February 18, 2019

Winnipeg
-22° C, Partly cloudy

Full Forecast

Advertisement

Advertise With Us

Opinion

Too quick to ask for early death?

Hey there, time traveller!
This article was published 16/3/2016 (1068 days ago), so information in it may no longer be current.

The moment we are born, our lives take flight; and the longer we are airborne, the greater the chance of encountering turbulence along the way. While every flight is destined to land, some landings are harder to contemplate than others.

The parliamentary committee tasked with advising the federal government on how to roll out physician-hastened death must have struggled with the prospect of dying with dementia. Their advice to lawmakers was anyone with a condition likely to cause a loss of competence should be able to complete an advance directive any time after their diagnosis, directing that they should be euthanized.

This recommendation goes well beyond anything the Supreme Court of Canada intended.

The court stipulated physician-hastened death must only be considered for competent adults, in the circumstances of their current condition. The idea that Canada would make it lawful for people to consider a future version of themselves unacceptable and sign off on a euthanasia order was not something the court contemplated. After all, in any assisted-dying regime, a competent patient is free to change their mind or express their ambivalence by withdrawing a request or postponing an assisted death. To permit an assisted death to proceed on the basis of an advance directive effectively denies this protection to persons who are no longer capable of making or expressing health-care decisions.

Get the full story.
No credit card required. Cancel anytime.

Join free for 30 days

After that, pay as little as $0.99 per month for the best local news coverage in Manitoba.

 

Already a subscriber?

Log in

Join free for 30 days

 

Already a subscriber?

Log in

Subscribers Log in below to continue reading,
not a subscriber? Create an account to start a 30 day free trial.

Log in Create your account

Your free trial has come to an end.

We hope you have enjoyed your trial! To continue reading, we recommend our Read Now Pay Later membership. Simply add a form of payment and pay only 27¢ per article.

For unlimited access to the best local, national, and international news and much more, try an All Access Digital subscription:

Thank you for supporting the journalism that our community needs!

Your free trial has come to an end.

We hope you have enjoyed your trial! To continue reading, we recommend our Read Now Pay Later membership. Simply add a form of payment and pay only 27¢ per article.

For unlimited access to the best local, national, and international news and much more, try an All Access Digital subscription:

Thank you for supporting the journalism that our community needs!

We hope you have enjoyed your free trial!

To continue reading, select a plan below:

All Access Digital

Introductory pricing*

99¢

per month

  • Unlimited online reading and commenting
  • Daily newspaper replica e-Edition
  • News Break - our award-winning iOS app
  • Exclusive perks & discounts
Continue

Read Now Pay Later

Pay

27¢

per article

  • Commitment-free
  • Cancel anytime
  • Only pay for what you read
  • Refunds available
Continue

*Introductory pricing schedule for 12 month: $0.99/month plus tax for first 3 months, $5.99/month for months 4 - 6, $10.99/month for months 7 - 9, $13.99/month for months 10 - 12. Standard All Access Digital rate of $16.99/month begins after first year.

We hope you have enjoyed your free trial!

To continue reading, select a plan below:

Read Now Pay Later

Pay

27¢

per article

  • Commitment-free
  • Cancel anytime
  • Only pay for what you read
  • Refunds available
Continue

All Access Digital

Introductory pricing*

99¢

per month

  • Unlimited online reading and commenting
  • Daily newspaper replica e-Edition
  • News Break - our award-winning iOS app
  • Exclusive perks & discounts
Continue

Mon to Sat Delivery

Pay

$34.36

per month

  • Includes all benefits of All Access Digital
  • 6-day delivery of our award-winning newspaper
Continue

*Introductory pricing schedule for 12 month: $0.99/month plus tax for first 3 months, $5.99/month for months 4 - 6, $10.99/month for months 7 - 9, $13.99/month for months 10 - 12. Standard All Access Digital rate of $16.99/month begins after first year.

We hope you have enjoyed your free trial!

To continue reading, select a plan below:

All Access Digital

Introductory pricing*

99¢

per month

  • Unlimited online reading and commenting
  • Daily newspaper replica e-Edition
  • News Break - our award-winning iOS app
  • Exclusive perks & discounts
Continue

Read Now Pay Later

Pay

27¢

per article

  • Commitment-free
  • Cancel anytime
  • Only pay for what you read
  • Refunds available
Continue

*Introductory pricing schedule for 12 month: $0.99/month plus tax for first 3 months, $5.99/month for months 4 - 6, $10.99/month for months 7 - 9, $13.99/month for months 10 - 12. Standard All Access Digital rate of $16.99/month begins after first year.

We hope you have enjoyed your free trial!

To continue reading, select a plan below:

Read Now Pay Later

Pay

27¢

per article

  • Commitment-free
  • Cancel anytime
  • Only pay for what you read
  • Refunds available
Continue

All Access Digital

Introductory pricing*

99¢

per month

  • Unlimited online reading and commenting
  • Daily newspaper replica e-Edition
  • News Break - our award-winning iOS app
  • Exclusive perks & discounts
Continue

*Introductory pricing schedule for 12 month: $0.99/month plus tax for first 3 months, $5.99/month for months 4 - 6, $10.99/month for months 7 - 9, $13.99/month for months 10 - 12. Standard All Access Digital rate of $16.99/month begins after first year.

Hey there, time traveller!
This article was published 16/3/2016 (1068 days ago), so information in it may no longer be current.

The moment we are born, our lives take flight; and the longer we are airborne, the greater the chance of encountering turbulence along the way. While every flight is destined to land, some landings are harder to contemplate than others.

The parliamentary committee tasked with advising the federal government on how to roll out physician-hastened death must have struggled with the prospect of dying with dementia. Their advice to lawmakers was anyone with a condition likely to cause a loss of competence should be able to complete an advance directive any time after their diagnosis, directing that they should be euthanized.

This recommendation goes well beyond anything the Supreme Court of Canada intended.

The court stipulated physician-hastened death must only be considered for competent adults, in the circumstances of their current condition. The idea that Canada would make it lawful for people to consider a future version of themselves unacceptable and sign off on a euthanasia order was not something the court contemplated. After all, in any assisted-dying regime, a competent patient is free to change their mind or express their ambivalence by withdrawing a request or postponing an assisted death. To permit an assisted death to proceed on the basis of an advance directive effectively denies this protection to persons who are no longer capable of making or expressing health-care decisions.

That is a risky proposition.

Research shows people are not very good at predicting what they would want and what they might need and feel in circumstances they have not yet confronted. The farther removed those circumstances are from today’s reality, the more difficult it is to imagine the response.

Case in point: the Oregon Death With Dignity Act, allowing for assisted suicide for patients with less than six months to live, was supported on a referendum ballot by the majority of Oregonians. And yet, less than half of one per cent of deaths in Oregon are accounted for by physician-assisted suicide. Clearly, what people think they might want, and what they end up wanting due to the circumstances of their condition, are simply not the same.

So why did the Canadian committee go as far as it did?

Fear is seldom a reliable guide to good social policy. But like most of us, parliamentary committee members must have found the prospect of turning into an altered version of their former selves terrifying. They likely did not appreciate that dementia is a progressive terminal illness; the seventh-leading cause of death in Canada. They probably did not appreciate the suffering they imagined was due to lack of adequate or appropriate end-of-life care these patients receive — despite ample evidence that the symptom burden can be comparable to cancer. Patients with dementia are less likely to be referred for palliative care, have family caregiver involvement in decision-making or receive palliative medication, including pain medication.

Dutch legislators included a euthanasia advance-directive provision for patients anticipating a cognitive decline. While their rationale likely mirrored the Canadian parliamentary committee, the idea has turned out to be completely untenable. Despite requests occasionally being made, they are rarely adhered to.

In the vast majority of instances, physicians find it "inconceivable" to comply with the requests, given the patient with dementia has become a psychologically different person than the one who made the original request; physicians are no longer able to determine the patient’s current wishes, feel the patient is not suffering or believe that they no longer want to die. While family members were supportive of not including life-prolonging treatment, they asked that the euthanasia advance directive not be followed because of uncertainty about the person’s current wishes, not being ready for the person to die or not sensing that the person is suffering.

As for planning a good death with dementia, end-of-life discussions need to start sooner rather than later. Patients must have the opportunity to express their wishes and preferences for care. Their pain and symptoms need to be well-managed. Advanced-care planning can ensure unwanted treatments, which may prolong the length of life without sustaining or improving the quality of life, are not imposed. Such planning can also reduce the likelihood of unnecessary hospitalizations and increase the chances of dying where people choose.

There is good data to demonstrate that compassion, a gentle touch, respect, and patience can benefit even those patients with moderate to severe dementia. Granted, this approach is not the quick and efficient landing the parliamentary committee members may have had in mind. But for now, it is the very best we can do.

Dr. Harvey Max Chochinov, a distinguished professor of psychiatry at the University of Manitoba, holds the only Canada research chair in palliative care. He was the former chairman of the federal government’s external panel for options to Carter v. Canada.

Next week: Mental health is still loaded with stigma in Canada; is offering physician-assisted death to the afflicted really progress?

Advertisement

Advertise With Us

You can comment on most stories on The Winnipeg Free Press website. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or digital subscriber to join the conversation and give your feedback.

Have Your Say

New to commenting? Check out our Frequently Asked Questions.

Have Your Say

Comments are open to The Winnipeg Free Press print or digital subscribers only. why?

Have Your Say

Comments are open to The Winnipeg Free Press Subscribers only. why?

The Winnipeg Free Press does not necessarily endorse any of the views posted. By submitting your comment, you agree to our Terms and Conditions. These terms were revised effective January 2015.

Advertisement

Advertise With Us