{"id":1657,"date":"2015-11-13T13:43:03","date_gmt":"2015-11-13T13:43:03","guid":{"rendered":"http:\/\/tvndy.ca\/?p=1657\/"},"modified":"2018-11-07T16:16:50","modified_gmt":"2018-11-07T16:16:50","slug":"webcast-archive-safeguards-in-the-college-of-physicians-guide","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2015\/11\/webcast-archive-safeguards-in-the-college-of-physicians-guide\/","title":{"rendered":"Webcast archive: Safeguards in the College of Physicians&#8217; guide"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/rRYrXoX_lGU?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>Too little, too late: Safeguards in the College of Physicians&#8217; guide to MAID<\/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>SAFEGUARDS: TOO LITTLE, TOO LATE:\u00a0 THE COLLEGE OF PHYSICIANS GUIDE TO MAID<\/strong><\/p>\n<ul>\n<li>A few weeks ago when we talked about the Qu\u00e9bec physicians\u2019 guide to Medical Aid in Dying, we promised we would get back to it in more detail.\u00a0 Today, we return to the guide.<\/li>\n<li>It can be hard to talk about the safeguards in the guide because:\n<ul>\n<li>It\u2019s hard to describe something that isn\u2019t there.<\/li>\n<li>The authors assume that safeguards are not necessary.<\/li>\n<li>Though all of the decisions are left up to one doctor, the responsibility for protecting people in vulnerable circumstances rests with society as a whole.<\/li>\n<\/ul>\n<\/li>\n<li>Some of the typical problems as found in the Qu\u00e9bec plan include\n<ul>\n<li>Safeguards are seen as working against the person\u2019s interest (mentioned on pp. 21, 31).<\/li>\n<li>Dying is portrayed as \u201crelief\u201d from suffering, (see pp. 17, 30, 31).<\/li>\n<li>Standards are relaxed over time (pp. 26, 54).<\/li>\n<li>All decisions are concentrated in the hands of one doctor. (pp. 27, 28).<\/li>\n<li>By taking a strictly medical approach, the program does not address the primary reasons people ask for assisted suicide:\n<ul>\n<li>Loss of autonomy<\/li>\n<li>Loss of ability to do the things the person enjoyed<\/li>\n<li>Perceived loss of dignity<\/li>\n<li>Loss of control of bodily functions<\/li>\n<li>Feeling like a burden<\/li>\n<li>Pain or concerns about pain<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>The effects of prejudice and discrimination\n<ul>\n<li>Examples of \u201cpsychological suffering\u201d that merits euthanasia includes (p. 15):\n<ul>\n<li>Total dependence.<\/li>\n<li>Desperation when faced with a no-win situation.\n<ul>\n<li>These are caused by badly managed services and supports.<\/li>\n<li>These could apply to a survivor of domestic violence.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>The assumption that living with dying is intolerable.<\/li>\n<\/ul>\n<\/li>\n<li>The Application Process\n<ul>\n<li>Lacks provisions for accessibility\n<ul>\n<li>Sign language interpreters &amp; Scribes (p. 14)<\/li>\n<li>Print materials in alternative formats<\/li>\n<\/ul>\n<\/li>\n<li>No protection against family members with financial interests who witness or write forms. (p. 14)<\/li>\n<li>Nothing prevents a doctor from falsifying documents.<\/li>\n<li>There don\u2019t appear to be any barriers to applying multiple times (p. 30, 34) or \u201cdoctor shopping.\u201d<\/li>\n<\/ul>\n<\/li>\n<li>Preventing Abuse\n<ul>\n<li>Doctors lack training to detect signs of abuse<\/li>\n<li>Neither a psycho-social evaluation, nor a home visit is required.<\/li>\n<li>\u201cConversations with families\u201d are not mandatory (p. 18).<\/li>\n<li>There is no provision for intervention where abuse is detected.<\/li>\n<\/ul>\n<\/li>\n<li>Competency determination\n<ul>\n<li>Appears to be only medical judgment rather than the legal decision (as provided for in the Civil Code of Qu\u00e9bec) (p. 28).<\/li>\n<li>Choosing to undergo a medical procedure is not the same as choosing to end one\u2019s life.<\/li>\n<li>The Guide does not mention \u201cdepression\u201d or mandate a psychological assessment.<\/li>\n<\/ul>\n<\/li>\n<li>\u201cFree and informed\u201d choice\n<ul>\n<li>Information is not the same as options (p. 22).<\/li>\n<li>Options offered are exclusively medical and don\u2019t address social or discrimination issues.<\/li>\n<li>The \u201cchoice\u201d to die is an illusion where the person doesn\u2019t have a choice of where or how to live. (p. 16).<\/li>\n<\/ul>\n<\/li>\n<li>\u201cEnd of life\u201d definition\n<ul>\n<li>Criteria are entirely subjective.<\/li>\n<li>Range from two months to eight years (p. 16, 18).<\/li>\n<li>The College of Physicians did not focus on the stage that occurs a few days before natural death (p. 17).<\/li>\n<\/ul>\n<\/li>\n<li>\u201cTreating physicians\u201d\n<ul>\n<li>Decision is made and procedure done by treating physician (p. 14)\n<ul>\n<li>What happens to the 25% of Qu\u00e9b\u00e9cois do not have a primary care doctor?<\/li>\n<li>Does this include specialists, or only generalists?<\/li>\n<\/ul>\n<\/li>\n<li>Pressure on \u201ctreating physicians\u201d not to refuse to provide euthanasia is very intense, invoking guilt, professionalism and responsibility.<\/li>\n<li>All decisions and power are in the hands of the treating physician, others are merely advisors.<\/li>\n<\/ul>\n<\/li>\n<li>\u201cInterdisciplinary teams\u201d\n<ul>\n<li>Are suggested, but apparently not required (p. 15).<\/li>\n<li>Teams are required for coaching the doctor (p. 29), but not for working with the person making the request.<\/li>\n<li>The multidimensional approach recommended is not guaranteed where \u201cresources are not available\u201d (Speech by P. Couillard, 4 June 2014).<\/li>\n<\/ul>\n<\/li>\n<li>\u00a0\u201cMedical Judgments\u201d\n<ul>\n<li>Euthanasia is more than just a medical issue (\u00a7 3.4.2, p. 23).\n<ul>\n<li>Capacity is a legal matter,<\/li>\n<li>Mental health and family supports are social issues.<\/li>\n<\/ul>\n<\/li>\n<li>Describing pain as \u201cimpossible to relieve\u201d shows ignorance of palliative techniques (p. 24).<\/li>\n<li>Requiring the doctor to \u201cassure himself\u201d of compliance creates a low standard of objectivity (p. 27).<\/li>\n<\/ul>\n<\/li>\n<li>Doctors should develop expertise and proficiency\n<ul>\n<li>There is no indication as to how doctors will be trained. (p. 24).<\/li>\n<li>The guide estimates that they will perform euthanasia less than once per year provides insufficient opportunity to \u201cpractice\u201d (p. 12).<\/li>\n<li>Things don\u2019t always go as planned when performing euthanasia (p. 32)<\/li>\n<li>There is insufficient research to reliably predict what will happen in all cases (p. 33).<\/li>\n<\/ul>\n<\/li>\n<li>Doctors\u2019 Conscience Rights\n<ul>\n<li>It appears doctors must determine eligibility, regardless of their beliefs about euthanasia (p. 24).<\/li>\n<li>Must make a referral to another physician for euthanasia<\/li>\n<li>Multiple passages discourage doctors from following their conscience and refusing to kill (p. 24, 25)<\/li>\n<li>Doctors who don\u2019t want to kill can\u2019t consult (p. 29).<\/li>\n<\/ul>\n<\/li>\n<li>Other Issues\n<ul>\n<li>The length of \u201creasonable delay\u201d (waiting period) is not defined, (p. 28)<\/li>\n<li>Doctors must indicate underlying illness, not euthanasia, as cause of death on the death certificate (p. 49).<\/li>\n<li>As we mentioned last summer regarding the regulations for forms doctors must turn in, it appears that the actual medical record will not be sent to the Commission on end of life care.\u00a0 Instead, forms and reports filled out by the treating physician can only be compared against the report of the second physician for accuracy.<\/li>\n<\/ul>\n<\/li>\n<li>Problems Unique to Qu\u00e9bec\n<ul>\n<li>Qu\u00e9bec continues to perpetuate the Big Lie \u2013 That everyone supports euthanasia (p. 12)\n<ul>\n<li>A report by Living with Dignity in 2012 showed that majority of Commission witnesses opposed AS\/E.<\/li>\n<li>An Ipsos poll sponsored by Living with Dignity in 2013 showed many confused \u201cMedical Aid in Dying\u201d with \u201cpalliative care.\u201d<\/li>\n<\/ul>\n<\/li>\n<li>Despite freedom of conscience provision in the law (\u00a7 72) for hospices, Qu\u00e9bec government is threatening to withhold funding from hospices that refuse to euthanize.\u00a0 One hospice has already yielded before the threat.<\/li>\n<li>The method of administration\n<ul>\n<li>Prepare the intravenous site<\/li>\n<li>Inject a tranquilizer<\/li>\n<li>Induce an artificial coma using barbiturates<\/li>\n<li>Inject a neuromuscular blocker to stop the heart and respiration.<\/li>\n<\/ul>\n<\/li>\n<li>Nurses\n<ul>\n<li>must help doctors at several stages, including setting up the IV.<\/li>\n<li>The guide does not state that nurses have\u00a0conscience rights to refuse.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nThis week, we continue our discussion on the Quebec College of Physicians guide to MAID.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2015\/11\/webcast-archive-safeguards-in-the-college-of-physicians-guide\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Safeguards in the College of Physicians&#8217; guide&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2015\/11\/webcast-archive-safeguards-in-the-college-of-physicians-guide\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Safeguards in the College of Physicians&#8217; guide&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":[371,121,372,53,96,118],"class_list":["post-1657","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-application","tag-euthanasia-disability","tag-physician","tag-quebec-en","tag-safeguards","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1657","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=1657"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1657\/revisions"}],"predecessor-version":[{"id":3758,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/1657\/revisions\/3758"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=1657"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=1657"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=1657"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}