to stay alive and resigned once he knew it was futile. I did not say that I have trained my pets to not to kill. I did not say that I have such a respect for all life and that I think it is precious, because it was a quick question when people are speaking. I have lived long and have studied and travelled and have and still know so many people that I need to be open to what people think. I need to reflect. I do not judge and catch myself when I do. My job is not to dictate to others or tell others how to live their lives. However, I do have my own personal thoughts, my own reflections and so don’t ask if you do not like the answer. There is a whole world out there with all sorts of ideas and ideas of right or wrong. And if you are upset because one does not think a new law is a great idea when just until recently it was illegal, well too bad so sad. She also had a problem with the term “Physician Assisted death.” She wanted to call it something else. Well, I commented before she knew my stance, “I call it as it is, a spade is a spade. We use euphemisms because it is uncomfortable to call it as it is.” Lunch was called and I went to the 10th floor with some of my colleagues who I have known for some time. It was recommended the last time we were here but food had priority. This time I thought I would take the time and it was indeed worth it. What a nice building and the view - spectacular. I found my way outside and there was a patient at the edge of the glass where there was a breath taking view. My colleagues cried out that this looked more suitable as a hotel upper class of course. I replied that all it needed was a pool and bar. “What do you think about that I asked the patient? I sat down beside him to look out at the view. He told me that he is 91, a pilot and that he was in the war. He also said that he felt he was in his twenties. I enjoyed his company and his spirit. We shared a few stories and then I joined my colleagues to go for lunch. Lunch of course was great. I was told that my meal was at the back, so I didn’t have to stand in the long line. I joined the kosher group at the back of the room. I remarked at how much food I ate which was kosher though I wasn’t a Jew. I sneaked into the other area for potatoes and salad (I’m bad). The afternoon was ready to begin with the remaining speakers. My previous professor, and mentor who is always trying to volunteer me for something or other joined me. Actually, I went to retrieve him because he is blind. It was nice spending time with him. He is now 80. He has taught me so much. He is kind with immense knowledge. The afternoon began with our next speaker Dr Prashant Jani: Hindu. He spoke of spirtual beings having a human experience. As a body changes in this life, from a boy to teen to man, etc, the same happens after this human life. There is another life after death. He spoke of incidents where children and adults remember past lives where it would not be possible for them to know of. I remember books on that topic. He spoke about Karma. He said that everything is regulated here. You cannot choose your parents, skin colour, religion etc…At death it is the same. Life is not measured in years but breaths you take. This life or past lives, you must go through the reactions of those lives. Suffering in life or also at death are also karma. To interfere in this cycle by anyone, by law, or criminal is to interfere with the process. We are all under the same law regardless. If there is interference, there will be consequences. Does treatment to prolong life interfere with Karma? Yes, definitely. Next speaker was Dr Ralph Lewis, a psychiatrist and Humanist at the University of Toronto. He is also a Jew. For your benefit a psychiatrist is a medical doctor with three years of psychology now to my understanding. It used to be one which is clearly not enough. What’s happening in the physician community and Medical Association? There have been informed discussions with physicians, in particular the psychiatric community. He spoke of the capacity to make informed decision when there is a psychiatric disorder in particular and how there seems to be a distinct possibility for medical guidelines. He spoke about how some years ago most physicians were opposed to assisted dying. More physicians are in support of the ruling but there is a significant amount still opposed. There is also a fear that they would be coerced to participating (unlikely to happen he feels) or to refer to others in agreement with the law. How will this come into operation? They are looking at jurisdictions in Europe and the United States, where two opinions as experts in physical condition of the patient and probably a psychiatrist involved in many. What about people who are depressed, who has perhaps cancer but is motivated by depression? All of the DSM can be listed as a medical condition. What if there is a preference in medical aid in dying perhaps biased in a negative direction? How long do we let people suffer until we allow them their right to die? Our eighth speaker, Dr Bridget Campion, an ethicist in support of social justice: Roman Catholic. What does it mean to Catholic clinicians? Roman Catholicism prohibits euthanasia. Roman Catholics are not to perform or assist or refer to those who perform this. As a health care professional you have the right to say no as a democratic right. “How healthy is our health care system.” There is no scientific evidence when there is a soul. However, one is human at conception. (I always presumed that all humans have a soul). Next: Shaykh Yusuf Badat: Muslim. Born and raised in Toronto; memorized the Koran. Islamic perspective. The common theme is the preservation of life. No one has the right to take a life, not even yourself. Provide treatment and healing that is beneficial. If treatment does not cause improvement, then permitted to stop - no flexibility to take the person’s life with our own doing. Death must be natural. Assisted death is taking away life no matter what you call it. In Islam it is inappropriate. The way you live your life is the way you will die. If you ever reach a way of life, blessings if you lived with goodness, character and ethics. A good death is adhering to God as instructed and being a good person. Islamics when following God being a good person are blessed and rewarded. Person may be in final moments of suffering. Sometimes God tests people with suffering and it is a place, in a higher place after death. There is a duty of family and community to help the patient but at the end it is the decision of the patient. When there is no brain activity, life is gone. If there is movement, life is there. Our final speaker, Rev. Dr. Roger Hutchinson. United Church. The church does not have an official stand. There are concerns about the impact of acceptance of assisted dying on vulnerable people. There is a potential for recovery. Hi indicated that there has been more debate on same sex marriage and abortion than assisted dying. There were questions presented in writing which some of us as an audience had asked to particular panelists. One was from a Catholic who questioned the Catholic stance as this person had seen so many patients suffer. The answer was that one’s own conscience needs to be examined and if it is contrary to the religion than perhaps the person is no longer able to be part of the Catholic religion (or words to that effect. I suppose if you do not agree with a religion than you have the option to leave it and go where the thinking is more applicable for you). The psychiatrist spoke about empathy. He spoke of conveying that to his patients, to convey meaning to them, to tell them how much they matter even if isolated and embittered who have pushed everyone away or not attached and isolated. How much they matter to us (and they certainly mean much to me). He spoke of how much he has learned from his patients and tells them that. “I am learning from you. I’m learning how people cope with suffering……I am a vehicle….lessons to be learned from your suffering. Please teach me more so I can be that vehicle for my students and others to help others. The psychiatrist spoke of the differences of opinions among humanists as well. There are concerns about abuse, pressure, devaluing disabilities, palliative care and humanists would probably be opposed on those grounds. One panel person spoke of a new diaper that holds 24 cups of urine. People who are continent become incontenant in long term care. A lot more money should be placed in long term care. One person should not be in charge of 18 patients. Another panelist said there is a complete consensus for more attention to palliative care. There are some suffering and it cannot be alleviated. Will physicians be forced to do this if they are contrary to this? It is not thought that physicians can be forced into anything that goes against their conscience. The question and debate is regarding referring. There was a reason why the ruling was found in favour of assisted dying. The concerns of the “slippery slope” were found in some cases where this law is implemented but not normal. People want a sense of control. (By slippery slope he means where there were ulterior motives for assisted dying). The day was very informative and I would not leave the room for any reason because I did not want to miss something important. What do I think about all this? I think it is important to know what is going on. I think it is important to know what the different religions perspective is. That is important in my practise. Living in Toronto I see people from a variety of religious and cultural backgrounds. This enriches me. I need to understand their religion and culture to understand an important part of them. It is not my focus to correct them about their religion, it is important that I have the answers if questions are asked regarding various perspectives. When my neighbour sees me and asks me about the Jewish perspective, I can now answer him. How do we help people unless we make the effort to understand what is important to them. Regardless of the laws, how people perceive them is critical. My job is easy regarding this aspect. If I am asked to be there for someone, who chooses death, than I shall be there. It is not up to me to judge the decisions of others. It is not up to me to impose my own beliefs on others. I have seen a lot of suffering and I know of at least one person who wanted to die at her own hands. I think more could have been done for her. Consistency of having one person with her rather than a variety would have helped her. That is my opinion. Being with the same person you connect with while going through all the stages facing death is in my opinion more effective than seeing different people and telling your same story over and over rather than having someone journey with you and beside you. I have seen physicians respect life so much that I am in awe. A physician once told me that his patient had no brain activity what so ever when he was brought in and then there was. “How often does that happen?” I asked. “It doesn’t” he replied. The woman nearby who was upset that I am in favour of life was angry that a prominent cardiologist had no problem saying that she would not be part of assisted dying. One ethicist perked up, “was that in front of patients?” It was not. If I have learned anything, it is that nothing is ever as simple as it sounds. I do have my concerns. I have my concerns because I have seen people at the brink of suicide, and with extensive therapy they are able to change their lives around. In my undergrad when studying in a course regarding medicine and I am sure I will eventually find my notes and post them as well there was a period in the middle ages Rome I believe where assisted dying was legal. They made it illegal again after awhile because there were people being killed because family members wanted their assets. Apparently this is the “slippery slope” that seems to be very limited. Statistically, a high amount people who try to commit suicide and fail, move on to live very productive lives and would not consider suicide again. However, if this is legal and someone who is suicidal and if you wanting to die and this is granted, then what does this mean? That is my biggest concern. I know that you can always find and get a second opinion. There are always different concerns or biases or perspectives in any field or expertise. Everyone has an opinion as a professor wants exclaimed not wanting to go to a meeting to hear anymore. I think that this is important and there needs to be discussion regardless if some do not like to hear what others think. This requires collaborative thought so we can move forward. I love life and value life, however I am healthy. I have seen people return to a good quality of life where they have struggled with initially. I have also seen people who had one moment wanted to die and then with some behavioural changes look at life again through different lens. There are too many people out there who live in isolation, in fear, who feel unloved and uncared for. Are we going to put them out of their misery so to speak? I can understand a person wanting to die when they are in pain and in that moment they see no other option. Can we not improve ensuring that people get the mental health treatment they deserve rather than having them on the streets fending for themselves? Can we not have OHIP to include mental health treatment outside the scope of psychiatry or hospital for those who have no insurance? Can we not consider options to improve mental health for those who cannot afford to pay for it? Can we not improve palliative care? As baby boomers retire and burden the health care system by growing old, are we going to care for them humanly or are we going to find diapers than can hold more than 24 cups. I do have my reservations and concerns aside from the religious perspectives. What do you think? I am posting this without reviewing it so please forgive me but I do think I should post this now rather than later. I encourage you to express your thoughts. This is new for Canada.