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Assisted Suicide and Euthanasia: O Canada!

By | June 26, 2017 | 0 Comments

 


Hippocrates, c. 460-370 B.C.

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Canada Supreme Court, 2017

Hippocrates lived 25 centuries ago. He practiced and taught medicine on the Greek island of Kos. The Supreme Court of Canada sits today in the capital at Ottawa. My choice of images was intentional. We do not know what Hippocrates looked like, other than that he had male-pattern baldness. But I chose to show a modern conception of his likeness. I could have shown a photo of the nine Supreme Court justices. But I chose to show a photo of the building.

My intention was to suggest that though we don’t know what Hippocrates looked like, we do know that he was a role model of the humane physician. And while we do know what the Canadian justices look like, we also know that they value human life less than did the ancient Greek ‒ hence the cold stones of the building.

I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give a woman an instrument to produce abortion.
– Hippocrates, Physicians’ Oath, c. 400 B.C.

Canadian Supreme Court legalizes euthanasia and assisted suicide.
News report, 2016

In the first six months, more than 744 Canadians have been euthanized. It is anticipated that 5% of all deaths will be by euthanasia or assisted suicide.
News report, 2016

Woman in nursing home euthanized who may have had only a bladder infection.
News report, 2016

The court’s decision was ratified by Canada’s parliament four months later. But the fact remains that unelected potentates decided to overthrow a basic principle of medicine that had endured for two and one-half millennia: physicians do not kill their patients.

Canada thus followed in the stumbling footsteps of the Netherlands, Belgium, Switzerland, Luxembourg, and Colombia, as well as Oregon, Washington, Vermont, Montana, Colorado, and California.

When severely brain-damaged Terry Schiavo was slowly dehydrated and starved to death over 13 days, people said, “I wouldn’t want to live like that.” Neither would I. But I also wouldn’t like to live like homeless persons. That doesn’t give me the right to drive to a freeway overpass and start shooting them. My fear doesn’t give me the equivalent of James Bond’s double-zero license. It doesn’t empower me to violate the laws of God or man. My fear of disability doesn’t empower me to kill you if you become disabled.

We can question whether it is wise – or safe – to conflate the role of healer with the role of executioner. We can question whether we will be able to see someone in a white coat enter our hospital room, and not feel a pang of doubt about whether he or she is there to help us get better – or to help us die sooner.

Specifically, we can ask this question: Why is taking an overdose of barbiturates – prescribed by a “health-care provider” with the approval of the state – somehow a beautiful and uplifting way of leaving this world, while taking pills or shooting yourself on your own is unacceptable? Why does the first supposedly have no ill effects on surviving loved ones, while the second may lead to an increased suicide risk among family members?

Here is a related question: Why is an overdose of barbiturates “terribly painful” and so fraught with error that a federal judge banned its use in California to put convicted murderers to death, yet at the same time it is a painless and sure way to kill medical patients? Say what?

And we can ask these questions:

● The Canadian law supposedly provides safeguards for hospital-administered euthanasia. But it provides few safeguards for assisted suicide performed outside a hospital. Assisted suicide may be provided by a nurse practitioner, who must consult with a second “health-care provider,” who may also be a nurse practitioner. That is, a Canadian patient can be killed without the approval of even one physician. Don’t believe me? Read the prestigious New England Journal of Medicine, a staunch defender of euthanasia and assisted suicide: N Engl J Med 2017; 376:2082-2088, May 25, 2017. See: http://www.nejm.org/doi/full/10.1056/NEJMms1700606

● Oddly, the Canadian law includes no provision for a patient who changes his or her mind, and now refuses euthanasia or assisted suicide. It is assumed that the “team” will accede to the patient’s revised wishes. In matters of life and death, one should not rely on assumptions.

● Why is there is no mention of verifying the diagnosis except by “reviewing the chart”? Reviewing the chart gives us a good idea of the chart, but not of the patient. I spent 25 years in medical oncology at a university medical center. For every patient, we reviewed the biopsy slides with our pathologists. Usually the referring diagnosis was correct. Sometimes it wasn’t. In matters of life and death, one should not rely on assumptions.

Similarly, patients with neurologic disease should be evaluated by an independent neurologist, patients with heart disease should be evaluated by an independent cardiologist, and patients with intractable pain should be evaluated by an independent specialist in pain management. Why is this not required?

● Why is there is no requirement that the patient be seen by an independent psychiatrist or psychologist to rule out depression? True, anyone contemplating suicide is by definition depressed. The question is whether the physical disease or the depression is the chief reason for suicidal thoughts.

The treatment for depression includes psychotherapy, antidepressants, and family support. Suicide is not a treatment for depression. Suicide is the result of failure of treatment for depression.

On the other hand, availability of a “way out” may help some sufferers to endure their problems. Some patients express gratitude, even when they decide not to commit suicide. Honesty requires that we recognize this fact.

Advocates for assisted suicide or euthanasia often talk about respecting the patient’s “autonomy.” To me, this word means that I decide whether or not to end my life. And if my answer is yes, I take responsibility for ending it my way, and don’t ask others to do it for me – unless, of course, I am quadriplegic. “Autonomy” should mean what it says.

Suggesting suicide to a patient should not be called “respecting autonomy.” In many cases, a more honest term would be “cost containment.”

● Why is there is no comment on possible errors – that is, facilitating the deaths of patients who were not “terminal”?

“Terminal” used to mean “in the actual process of dying.” But now, “terminal” means “expected to die in six months.” Such predictions are often inaccurate. Cosmologist Stephen Hawking was told he had two years to live at age 21 – that was 54 years ago.

Despite the problems with predicting how long a patient may live, the Canadian law lacks even this requirement. That is, the disease may be incurable, but the specific patient may have years left ‒ and still be a candidate for euthanasia or assisted suicide. This goes beyond troubling and reaches the level of frightening.

● Why is it that under these laws, the doctor makes out the death certificate to indicate the underlying disease as the cause of death, but omits assisted suicide? The cases are supposed to be reported to a central authority, but may not be. If assisted suicide is praiseworthy, why conceal it?

As is true elsewhere, Canadian applicants for assisted suicide often name fear of being a burden as a reason, but rarely name uncontrolled pain. The treatment for fear of being a burden is reassurance that the patient is not a burden and is still loved and valued as a unique human being created in God’s image. The treatment is not to remove the burden by killing the patient.

The bias of physicians from the time of Hippocrates, 25 centuries ago, until only a few years ago, was for the continuation of life. The bias is now shifting. Unless we do something, soon the bias will be for the cessation of life as soon as it becomes inconvenient to others. In an era of “cost containment,” this thought should trouble all of us.

We are all going to die sometime. In that sense, we are all “terminal.” Let us act accordingly – by doing the best we can in however many or few days remain to us, rather than denying reality by attempting to control death, the final proof that we are not in control.

Advocates of “single payer” – that is, government-run health care – promise “universal coverage.” In view of the increasing acceptance of euthanasia and assisted suicide, we have a right to ask whether the “coverage” will be by six feet of dirt.

 

Disability-Rights Advocates

Author’s Note: For further information, go to Not Dead Yet and Euthanasia.com.

Contact: dstol@prodigy.net. You are welcome to publish or post these articles, provided that you cite the author and website.

www.stolinsky.com

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