{"id":2535,"date":"2018-02-02T15:27:26","date_gmt":"2018-02-02T15:27:26","guid":{"rendered":"http:\/\/tvndy.ca\/?p=2535\/"},"modified":"2018-10-24T18:29:50","modified_gmt":"2018-10-24T18:29:50","slug":"webcast-archive-capacity-and-undue-influence-part-i","status":"publish","type":"post","link":"https:\/\/tvndy.ca\/en\/2018\/02\/webcast-archive-capacity-and-undue-influence-part-i\/","title":{"rendered":"Webcast archive: Capacity and Undue Influence \u2013 Part I"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"1180\" height=\"664\" src=\"https:\/\/www.youtube.com\/embed\/wxuFanBKFYQ?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen><\/iframe><\/p>\n<p>In this episode of\u00a0<em>Euthanasia &amp; Disability<\/em>, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:<\/p>\n<ul>\n<li>Capacity and Undue Influence \u2013 Part I<\/li>\n<li>Ontario court orders doctors to refer for AS\/E<\/li>\n<li>Announcement: We still need YouTube subscribers<\/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>CAPACITY AND UNDUE INFLUENCE \u2013 PART I<\/strong><\/p>\n<ul>\n<li>In all assisted suicide and euthanasia (AS\/E) laws, one of the supposed safeguards is that, in order to be eligible for AS\/E, the person has to be\u00a0<strong>capable<\/strong>\u00a0to make a decision, and the decision must be\u00a0<strong>informed<\/strong>\u00a0and\u00a0<strong>voluntary<\/strong>\u00a0(not subject to \u201cundue influence\u201d or \u201cexternal pressure\u201d).<\/li>\n<li>Specifically, in the Carter case, the Supreme Court wanted to protect \u201cvulnerable people\u201d from \u201cbeing induced to commit suicide in a time of weakness.\u201d<\/li>\n<li>In the next few weeks we\u2019re going to talk about what it means to be capable to choose death, who makes that decision, and how.\u00a0 We\u2019ll discuss what \u201cvulnerable person\u201d means, and we\u2019ll also define \u201cundue influence\u201d and \u201cexternal pressure\u201d as they apply to AS\/E.\u00a0 Finally, we\u2019ll look at a study from the Netherlands showing that doctors there aren\u2019t being very careful in how they determine capacity.<\/li>\n<li>I said \u201csupposed\u201d safeguards because assisted suicide and euthanasia laws don\u2019t actually explain how these safeguards are supposed to be carried out or enforced.\u00a0 So even though the Courts in the Carter case said we need a \u201cstringently limited, carefully monitored system,\u201d there are no directions in the law or the proposed regulations as to how the doctor should decide who has the capacity to choose to die, or what situations add up to \u201cundue influence\u201d or \u201cexternal pressure.\u201d<\/li>\n<li>The words \u201ccapacity\u201d and \u201ccompetence\u201d are often used to say the same thing.\u00a0 In legal terms, \u201ccapacity\u201d means the ability to make medical decisions, while \u201ccompetence\u201d means the person is able to make decisions about financial or other matters.\u00a0 But if you read any articles, court cases or laws, you\u2019ll see that the two words are used interchangeably.<\/li>\n<li>One really basic problem with using the capacity standard is that it applies to decisions for medical\u00a0<em>treatment<\/em>, not euthanasia, where the stakes are much higher.\n<ul>\n<li>Medical decisions are based on the hope of cure or improvement. The \u201chope\u201d provided by AS\/E is only of a false idea of control; it doesn\u2019t end the person\u2019s suffering as much as it ends the person who is suffering.<\/li>\n<li>Medical decisions are about risk and weighing costs and advantages of one choice over another or try other treatments.\u00a0 AS\/E has only one outcome.<\/li>\n<li>With medical decisions, the person may have the option to change their mind.\u00a0 With AS\/E you can\u2019t take it back.<\/li>\n<\/ul>\n<\/li>\n<li>In general, the higher the stakes, the more detailed the evaluation of capacity is supposed to be.\u00a0 So, you would imagine that the person who does the evaluation would be trained to do it and would use the best tool possible.\u00a0 Not so much.<\/li>\n<li>There are several questionnaires (assessment tools) that mental health experts have created to evaluate someone\u2019s capacity.\u00a0 None of them are adapted to use for AS\/E decisions.\u00a0 Nor is it mental health professionals who decide if a person is capable, it\u2019s family doctors, and they are not required to use an assessment tool to determine a person\u2019s capacity.<\/li>\n<li>An important thing to know about capacity is that everyone is assumed to be capable to make medical decisions, unless there\u2019s some reason to think they\u2019re not.\u00a0 Under the most common definition of capacity, the person must be able to:\n<ul>\n<li>Understand the information they are given (understanding);<\/li>\n<li>Apply the facts to their situation (appreciating);<\/li>\n<li>Weigh the benefits and risks of each choice (reasoning);<\/li>\n<li>Make a choice, and express it (expression).<\/li>\n<\/ul>\n<\/li>\n<li>This definition focuses on a person\u2019s cognitive abilities (to remember and think things through), but completely ignores the emotional and social factors that can influence the decision.\u00a0 Adding that the choice must be \u201cvoluntary\u201d doesn\u2019t cover all those factors.<\/li>\n<li>In a 2016 report entitled \u201cAssessing Vulnerability in a system of Physician Assisted Death in Canada,\u201d the Canadian Association of Community Living listed and explained some of these factors in defining what makes a person vulnerable to \u201cbeing induced to commit suicide in a time of weakness.\u201d These are:\n<ul>\n<li>The person is suicidal, rather than making a \u201cwell-reasoned\u201d request<\/li>\n<li>The person\u2019s \u201csuffering\u201d comes from social and emotional, more than physical factors.<\/li>\n<li>The person is being persuaded, encouraged, pressured or coerced to ask for euthanasia.<\/li>\n<li>The person lacks resilience, meaning they can\u2019t bounce back, or they don\u2019t have the energy or strength to resist and overcome the problems they face.<\/li>\n<li>Evidence that the person is actually vulnerable, not just possibly vulnerable.<\/li>\n<\/ul>\n<\/li>\n<li>Here are some other problems that arise when deciding if someone is capable.\n<ul>\n<li>If the person has a communication disability, the doctor may depend on a relative or carer to speak for them, or my use a communication tool that doesn\u2019t work well.<\/li>\n<li>Even when the person doesn\u2019t have a communication problem, doctors may talk to the family member instead of directly to the disabled person.<\/li>\n<li>Doctors rarely provide all the information the person needs to make an informed decision.<\/li>\n<li>People often don\u2019t remember everything the doctor told them, and doctors don\u2019t verify that the person really understands what they\u2019re saying.<\/li>\n<li>People don\u2019t always use the information in logical ways:\n<ul>\n<li>They may make decisions based on intuition or instinct, rather than on the facts;<\/li>\n<li>People may only look at the possible results, rather than weighing the risks.<\/li>\n<\/ul>\n<\/li>\n<li>People feel pressure to sign informed consent forms.\u00a0 One study showed that most people thought they had to sign the consent form, whether they wanted the treatment or not.<\/li>\n<li>Many people prefer to give over the decision making to others.<\/li>\n<li>The informed consent process takes a while, and doctors often don\u2019t allow enough time to help the person think about their options.<\/li>\n<li>The feelings and values of the person and the doctor are not taken into account.<\/li>\n<li>The doctor\u2019s estimate of the person\u2019s quality of life plays a huge role in the capacity decision.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>ONTARIO COURT ORDERS DOCTORS TO REFER FOR AS\/E<\/strong><\/p>\n<ul>\n<li>An Ontario Divisional Court Decision, released yesterday, says that physicians in the province who have a moral or religious objection to some controversial medical procedures \u2013 such as euthanasia \u2013 must refer patients to another doctor who will perform the procedure.<\/li>\n<li>Five Ontario doctors and three groups, (the Christian Medical and Dental Society of Canada, the Canadian Federation of Catholic Physicians\u2019 Societies and Canadian Physicians for Life) challenged the policy making the referrals mandatory. They called it a violation of the \u201cfreedoms of religion and conscience\u201d guaranteed in the Charter of Rights and Freedoms. The policy was originally put in place by the College of Physicians and Surgeons of Ontario, in 2015.<\/li>\n<li>The Divisional Court decision conflicts with the preamble to Canada\u2019s assisted suicide law, which states in part, \u201ceveryone has freedom of conscience and religion under section\u00a02\u00a0of the\u00a0Canadian Charter of Rights and Freedoms\u2026(and) nothing in this Act affects the guarantee of freedom of conscience and religion.\u201d<\/li>\n<li>Although the court acknowledges the limits it has placed on freedom of conscience, it says the limits are justified by the benefits to people seeking medical care.\u00a0 The most important one is equal access to care, especially in rural areas.<\/li>\n<li>The court added that there is no \u201cright\u201d to practice medicine, or to work in a particular specialty. Someone can choose to practice an area of medicine that will not include these moral dilemmas. \u00a0However, someone in need of medical treatment cannot choose whether they need it.<\/li>\n<\/ul>\n<p><strong>ANNOUNCEMENT:\u00a0 WE STILL NEED YOUTUBE SUBSCRIBERS!<\/strong><\/p>\n<ul>\n<li>Just a reminder that we need people to subscribe to our YouTube channel.\u00a0 You can search YouTube for Amy Hasbrouck or go to:\u00a0<a href=\"https:\/\/www.youtube.com\/channel\/UCMxJd8vID7g4pB7ugZOxbuw\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/www.youtube.com\/channel\/UCMxJd8vID7g4pB7ugZOxbuw<\/a><\/li>\n<\/ul>\n   ","protected":false},"excerpt":{"rendered":"<div class=\"entry-summary\">\n<div class=\"entry-summary\">\nThis week, we look at the definition of &#8220;capacity,&#8221; and the many factors that may influence decision-making related to assisted suicide.\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2018\/02\/webcast-archive-capacity-and-undue-influence-part-i\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Capacity and Undue Influence \u2013 Part I&rdquo;<\/span>&hellip;<\/a><\/div>\n<\/div>\n<div class=\"link-more\"><a href=\"https:\/\/tvndy.ca\/en\/2018\/02\/webcast-archive-capacity-and-undue-influence-part-i\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &ldquo;Webcast archive: Capacity and Undue Influence \u2013 Part I&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":[215,121,118],"class_list":["post-2535","post","type-post","status-publish","format-standard","hentry","category-webcast-archive","tag-capacity","tag-euthanasia-disability","tag-webcast","entry"],"_links":{"self":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/2535","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=2535"}],"version-history":[{"count":4,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/2535\/revisions"}],"predecessor-version":[{"id":3475,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/posts\/2535\/revisions\/3475"}],"wp:attachment":[{"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/media?parent=2535"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/categories?post=2535"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tvndy.ca\/en\/wp-json\/wp\/v2\/tags?post=2535"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}