Tuesday, February 16, 2010

Canadian Poll on "Euthanasia" Contested.

While a new poll by Angus Reid shows that a majority of Quebec and BC residents support "euthanasia" policies, the poll is contested by disability and "pro-life" groups who say that the general public does not properly address disability and end of life issues.

I post this article (best when contrasted with last week's Angus Reid poll of the US) because of a comment, bolded below, by the pollster. It seems, he says, that where the euthanasia debate is greatest - in the news, as in Quebec - people are more willing to support it. This is substantial in a number of ways: does more information regarding end of life care, palliative care, and aid in dying change opinions toward favorable?

Catch the comments if you want to hear more about how the general public articulates support for "euthanasia" laws.

From the Globe and Mail:

The online survey compiled the opinions of 1,003 Canadian adults, with Quebec and B.C. showing the highest support for euthanasia, respectively.

Nationally, 85 per cent of Canadian respondents believe legalizing euthanasia would allow an opportunity for suffering people to ease their pain, in addition to establishing clearer regulations for doctors with end-of-life decisions.

Further, two-thirds of Canadians agreed that legalizing euthanasia would not send the message that the lives of the sick or disabled are less valuable.

Jaideep Mukerji, public affairs vice president for Angus Reid, said the differences amongst the provinces showed interesting variations. “In Quebec, where there is a much stronger political debate surrounding euthanasia, it was interesting to note that the poll indicated that the provincial result was nearly 10 points higher than the national average,” he said.

Cheryl M. Eckstein is an anti-euthanasia activist and president of the Euthanasia Prevention Coalition. Despite her status as a chronic pain patient, which went undiagnosed for months, Eckstein remains a staunch opponent to assisted suicide. She believes the latest poll revealed a lack of public understanding on the topic of euthanasia.

“There isn't a lot of information about what is euthanasia,” she said. “Some people don't really understand what it is. They think euthanasia is the same as pulling the plug.”

Regardless of public misconceptions, the poll established that 50 per cent of British Columbians agree there should be no penalty applied to a parent found guilty of assisting the death of a terminally ill child, whereas only a third of Ontarians and Albertans felt the same way. Currently in Canada, it is a crime to counsel or aid someone with suicide, punishable by a 14-year prison sentence.

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More, Better Hospice Care.

Patrice Villars writes at GeriPal on the ways to improve care for patients in hospice care: make treatments more individualized:

Registered nurses are trained to alleviate suffering through diagnosis and treatment of human responses to actual or potential illness. We are trained to assess and treat based on holistic goals and to view the patient in the context of their defined family. Palliative care and nursing philosophy share a holistic approach to care that encompasses physical, emotional and spiritual concerns of the patient and family unit. It is no small wonder that nurses have been the foundation of community hospice work since its beginnings. Physicians are trained to formulate and treat medical diagnoses. Nurse Practitioners are, well, the middle children. We are nurses who have advanced training in diagnosis and treatment of medical conditions in addition to our foundational training. Our medical training is not as deep or broad as that of physicians. Nurse practitioners often pursue further training to develop an area of expertise.

None of us truly knows what we don’t know. Even the most experienced hospice nurses don’t know how their practice would differ if they had the advanced education and training of a nurse practitioner. Few physicians or physician assistants understand the level of training of RNs or LVNs/LPNs, nor their scope of practice. How could they? They’re not nurses. Only the nurse practitioner holds the dual training and, as such, is the perfect liaison for optimal collaboration between these two disciplines.

Surprisingly, nurse practitioners do not play a pivotal role in most community hospice agencies. Medicare requires that there be a physician medical director. Registered nurses usually function as the hospice case manager for the care of the end stage illness.

Hospice nurses are well trained in using medications to manage symptoms. Hence the array of the (all too often) ‘one size fits all’ order set of PRNs. This makes sense when the nurse is out in the home or on the phone doing her/his very best to assess and treat distressing symptoms at the end of life. It’s pretty difficult to track down the doctor of record, contact her/him, describe the situation, request an order and get it to the patient within a reasonable period of time such that the patient (and family) does not suffer for hours longer. Having pre-signed orders to use PRN can be a life-saver (no pun intended) at times. The downfall is the one size fits all practice. Shortness of breath equals morphine; anxiety equals lorazepam; confusion/agitation equals haldol.

There is continued grumbling among hospices and palliative care folks that patients are often referred too late to hospice care. However, at least in the case of patients with some non-cancer diagnoses, are they? Is our system set up to care for these patients optimally at the end of life? Sadly, I think not.
Happily, there is a relatively easy solution – use nurse practitioners who have advanced training in palliative care and (my bias) gerontology.
What if hospice nurses had easy access to a palliative care NP who had the training to assess and treat medically complex patients at the end of life? What if the hospice nurses had access to someone who understood their practice and could provide the appropriate education and support to improve their practice? What if the NP was available for home visits? Hospice nurses might practice differently. Patients would get better care. And health care providers might not be so reticent to refer their patients a little earlier.

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Case of Mercy Killing Hits British Media.

From my friend Graciela: a new British documentary on assisted suicide contains the admission by veteran BBC reporter Ray Gosling that many years ago, when his lover who was dying from Aids, he honored their pact by holding a pillow over the dying man's face to prevent more suffering.

Sarah Garrod reports at InTheNews:

A BBC broadcaster is being investigated by police after he confessed live on air he had smothered his lover who was dying of Aids.

Ray Gosling, 70, said he had committed the killing as a mercy act, to prevent his lover from suffering "terrible pain".

Mr Gosling made the confession on the BBC East Midlands programme Inside Out broadcast last night. It is understood the show was recorded last November, but the BBC had not notified the police.

Nottinghamshire police said: "We were not aware of Mr Gosling's comments until the BBC Inside Out programme was shown.

"We are now liaising with the BBC and will investigate the matter."

Mr Gosling said on the show: "I killed someone once. He'd been my lover and he got Aids.

"I picked up the pillow and smothered him until he was dead. No regrets."

He added that he had killed the man after doctors told him in hospital that nothing more could be done for him: "I said to the doctor: 'Leave me… just for a bit,' and he went away.

"I picked up the pillow and smothered him until he was dead. The doctor came back and I said: 'He's gone.' Nothing more was ever said.

"When you love someone, it is difficult to see them suffer. My feelings on euthanasia are like jelly - they wobble about.

"This is the time to share a secret I have kept for quite a long time."

Care Not Killing, a UK-based alliance which promotes "more and better palliative care" and aims to ensure "that existing laws against euthanasia and assisted suicide are not weakened or repealed during the lifetime of the current Parliament", said following the broadcast of the show: "It is impossible for any outsider to establish the facts in this case objectively as all we have currently is Mr Gosling's confession.

"The police will need to investigate the case thoroughly in order to establish the facts and then it will be up to the Director of Public Prosecutions (DPP) to decide whether to bring a prosecution. If the DPP proceeds it will then be a matter for the courts. A key difficulty faced by all those involved will be that the key witness, the deceased, will be unable to give any account about what actually happened.

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When Are You Dead?

Arri Elsen at ReligionDispatches today looks at the new study (I've written about it here) that shows some persistent vegetative state patients are able to "answer" questions with brain waves. He examines some of the diverse emotional reactions we have to this study and asks what we can do to better understand the definition of death.

But you can get an idea of the complexity of this research’s ethical implications from the reactions of students in two very different courses I happened to be teaching in a single day. In one class—of physicians discussing research ethics—a neurologist was very upset. She thought these research findings would be just as likely to make it even more difficult for her and families to decide what to do with those in a vegetative or near-vegetative state. The families might demand the new test, and then, if there is some intentional brain activity, they might be excited or even more frustrated and upset, depending on how they interpreted the results in their own consciousnesses.

As if confirming this, in my other course—this time a class of undergraduates exploring why we believe the things we do—we happened to be exploring the question of what constitutes a person. We had just read Descartes’ famous treatise (in which he proclaims “I think, therefore I am”) and the neuroscientist Antonio Damasio’s Descartes’ Error. Based on this new MRI research, we asked the question: If your Dad can only communicate through ‘thought MRI’ like patients in this study, would you consider him alive?

A student answered: I’d rather pull the plug, let him die. From personal experience, I’d rather just pull the plug. Tears formed in the student’s eyes, she broke down, and ran from the room.

Does religion help us here? Yes and no, as we heard in the (in)famous Terry [sic] Schiavo case. There are diverse responses to such cases even within particular religions, because the factual and conceptual lines are so blurry. A Catholic or a Jew might say: in Genesis we learn that we are all made in the image of God, we all have an inherent dignity, and to take that away is wrong.

But what constitutes dignity here? another Catholic or Jew (or my student who ran from the room) might ask. A Muslim might say: to kill one person is to kill all people, to help one is to help all—but another might ask: how are we defining life?

One Buddhist says, we must hold on and wait for a miracle—but another responds: we must let this person and her soul go peacefully or else we are negatively impacting its next life.

Once again, science sneaks in on (invades?) the way we live and die—and makes it easier, and harder, to do so.

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