{"id":1498,"date":"2015-01-16T15:11:37","date_gmt":"2015-01-16T15:11:37","guid":{"rendered":"http:\/\/tvndy.ca\/?p=1498\/"},"modified":"2018-11-09T03:58:28","modified_gmt":"2018-11-09T03:58:28","slug":"webcast-archive-ontario-college-of-physicians-end-of-life-policy","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2015\/01\/webcast-archive-ontario-college-of-physicians-end-of-life-policy\/","title":{"rendered":"Webcast archive: Ontario College of Physicians&#8217; \u201cend of life\u201d policy"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/ubMKwM6dxgI?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p>In this episode of <em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck and Christian Debray discuss:<\/p>\n<ul>\n<li>Ontario College of Physicians&#8217; \u201cend of life\u201d policy<\/li>\n<li>News Briefs<\/li>\n<\/ul>\n<p>Please note that this text is only a script and that our webcast contains additional commentary.<\/p>\n<p><strong>ONTARIO COLLEGE OF PHYSICIANS\u2019 \u201cEND OF LIFE\u201d CARE POLICY<\/strong><\/p>\n<ul>\n<li>In December the Ontario College of Physicians issued a draft policy on end-of-life care, and asked for pubic comments.<\/li>\n<li>The policy is available at: <a href=\"http:\/\/policyconsult.cpso.on.ca\/?page_id=4943\">http:\/\/policyconsult.cpso.on.ca\/?page_id=4943<\/a><\/li>\n<li>The document is not very complete. It seems more like an exercise in public relations.\u00a0 It\u2019s not directed at doctors or administrators to help them make decisions.\u00a0 If the College wants to publish a flyer for the public, that would be one thing, but don\u2019t call it a policy statement.<\/li>\n<li>From the disability perspective, the policy presents many problems.<\/li>\n<li>Like the majority of documents that discuss, \u201cend of life\u201d the policy doesn\u2019t distinguish between people who are in the process of dying and those who have severe functional limitations.<\/li>\n<li>The policy neither recognizes nor resolves the double bind in which doctors must defend the interest of their patients at the same time they are pressured to keep costs down.<\/li>\n<li>In our comments, TVNDY listed several principles that should be included in a real policy to guide doctors and administrators providing health care.\n<ul>\n<li>A bias toward life should govern all decisions<\/li>\n<li>\u201cEnd of life\u201d should not mean \u201cending of life.\u201d<\/li>\n<li>The word \u201cperson\u201d should be used instead of \u201cpatient.\u201d<\/li>\n<li>Discrimination is not acceptable, especially in life or death judgments.<\/li>\n<\/ul>\n<\/li>\n<li>To prevent requests to terminate treatment, each person must have access to services and supports to allow a true choice in where and how to live.<\/li>\n<li>A request for euthanasia, assisted suicide or to withhold or withdraw medical treatment should trigger suicide prevention intervention.<\/li>\n<li>Every person who needs it should have access to services and devices to allow for effective communications<\/li>\n<li>Every person will have access to necessary services and adaptive equipment to allow for timely and effective medical care.<\/li>\n<li>\u201cSelf-regulation\u201d is insufficient to prevent conflicts of interest and failure of accountability.\n<ul>\n<li>Many essential terms are not defined in the policy, such as \u201cend of life\u201d, \u201cclinical benefit\u201d, \u201ccapacity\u201d and \u201cfutile care.\u201d<\/li>\n<li>The policy lacks an explanation of standards of quality care; the list of \u201cwhat is important to patients and their families\u201d is not a policy. Some examples of standards for care doctors should provide:<\/li>\n<\/ul>\n<\/li>\n<li>Provide (or coordinate and oversee the provision of) state-of-the-art medical care to ensure the maximum level of functioning and quality of life.<\/li>\n<li>Provide (or coordinate and oversee the provision of) state-of-the-art pain and symptom management to relieve physical and psychological and symptoms.<\/li>\n<li>Advocate on the person\u2019s behalf to obtain necessary authorization for medical treatment.<\/li>\n<li>Provide clear, honest, information to the person receiving treatment and his\/her family. Communicate on a timely and consistent basis in language and by whatever means to ensure understanding and participation (including using language or sign interpreters, technology or facilitators).\u00a0 Inform the person of her diagnosis, prognosis, available treatments (their potential efficacy and drawbacks), and the consequences of any decision.<\/li>\n<li>Be honest, forthright and compassionate in all dealings with the individual, his\/her family and other providers.<\/li>\n<li>Work with social service and rehabilitation professionals to ensure that each person obtains services to support the maximum level of independence and integration.<\/li>\n<li>Along with mental health providers, social service and chaplaincy staff, promote positive family participation in decision-making, achieving a sense of control and meaning, satisfying spiritual needs, completing important tasks, and preparing for the end of life by resolving conflicts, saying goodbye, and preparing for death.<\/li>\n<li>Ensure that all medical services, equipment and facilities are accessible and available to persons with disabilities in a timely fashion.<\/li>\n<li>Ensure that the person is free from abuse, exploitation and mistreatment.<\/li>\n<li>Care for the whole person, treating her with respect at all times. Affirm her\/his inherent dignity by empowering the person to control his\/her circumstance.\n<ul>\n<li>The section on \u201cadvance care planning\u201d looks more like \u201cdeath planning.\u201d As such, the policy excludes important decisions, such as arranging long-term care (at home) and how to obtain, use and adapt to life-saving equipment and medical services.<\/li>\n<li>This section suggests that doctors frequently encourage people to prepare \u201cadvance care planning\u201d documents. On the ground, this means people with disabilities are often harassed to sign \u201cdo not resuscitate\u201d orders, or such orders are placed on people\u2019s medical without their knowledge or consent.<\/li>\n<li>Documents used for \u201cadvance care planning\u201d are usually biased against life-sustaining treatment. They describe feeding tubes and respirators in negative terms, rather than as the life-saving aides they are.<\/li>\n<li>The section on refusing medical treatment doesn\u2019t mention that such requests are suicidal gestures (and should be treated as such).<\/li>\n<li>The policy should require doctors to consult palliative care and pain management specialists. Most physicians receive only eight hours of training in pain management during their medical education; this is not enough to offer effective, state-of-the-art care.<\/li>\n<li>The paragraph that talks about \u201caggressive pain management\u201d gives the impression that this practice and the use of opiates should be limited to the end of life, which is not the case.<\/li>\n<li>The policy does not explain how bias and prejudice regarding people with disabilities will be excluded from doctors\u2019 decision about what is the \u201cstandard of care.\u201d<\/li>\n<li>Regardless of the state of the law on euthanasia and assisted suicide, physicians should keep in mind that killing is not medical treatment. It is neither the duty nor the responsibility of medical staff to end the life of persons under their care, even if the person requests it.\u00a0 The medical profession is charged to value, preserve and improve the quality of life until the moment of natural death.\u00a0 This includes implementing the public policy of suicide prevention, not providing suicide assistance.\u00a0 A person who wishes to end his or her life may refuse medical treatment if s\/he is too ill to take her own life, or otherwise commit suicide unaided.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>NEWS BRIEFS<\/strong><\/p>\n<ul>\n<li>Activists with NDY-UK were in the streets of London again today to protest the Falconer bill, which is being heard in the House of Lords. 350 people participated in a \u201cThunderclap\u201d campaign which generated 200,000 tweeted messages opposing the Falconer bill.\u00a0In addition, activists created posters with photos and messages so activists who couldn\u2019t be their physically could attend virtually.<\/li>\n<li>Man serving life sentence in Belgium won\u2019t get euthanasia \u2013 Frank Van Den Bleeken, who is serving a life sentence, had been granted permission by the Euthanasia Commission to be euthanized. However at the last minute, Belgium\u2019s Justice Ministry intervened and cancelled the procedure.\u00a0 No reason was given for the change.<\/li>\n<li>In December, a bill was proposed in France that would allow for terminal palliative sedation, or passive euthanasia.<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nToday, we discuss the new euthanasia policy from the Ontario College of Physicians.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2015\/01\/webcast-archive-ontario-college-of-physicians-end-of-life-policy\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Ontario College of Physicians&#8217; \u201cend of life\u201d policy&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2015\/01\/webcast-archive-ontario-college-of-physicians-end-of-life-policy\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Ontario College of Physicians&#8217; \u201cend of life\u201d policy&rdquo;<\/span>&hellip;<\/a><\/div>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[92],"tags":[282,245,34,121,118],"class_list":["post-1498","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-belgium","tag-bill","tag-discrimination","tag-euthanasia-disability","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/comments?post=1498"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1498\/revisions"}],"predecessor-version":[{"id":3852,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1498\/revisions\/3852"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=1498"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=1498"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=1498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}