{"id":1546,"date":"2015-03-20T17:18:04","date_gmt":"2015-03-20T17:18:04","guid":{"rendered":"http:\/\/tvndy.ca\/?p=1546\/"},"modified":"2018-11-08T20:47:46","modified_gmt":"2018-11-08T20:47:46","slug":"webcast-archive-evaluation-for-competency","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2015\/03\/webcast-archive-evaluation-for-competency\/","title":{"rendered":"Webcast archive: Evaluation for competency"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/b3z3T5SdA7s?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>Evaluation for competency &amp; depression in assisted suicide requests<\/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>COMPETENCY AND ASSISTED SUICIDE<\/strong><\/p>\n<ul>\n<li>The law of capacity embodies a tension between respecting a person\u2019s autonomy and society\u2019s desire to protect the person.<\/li>\n<li>Comes from laws made by legislatures and court cases<\/li>\n<li>In general, competency is the <strong>ability<\/strong> and <strong>legal qualifications <\/strong>to make a decision to <strong>do something<\/strong>.<\/li>\n<\/ul>\n<p>Ability to make a decision means:<\/p>\n<ul>\n<li>Ability to understand relevant information<\/li>\n<li>Ability to appreciate reasonably foreseeable consequences.<\/li>\n<li>Ability to manipulate information rationally<\/li>\n<li>Legal qualifications<\/li>\n<\/ul>\n<ul>\n<li>Competency is usually decided by a court.<\/li>\n<li>In many cases, a doctor makes a recommendation, which is approved by a court<\/li>\n<li>The person is presumed to be competent unless there is \u201cclear and convincing evidence\u201d to the contrary.<\/li>\n<li>Make a decision<\/li>\n<li>Do something \u2013 it depends on what you\u2019re trying to do:\u00a0enter into a contract or buy a house,\u00a0to prepare a will, to stand trial, to make medical decisions (catch-all category that have widely different consequences), agree to receive treatment or choose among different treatments (weigh benefits vs. side effects), refuse treatment (risk of death), request assisted suicide (death)<\/li>\n<li>Competency assessment questions for medical treatment: Does the person understand \u2026\n<ul>\n<li>the current medical condition?<\/li>\n<li>the natural course and outcome of the current medical condition?<\/li>\n<li>the proposed treatment intervention?<\/li>\n<li>the risks and\/or benefits of the proposed treatment?<\/li>\n<li>what is likely to happen if they refuse the proposed treatment?<\/li>\n<li>the alternatives to the proposed treatment?<\/li>\n<li>the risks and benefits of the alternatives?<\/li>\n<\/ul>\n<\/li>\n<li>Researchers <strong>Susan Block and Andrew Billings <\/strong>talk about\u00a0a different way to evaluate if a person is competent to request assisted suicide.\n<ul>\n<li>Physical suffering,<\/li>\n<li>Psychological suffering<\/li>\n<li>Decision-making ability<\/li>\n<li>Social suffering<\/li>\n<li>Existential\/spiritual suffering<\/li>\n<li>Problems in the relationship with her doctor(s)<\/li>\n<\/ul>\n<\/li>\n<li>Alternative: Assessment of demoralization &#8212; perceived incompetence, inability to cope, hopelessness, existential despair, and meaninglessness<\/li>\n<li>Gregory &amp; Catherine Hamilton \u2013 Suicide requests in Oregon, compare clinical assessment and treatment with assisted suicide competency determination.<\/li>\n<li>Clinical treatment model\n<ul>\n<li>Applies to everyone who is suicidal<\/li>\n<li>Suicidal feelings are a symptoms of a problem that can and should be treated<\/li>\n<li>Request for suicide is a cry for help to relieve suffering<\/li>\n<li>Life is valuable and should be saved<\/li>\n<\/ul>\n<\/li>\n<li>Assisted suicide model\n<ul>\n<li>Applies only to suicidal disabled people who are \u201csuffering\u201d<\/li>\n<li>Suicidal feelings are reasonable response to the person\u2019s situation<\/li>\n<li>Suicide request is a cry for help to die<\/li>\n<li>Death is preferred over life with a disability or illness<\/li>\n<\/ul>\n<\/li>\n<li>What to look for in a suicide-prevention assessment:\n<ul>\n<li>onset and recurrence of psychiatric symptoms<\/li>\n<li>previous similar episodes and treatments<\/li>\n<li>recent stresses<\/li>\n<li>social and economic difficulties<\/li>\n<li>religious or spiritual concerns<\/li>\n<li>symptoms of depression and substance abuse<\/li>\n<li>medications that can cause or exacerbate psychiatric disturbance<\/li>\n<li>cancers or other illnesses known to cause depression or anxiety<\/li>\n<li>the adequacy of pain control<\/li>\n<li>whether or not the person is confident she will receive adequate pain and symptom management<\/li>\n<li>sources of hope, self-esteem, and strength<\/li>\n<li>the seriousness and urgency of suicidal intent and the availability of means, including access to firearms and potentially lethal medications<\/li>\n<li>the person\u2019s mixed feelings about dying<\/li>\n<\/ul>\n<\/li>\n<li>Treatment goals\n<ul>\n<li>&#8220;understand and relieve the desperation that underlies the request for assisted suicide&#8221;<\/li>\n<li>resist becoming a &#8220;gatekeeper,&#8221; who would focus on issues of competence alone<\/li>\n<li>Deal with the person\u2019s\n<ul>\n<li>feelings of worthlessness, demoralization<\/li>\n<li>feelings of guilt requiring reassurance<\/li>\n<li>black-and-white thinking, rejecting possible solutions<\/li>\n<li>Complex feelings about their doctors<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Doctors have to deal with their own feelings about\n<ul>\n<li>Disability<\/li>\n<li>Failure to cure<\/li>\n<li>Competency model &#8212; Capacity to make a decision<\/li>\n<li>Lack of knowledge<\/li>\n<li>Coercion<\/li>\n<li>mental disorders (doesn\u2019t disqualify)<\/li>\n<\/ul>\n<\/li>\n<li>Shortly after a cancer diagnosis, Michael Freeland requested assisted suicide.\n<ul>\n<li>He saw no use in treating the cancer<\/li>\n<li>He had already tried to commit suicide years before after his mother killed herself.<\/li>\n<li>He was a recovering alcoholic<\/li>\n<li>He had surveillance cameras on his property, and many assault weapons in his home.<\/li>\n<li>Despite all that, he received a lethal prescription, without a psychiatric evaluation, despite his history of depression and suicide attempts.<\/li>\n<\/ul>\n<\/li>\n<li>Lets look at the support provided by a Compassionate Care volunteer vs. assisted suicide counselling provided by Compassion &amp; Dying doctors.\n<ul>\n<li>Removing the means for suicide (weapons) vs. providing the means.<\/li>\n<li>Consideration of Freeland\u2019s depression vs. lack of interest in mental health history<\/li>\n<li>Took Freeland\u2019s suicidal threats seriously because of previous attempts vs. uninterested in previous suicide attempts<\/li>\n<li>Provided support and arranged for mental health treatment, vs. believed Freeland didn\u2019t need psych evaluation, and was unaware that Freeland was hospitalized and determined incompetent by a psychiatrist.<\/li>\n<li>Arranged pain management and palliative care vs. offering to sit with Freeland while he took lethal dose.<\/li>\n<li>Encouraged him to take anti-depressants, which helped his mood and improved his quality of life.<\/li>\n<li>Reminded him she did not want him to die.<\/li>\n<li>Other doctors were put in a bind when faced with a suicidal mentally ill person, who had been given a lethal prescription by another doctor.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nToday, we discuss the link between suffering and competency in assisted suicide requests, including the story of Michael Freeland.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2015\/03\/webcast-archive-evaluation-for-competency\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Evaluation for competency&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2015\/03\/webcast-archive-evaluation-for-competency\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Evaluation for competency&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":[405,121,406,98,247,118],"class_list":["post-1546","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-competency","tag-euthanasia-disability","tag-michael-freeland","tag-suffering","tag-vulnerability","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1546","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=1546"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1546\/revisions"}],"predecessor-version":[{"id":3825,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1546\/revisions\/3825"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=1546"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=1546"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=1546"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}