Webcast archive: 18/10/12

In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:

  • News briefs

Please note that this text is only a script and that our webcast contains additional commentary.

PAEDIATRIC EUTHANASIA POLICY PROPOSED

  • This week we have three assisted suicide and euthanasia (AS/E) policy issues to bring to your attention.
  • On September 21, researchers at Sick Kids Hospital in Toronto published an essay in the British Journal of Medical Ethics, describing how they came to adopt new policies on euthanasia for young people. Though the policy can apply to adults, the working group seems to be expecting that the Council of Canadian Academies study, due out in December, will recommend that eligibility for euthanasia be extended to “mature minors” (people under 18 years old).  It would then be up to Parliament to change the law if they wish to.
  • The policy focuses on the question of whether “allowing someone to die” and “causing someone to die” are the same thing.  The authors believe that, if you focus on the “patient” rather than the doctor, the differences between allowing and causing death become irrelevant, because both satisfy the “primary goal of MAiD,” which is to “alleviate unendurable suffering.” (So much for “kill the pain, not the person”)
  • The working group describes a 15-step process for assessment, approval and administration of euthanasia.  The proposed policy, the working group:
    • Suggests that the conversation about AS/E should be started by the person making the request, though they note that “this is diametrically opposed to the way virtually all other medical communication is structured.”
    • Does not mention suicide prevention.  (Though steps 6a and 7 mention “medically appropriate treatment options,”, these are not listed.)  This seems odd, until you remember that AS/E are not considered suicide.
    • Supports Ontario’s presumption that a person is capable, regardless of their age.  This follows the current policy of allowing people under 18 to make life-and-death decisions, but raises an important question: if teenagers’ brains are unstable due to rapid growth and hormone storms, and that instability can put them at risk for suicide, are adolescents really equipped to make thoughtful decisions about AS/E?
    • Presents conflicting information about whether people can appeal a finding of ineligibility due to incapacity to Ontario’s  Consent and Capacity Board.
    • Allows young people to be euthanized without their parents’ knowledge or consent.  (Though adolescents are encouraged to inform their parents, they are not required to do so.  This contradicts the hospital’s own recommendations for suicide prevention among adolescents).
    • Fails to take into account the role of disability discrimination in creating a negative self-image.  The policy also doesn’t compensate for the impact of the age and power imbalance between adult medical personnel and minor children, or the role of learned compliance in institutional settings in discussing treatment options.
    • Ignores the fact that more parents request AS/E for their children than children ask for it themselves.

SASKATCHEWAN STOPS COUNTING AS/E AS SUICIDE

  • The province of Saskatchewan has stopped counting assisted suicide and euthanasia deaths as suicides, which require a coroner’s investigation. They will now be recorded as “unclassified” on the Medical Certificate of Death.  (Not to be confused with a Death Certificate, which is a separate document, used for legal proof that person is dead.)
    • Clive Weighill, the chief coroner for the province, has said his office will investigate any death “if somebody thinks it is sudden, unexpected, unnatural or unexplained,” implying that an autopsy must be requested. In the case of AS/E, that would include claims of coercion or an improper procedure. Weighill said that to his knowledge “that has never happened in Saskatchewan.”
    • As we noted last month, local law enforcement does not have the resources, the motivation or the expertise necessary to look into these cases.

NEW GUIDELINES FOR DISORDERS OF CONSCIOUSNESS

  • The American Academy of Neurology released new guidelines for doctors treating disorders of consciousness (DoC) caused by traumatic brain injuries or oxygen deprivation. The document emphasized:
    • the importance of periodic re-testing by qualified neurologists using tools recommended by the Academy of Neurology and the American Congress of Rehabilitation Medicine (ACRM).  They also recommend using functional Magnetic Resonance Imaging, and making sure the person is as awake as possible when doing the testing;
    • the need for rehabilitation services and stimulation, either at a rehabilitation facility or at home;
    • avoiding statements that suggest a “universally poor prognosis” when talking to the family;
    • the fact that, since many people with nontraumatic DoC recover consciousness after three months, and others with traumatic DoC wake up after 12 months, the authors suggest:
      • Applying the term “chronic Unresponsive Wakefulness State (UWS)” rather than “persistent vegetative state”; and
      • These benchmarks (adopted in 1994) should not be used as a signal to withdraw life support;
  • Doctors often rush to judgment about people’s ability to recover from brain injuries, or what that “recovery” will look like.
    • When Not Dead Yet US wrote about the new AAN standards in its blog, NDY referenced the story of a little boy whose life support was nearly removed just six weeks after a non-traumatic brain injury, as an example of the “rush to judgment”.
    • Sometimes the decision to withdraw life support is rooted in fear of the disability caused by brain injury; the family devalues their loved one’s disabled life rather than taking the time and support they need to adjust.
    • As well, the continued use of the term “vegetative state” is dehumanizing. No person can ever lose their humanity – or become broccoli!
  • We hope that medical professionals will follow these new standards, rather than cutting lives short because people weren’t given the time they needed to heal.