Friday, November 6, 2009

Canada's Upcoming Assisted Suicide Vote.

In the lead up to Canada's vote next week on the legality of assisted suicide, Quebec's College of Physicians has endorsed some forms of "euthanasia." The approval has caused an enormous stir in Canada, with "pro-life" groups claiming that any change to the law will "turn medicine on its head."

Alex Schadenberg of the Canadian Euthanasia Prevention Coalition and others are working hard to define not the specifics of the proposed Canadian bill (C-384) but the broader terms used for assisted suicide, thus evoking a broad and unspecific ideological approach to death that unfortunately aims to keep palliative, hospice and other end of life care practices in the dark.

Yet, Arthur Schafer skirts the hyperbole and writes for the Globe and Mail that legalization of the practice in other states and countries has proven otherwise.

Physician-assisted suicide has been legal in Oregon for 11 years and accounts for about one out of every thousand deaths a year. But, although it's not used often, one in six patients discusses this option with their family, and one in 50 raises it with their doctor. In other words, the safeguards appear to work. Few people opt for physician-assisted suicide, but many take comfort from the knowledge that, if their lives become unbearable, they can request – and be given – assistance to die.

Of course, as doctors sometimes acknowledge, euthanasia and assisted suicide are practised secretly in both the United States and Canada. Where these practices are illegal, they are practised in the dark and thus much more likely to result in mistakes and abuse.

Critics widely predicted that legalizing physician-assisted suicide would be a slippery slope to cutbacks in palliative care. Society would reason: Why offer expensive comfort care to suffering patients when it's cheaper to hasten their deaths? In practice, the opposite has occurred. Oregon legislation requires that dying patients be offered a full range of options, and the state has become a leader in palliative and end-of-life care.

One argument for legalizing assisted suicide considers the common practice of continuous deep sedation (CDS), often in the dark. Family members and doctors currently agree to sedate a dying patient who is extreme pain. Yet, this practice goes on without reporting primarily because doctors fear prosecution. Though CDS is legal in the US because the primary objective is to relieve pain, a shroud of secrecy now surrounds the practice. Because discussions regarding end of life pain treatment are not happening in the open, we know little about it.

Shafer rightly points out that in countries and states (Oregon) where assisted suicide is legal, the openness regarding end of life care and palliative treatment is revolutionizing care. Families, doctors, caregivers and society as a whole are able to discuss rational solutions to terminal and elder suffering. This open discourse and study which leads to advancements can only be a good thing for patients.

More: Canadian "pro-life" groups claim study reveals public confusion over issue.

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