In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:
- No free choice to die: Archie Rolland
- Medical errors
Please note that this text is only a script and that our webcast contains additional commentary.
NO FREE CHOICE TO DIE: ARCHIE ROLLAND
- Since last summer, TVNDY has been gathering stories of people who have been caught in the gears of the medical aid in dying (MAiD) machinery. Most were people who asked to die, but really needed help to live. Many were euthanized, or had life-sustaining care withdrawn or withheld, or simply pled their case via the media in the court of public opinion.
- Over the next few months, we’re going to tell these stories of how and why the system has failed people who needed help to live, not to die, in preparation for the five-year review of the MAiD law that is supposed to begin this summer.
- Archie Rolland was a landscape architect who lived with Amyotrophic Lateral Sclerosis for 15 years. From 2007 to 2015 he was treated at the McGill University Health Centre’s Chest Institute. In 2013 he wrote an opinion piece in the Montréal Gazette about his experience of “incarceration” in long-term care, and his fears about upcoming changes in his living situation.
- In January of 2015 Mr. Rolland was among 17 people, most of whom used respirators, who were transferred to Lachine Hospital’s Camille-Lefebvre long-term care wing, in advance of Montreal Chest’s move to the newly-built “super hospital.” According to a report in the Montreal Gazette, “only 70 per cent of the nursing staff made the transfer, and fewer than half the hospital attendants.” As well, attendants were put on a rotating schedule, which disrupted continuity of care.
- According to the Gazette, problems arose as soon as residents moved to the Lachine facility, and Mr. Rolland documented them in emails to the head nurse, the ombudsman, hospital officials and a patient’s committee representative. He reported long delays after pressing the call button, not being provided water, poor positioning causing bed sores, and more dangerous problems. In one incident, staff failed to remove mucus from his throat, then ignored the respirator alarm until his mother ran to get help. On another occasion, attendants leaned on his bed rail, jamming the call button against his head and “laughed at me in my distress.”
- Other families also contacted the media about problems caused by staff shortages and rotating schedules, and multiple reports appeared in the Gazette detailing the problems at the Lachine facility. In the summer of 2016, three doctors resigned because their “pleas for additional support led nowhere.”
- By July of 2016, Mr. Rolland had had enough. In emails to the Gazette reporter he emphasized that it wasn’t his illness that was killing him; he was tired and discouraged from having to fight for necessary and compassionate care. On July 4 he left the Lachine facility and made the 10-hour trip to the family’s country home in Métis-sur-Mer. Three days later he ordered that his respirator be turned off.
- Though transfer to another facility was mentioned as a potential solution, in none of the reports was the possibility raised that Mr. Rolland could have lived at home with attendant services. The residents of the long-term care facility (referred to as “patients” rather than “people”) and were described as “hooked up to” respirators and feeding tubes, rather than “using” such equipment. Where is the choice in that?
- A search of Google News for information about the crash of Ukraine Airlines flight 752 on January 8 yields 11,900 results. Wikipedia reports there were 63 Canadians aboard. At the same time, according to a report from the Canadian Patient Safety Institute (CPSI), 76 Canadians die each day in Canada from falls, medical errors and infections they picked up in hospitals. The CPSI estimated that 28,000 Canadians died in 2013.
- Despite being the third leading cause of death in Canada, medical errors (a.k.a. “Adverse events,” a.k.a. “Patient Safety Incidents”) receive very little news coverage. A Google search found only a handful of articles in the mainstream press each year on the subject.
- Public attention was drawn to medical errors at the turn of the century with the publication of “To Err is Human: Building a safer Health System” in November of 1999 by the U.S. Institute of Medicine’s Committee on Quality of Health Care in America. In 2004, The Canadian Adverse Events Study found that problems occurred in 7.5% of the hospitalization records the researchers looked at; researchers found that 37% of these were preventable. A study of paediatric “adverse events” in 2013 found that more than 9% of children were harmed in Canadian hospitals.
- The Commission on end of life care in Québec has consistently found a 4% non-compliance rate in the provision of euthanasia in the province, so applying the 7.5% error rate to medical aid in dying seems within reason.
- Unlike in the aviation industry, where everyone (from mechanics to flight attendants) is encouraged to report problems, mishaps in medical settings remain shrouded in secrecy. For this reason, it’s still impossible to get accurate figures of exactly how many deaths are caused by errors, negligence, equipment failures, improperly-dispensed medications, instruments left in people’s bodies, and the myriad other things that can go wrong in the health care setting.
- According to Kathleen Finlay of the Center for Patient Protection, people who are harmed by medical errors face almost impossible barriers when seeking compensation. In a 2015 article she describes the role of the Canadian Medical Protective Association, which defends doctors who are sued over medical errors. “Membership fees paid to the CMPA give physicians [liability] insurance coverage and a right to representation in medical malpractice lawsuits. However, provincial governments reimburse physicians for at least a portion of their membership fees.”
- People who are harmed by medical errors also face legal rules that force the losing party to pay the winner’s legal fees and limit the kind and amount of damages that can be awarded even if the plaintiff wins.
- So to sum up, if you are one of the 400,000 people each year who are harmed by a “patient safety incident,” don’t count on winning in court, since your taxes are helping to pay the defendant’s legal team. And if an adverse event affects the diagnosis, treatment, eligibility determination or administration of medical aid in dying, you could be among the 7.5% of people who are killed due to medical error.