on the Coast
Flair
Flair on the Coast
Medical Assistance in Dying M.A.I.D.
Dr. Eddie Bernstein,
Flair, Rockwood, 10:30am to 11:30am, April 14th, 2018
Introduction
This was a very well attended session and many thanks to Carol and Jean for organizing this. It is obviously a topic that needs thoughtful discussion based on fact. Dr. Bernstein gave an excellent factual overview which included the history from a Canadian perspective leading to legislative authority, the safeguards built into the legislation, the steps taken by an individual to secure M.A.I.D., the actual process and drugs involved, and experiences of this on the Sunshine Coast.
History
Public awareness of the need for medically assisted dying was raised when Sue Rodriquez, dying of ALS, took the issue to the Supreme Court of Canada in 1993. Assisting in suicide was a criminal act in Canada under the Criminal Code, although suicide was not. The ruling against decriminalizing physician assisted suicide lost in a 5/4 split. Two decades later, in 2015, the Criminal Code was challenged again by the BC Civil Liberties Assn. on the basis of infringement of Charter rights and the Supreme Court of Canada at this time brought in a unanimous ruling in favour decriminalizing physician assisted dying. A year was given to come up with revised laws and regulations. The law changed in 2016. Dr. Bernstein commented that the law allows only for the most restrictive of measures and safeguards although there is some room for interpretation.
Providers
Persons who are qualified to participate include medical doctors and nurse practitioners. Pharmacists are covered as well as they will be providing the drugs. It is not a professional requirement that physicians perform this role so that access may be a problem in small communities and in faith based institutions. There is agreement on the Sunshine Coast that if necessary off coast physicians might be called to participate if necessary.
The process
There are two methods. One involves an intravenous drip, other oral medication. In the intravenous drip, the dying person falls asleep and after that the heart stops. There have been no difficulties with this method. Some have chosen oral medication but it has happened that they have made the person nauseous and complicated the process. It is not considered as reliable as intravenous. The physician must be present during the administration and until death is pronounced.
Eligibility
The rules are clear. In BC the person must be eighteen years or older, have a BC Care Card, be suffering and in the advanced state of an irreversible medical condition, with death in the foreseeable future. The request must come from the individual, it must be voluntary and it must be with informed consent. All options must be presented to the person who is requesting this, which would include palliative and hospice services available in the community. And the person can withdraw consent at any time in the process.
There has been some variation in interpretation of terminal and ‘death in the foreseeable future’ by physicians and there is some leeway for this interpretation.
The process
The person would seek a physician prepared to assist. The person would discuss this with the physician and sign a form. A second physician must also interview the person and agree they meet the criteria and that the decision is voluntary and informed. Both physicians must be independent of one another. Once the forms are signed there is a mandatory waiting period of ten days. During which time the person can change their mind. And their mind can change up to the point of the injection.
Myths
There have been concerns that vulnerable people are at risk. These concerns have been unfounded. Most people choosing this are well educated. Children, persons with mental illness, intellectual disability or dementia are not qualified for this procedure. There are concerns that some people within those categories are suffering needlessly because the eligibility rules are so stringent. For example, it is possible that persons with a history of depression, who may now have a terminal illness might not be eligible. BC Civil Liberties are bringing a Charter challenge on that basis.
Statistics
Since the law changed in 2016 there have been 3000 assisted deaths in Canada. 1000 in BC and 15 on the Sunshine Coast. The recent death of Syd Valentine was documented in the Coast Reporter and is well worth the read. There is a national committee report due out in a few months and it will likely have much move information on the state of this procedure in Canada.
Issues with M.A.I.D.
This is very time consuming for physicians and there is not sufficient recognition or financial compensation for this. There is a great deal of paper work. With more M.A.I.D. deaths occurring at home, grieving families and friends need time for emotional support and this can be overwhelming for the physician as well.
Issues with Death
We have not dealt well with death in this society. We have separated ourselves from death which makes death an alien and fearful process rather than a natural process that we will all face. Some of us fear the prospect of a painful death rather than the death itself. Discussions like this one with Dr. Bernstein are very helpful. Most people will not need M.A.I.D. at the end of their life. Death will come naturally or will be managed with palliative and hospice services. But it is very comforting to know that the option of medically assistance in dying is available on the Sunshine Coast if and when we or our loved ones are in need.
Dr. Eddie Bernstein,
Flair, Rockwood, 10:30am to 11:30am, April 14th, 2018
Introduction
This was a very well attended session and many thanks to Carol and Jean for organizing this. It is obviously a topic that needs thoughtful discussion based on fact. Dr. Bernstein gave an excellent factual overview which included the history from a Canadian perspective leading to legislative authority, the safeguards built into the legislation, the steps taken by an individual to secure M.A.I.D., the actual process and drugs involved, and experiences of this on the Sunshine Coast.
History
Public awareness of the need for medically assisted dying was raised when Sue Rodriquez, dying of ALS, took the issue to the Supreme Court of Canada in 1993. Assisting in suicide was a criminal act in Canada under the Criminal Code, although suicide was not. The ruling against decriminalizing physician assisted suicide lost in a 5/4 split. Two decades later, in 2015, the Criminal Code was challenged again by the BC Civil Liberties Assn. on the basis of infringement of Charter rights and the Supreme Court of Canada at this time brought in a unanimous ruling in favour decriminalizing physician assisted dying. A year was given to come up with revised laws and regulations. The law changed in 2016. Dr. Bernstein commented that the law allows only for the most restrictive of measures and safeguards although there is some room for interpretation.
Providers
Persons who are qualified to participate include medical doctors and nurse practitioners. Pharmacists are covered as well as they will be providing the drugs. It is not a professional requirement that physicians perform this role so that access may be a problem in small communities and in faith based institutions. There is agreement on the Sunshine Coast that if necessary off coast physicians might be called to participate if necessary.
The process
There are two methods. One involves an intravenous drip, other oral medication. In the intravenous drip, the dying person falls asleep and after that the heart stops. There have been no difficulties with this method. Some have chosen oral medication but it has happened that they have made the person nauseous and complicated the process. It is not considered as reliable as intravenous. The physician must be present during the administration and until death is pronounced.
Eligibility
The rules are clear. In BC the person must be eighteen years or older, have a BC Care Card, be suffering and in the advanced state of an irreversible medical condition, with death in the foreseeable future. The request must come from the individual, it must be voluntary and it must be with informed consent. All options must be presented to the person who is requesting this, which would include palliative and hospice services available in the community. And the person can withdraw consent at any time in the process.
There has been some variation in interpretation of terminal and ‘death in the foreseeable future’ by physicians and there is some leeway for this interpretation.
The process
The person would seek a physician prepared to assist. The person would discuss this with the physician and sign a form. A second physician must also interview the person and agree they meet the criteria and that the decision is voluntary and informed. Both physicians must be independent of one another. Once the forms are signed there is a mandatory waiting period of ten days. During which time the person can change their mind. And their mind can change up to the point of the injection.
Myths
There have been concerns that vulnerable people are at risk. These concerns have been unfounded. Most people choosing this are well educated. Children, persons with mental illness, intellectual disability or dementia are not qualified for this procedure. There are concerns that some people within those categories are suffering needlessly because the eligibility rules are so stringent. For example, it is possible that persons with a history of depression, who may now have a terminal illness might not be eligible. BC Civil Liberties are bringing a Charter challenge on that basis.
Statistics
Since the law changed in 2016 there have been 3000 assisted deaths in Canada. 1000 in BC and 15 on the Sunshine Coast. The recent death of Syd Valentine was documented in the Coast Reporter and is well worth the read. There is a national committee report due out in a few months and it will likely have much move information on the state of this procedure in Canada.
Issues with M.A.I.D.
This is very time consuming for physicians and there is not sufficient recognition or financial compensation for this. There is a great deal of paper work. With more M.A.I.D. deaths occurring at home, grieving families and friends need time for emotional support and this can be overwhelming for the physician as well.
Issues with Death
We have not dealt well with death in this society. We have separated ourselves from death which makes death an alien and fearful process rather than a natural process that we will all face. Some of us fear the prospect of a painful death rather than the death itself. Discussions like this one with Dr. Bernstein are very helpful. Most people will not need M.A.I.D. at the end of their life. Death will come naturally or will be managed with palliative and hospice services. But it is very comforting to know that the option of medically assistance in dying is available on the Sunshine Coast if and when we or our loved ones are in need.
For more information follow this link to Dying With Dignity.
