Project Value
July 27, 2016 7:55 AM Subscribe
"As we enter complex discussion in Canada about doctor-assisted suicide, we worry that Canadians are only getting one side of the disability story – that death is a natural choice for these poor suffering disabled people. But this story doesn’t speak to the experiences of many with disabilities. This project seeks to explore a different perspective; to share stories and experiences that contradict the narrative that disability is a fate worse than death."
Catherine Frazee is a professor emeritus who is a fierce spokesperson for dignified disabled lives.
Ing Wong-Ward is a former media professional who believes disabled lives are worth living. She was interviewed by CBC Radio. "We seem to be portrayed as people who are on the verge of death... and that is certainly not my life."
The project is looking for more stories from people who "live in opposition to their diagnosis".
Catherine Frazee is a professor emeritus who is a fierce spokesperson for dignified disabled lives.
Ing Wong-Ward is a former media professional who believes disabled lives are worth living. She was interviewed by CBC Radio. "We seem to be portrayed as people who are on the verge of death... and that is certainly not my life."
The project is looking for more stories from people who "live in opposition to their diagnosis".
I'm of two minds about this:
1) I think it's unquestionable that, in a capitalistic society where "voluntary" euthanasia is legal, the poor and infirm will be subtly pressured into killing themselves. The poor and infirm are already subtly pressured into killing themselves in other ways: through overwork, through working in bad, dangerous jobs, cultural discouragement for applying for welfare benefits, etc. It seems likely that any sort of "voluntary" system of anything will, eventually, be used by capitalism and capitalists to further their own ends, and - like "voluntary" unpaid overtime - will quickly go from "voluntary" to "kinda voluntary (but not really)".
2) It's also unquestionable that disabled people are being used by the pro-life movement to derail any sensible discussion on euthanasia and therapeutic abortion. Something has to be done about this, and fast, or else in a few decades the "differently-able rights movement" will just be an appendage of the pro-life movement, and therefore just an appendage of the Catholic and Evangelical churches.
posted by Tyrant King Porn Dragon at 8:22 AM on July 27, 2016 [15 favorites]
1) I think it's unquestionable that, in a capitalistic society where "voluntary" euthanasia is legal, the poor and infirm will be subtly pressured into killing themselves. The poor and infirm are already subtly pressured into killing themselves in other ways: through overwork, through working in bad, dangerous jobs, cultural discouragement for applying for welfare benefits, etc. It seems likely that any sort of "voluntary" system of anything will, eventually, be used by capitalism and capitalists to further their own ends, and - like "voluntary" unpaid overtime - will quickly go from "voluntary" to "kinda voluntary (but not really)".
2) It's also unquestionable that disabled people are being used by the pro-life movement to derail any sensible discussion on euthanasia and therapeutic abortion. Something has to be done about this, and fast, or else in a few decades the "differently-able rights movement" will just be an appendage of the pro-life movement, and therefore just an appendage of the Catholic and Evangelical churches.
posted by Tyrant King Porn Dragon at 8:22 AM on July 27, 2016 [15 favorites]
This whole debate has been an intra-disability community debate, because there isn't just one form of disability.
The proponents of assisted dying are primarily disabled people (often with chronic, progressive illnesses), and many of the opponents are also disabled people.
It isn't about disabled versus non-disabled.
As someone with an invisible chronic illness who also works in research related to invisible episodic disabilities, I do find that my perspective is very different from someone with a visible and/or stable disability. When someone with ALS or MS says that they wish to be able to access assisted dying, they aren't saying that they think disabled people's lives aren't worth living. They are saying that they prefer to chose their own path, and to judge their own quality of life.
posted by jb at 8:35 AM on July 27, 2016 [35 favorites]
The proponents of assisted dying are primarily disabled people (often with chronic, progressive illnesses), and many of the opponents are also disabled people.
It isn't about disabled versus non-disabled.
As someone with an invisible chronic illness who also works in research related to invisible episodic disabilities, I do find that my perspective is very different from someone with a visible and/or stable disability. When someone with ALS or MS says that they wish to be able to access assisted dying, they aren't saying that they think disabled people's lives aren't worth living. They are saying that they prefer to chose their own path, and to judge their own quality of life.
posted by jb at 8:35 AM on July 27, 2016 [35 favorites]
1) I think it's unquestionable that, in a capitalistic society where "voluntary" euthanasia is legal, the poor and infirm will be subtly pressured into killing themselves.
This is Canada though. Our system works very different than the American one. It's not perfect but I'm not sure the bottom line is really as significant of a motivating factor in a system with universal access to health care.
posted by Hoopo at 8:55 AM on July 27, 2016 [3 favorites]
This is Canada though. Our system works very different than the American one. It's not perfect but I'm not sure the bottom line is really as significant of a motivating factor in a system with universal access to health care.
posted by Hoopo at 8:55 AM on July 27, 2016 [3 favorites]
jedicus: So this seems to be a battle disability rights advocates have already won, at least in terms of assisted suicide law, but I'll admit this is an area of the law that I am only moderately familiar with.
In the CBC interview, she talks about a challenge to the law that's happening in BC, and the narrative about her specific disability that's being put forward in that lawsuit. The law and the courts tend to drift in some of the same directions that public opinion does, driven by the same stories. And public opinion is driven by snippets of stories and images here and there: If you saw the Capitol Crawl, you're going to have a different opinion on "the disabled" than someone who hears a heart-wrenching story from a disabled person who wants to die but won't for a long time. And for most people, a handful of stories is all they'll hear.
What's important, I think, is jb's point: Every person is different. Even people with exactly the same disability. Some people are overwhelmed by their disability and want to die; some people, with exactly the same disability, see it as a motivating challenge. Some people drift one way or another depending on how much social and personal support they get. What's important is to see them all as individuals.
My personal experience has been with my daughter's schooling, and the question of integrated vs. separate classrooms for the mentally disabled. What works best for each child and each family is different. There were brave parents who fought hard for integrated classrooms for their children, but that's not what's best for every child. The response is sometimes a grumbled, "We gave them what they want with integrated classrooms, and now they want separate classrooms? Well what do they want?!?"
What's wanted is the ability to have individuals recognized as individuals.
posted by clawsoon at 8:57 AM on July 27, 2016 [8 favorites]
In the CBC interview, she talks about a challenge to the law that's happening in BC, and the narrative about her specific disability that's being put forward in that lawsuit. The law and the courts tend to drift in some of the same directions that public opinion does, driven by the same stories. And public opinion is driven by snippets of stories and images here and there: If you saw the Capitol Crawl, you're going to have a different opinion on "the disabled" than someone who hears a heart-wrenching story from a disabled person who wants to die but won't for a long time. And for most people, a handful of stories is all they'll hear.
What's important, I think, is jb's point: Every person is different. Even people with exactly the same disability. Some people are overwhelmed by their disability and want to die; some people, with exactly the same disability, see it as a motivating challenge. Some people drift one way or another depending on how much social and personal support they get. What's important is to see them all as individuals.
My personal experience has been with my daughter's schooling, and the question of integrated vs. separate classrooms for the mentally disabled. What works best for each child and each family is different. There were brave parents who fought hard for integrated classrooms for their children, but that's not what's best for every child. The response is sometimes a grumbled, "We gave them what they want with integrated classrooms, and now they want separate classrooms? Well what do they want?!?"
What's wanted is the ability to have individuals recognized as individuals.
posted by clawsoon at 8:57 AM on July 27, 2016 [8 favorites]
Agreed with jb and Tyrant. While in theory I support assisted dying, the devil is in the details. For example, I don't think that the conditions in Canadian law that jedicus cites are that clear as constraints or safeguards against caretakers or society pressuring people living with disabilities requiring a significant amount of assistance to kill themselves. What constitutes an "advanced state of irreversible decline in capability"? Becoming paralyzed in or losing two or more limbs would be a pretty advanced and irreversible decline in capability to someone who previous had use of all limbs, yet many people live without the use of multiple limbs with quite a high quality of life. Everyone's "natural death is reasonably foreseeable"; how much of a statistical decrease in life expectancy is considered sufficient for this clause? If people with a certain condition die on average at age 60 instead of age 80, is that sufficient? Age 40? Age 20? Not requiring a prognosis for at least a statistically likely short length of time to death seems to be a bit of a gap. Both of these clauses have so much room for interpretation based on our societal understanding of disability and terminal illness, and how grave such conditions are perceived to be. The law doesn't specify that it is to be applied to terminally ill people, not just people living permanently with significant disabilities (with some good reason: defining illness, and terminal illness, in a precise and legal manner is difficult), so this leaves room for interpretation.
So that brings us to the more personal condition, "that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable". To me, this is the key: people should be allowed to make their own decisions. But in a humane society, we need to do a better job than we currently do at providing options to accommodate disability or differently-abled bodies, to minimize the physical and psychological suffering that currently is often taken for granted as accompanying disability, but that is due to our societal structures, not the illness or disability itself. That change needs to be led by the actual experiences and concerns of differently abled people, to be at all effective. And the rest of us need to work harder on our own awareness and active acceptance of different bodies. Unfortunately, there's an interaction between this last component and narratives and arguments around assisted dying: some of the narratives around assisted dying do reinforce some of the misconceptions and prejudices that lead to physical or psychological suffering for disabled or terminally ill people.
On preview, adding:
This is Canada though. Our system works very different than the American one. It's not perfect but I'm not sure the bottom line is really as significant of a motivating factor in a system with universal access to health care.
posted by Hoopo
Canada's health care system is more effective than the US health care system. That's really, really not saying much, though. There are so many gaps in Canadian mental health care and disability care, including for example access to assistive technologies. Last I heard, Nova Scotia requires people needing equipment such as motorized wheelchairs to ask around all of their local charities for funding before they will pay anything for such devices. This is degrading, and causes significant delays in people getting the assistive technologies that they need to live full lives - neither of which are conducive to good mental health outcomes; and then there's the difficulty of getting timely, affordable, and appropriate mental health care in the province.
Not allowing people to make their own decisions about how and when to die, in cases where they are going to die anyway, seems cruel and unnecessary, but we need to make it a priority to guarantee that the rest of our health care and societal structures are such that the progress of an individual's terminal disease is the only factor affecting their decisions around assisted dying. And we need to make sure that we always, always bring in the perspectives of disabled and terminally ill people and talk about these societal issues when we bring up the topic of assisted dying, if we want to avoid any coerced death outcomes.
posted by eviemath at 9:15 AM on July 27, 2016 [10 favorites]
So that brings us to the more personal condition, "that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable". To me, this is the key: people should be allowed to make their own decisions. But in a humane society, we need to do a better job than we currently do at providing options to accommodate disability or differently-abled bodies, to minimize the physical and psychological suffering that currently is often taken for granted as accompanying disability, but that is due to our societal structures, not the illness or disability itself. That change needs to be led by the actual experiences and concerns of differently abled people, to be at all effective. And the rest of us need to work harder on our own awareness and active acceptance of different bodies. Unfortunately, there's an interaction between this last component and narratives and arguments around assisted dying: some of the narratives around assisted dying do reinforce some of the misconceptions and prejudices that lead to physical or psychological suffering for disabled or terminally ill people.
On preview, adding:
This is Canada though. Our system works very different than the American one. It's not perfect but I'm not sure the bottom line is really as significant of a motivating factor in a system with universal access to health care.
posted by Hoopo
Canada's health care system is more effective than the US health care system. That's really, really not saying much, though. There are so many gaps in Canadian mental health care and disability care, including for example access to assistive technologies. Last I heard, Nova Scotia requires people needing equipment such as motorized wheelchairs to ask around all of their local charities for funding before they will pay anything for such devices. This is degrading, and causes significant delays in people getting the assistive technologies that they need to live full lives - neither of which are conducive to good mental health outcomes; and then there's the difficulty of getting timely, affordable, and appropriate mental health care in the province.
Not allowing people to make their own decisions about how and when to die, in cases where they are going to die anyway, seems cruel and unnecessary, but we need to make it a priority to guarantee that the rest of our health care and societal structures are such that the progress of an individual's terminal disease is the only factor affecting their decisions around assisted dying. And we need to make sure that we always, always bring in the perspectives of disabled and terminally ill people and talk about these societal issues when we bring up the topic of assisted dying, if we want to avoid any coerced death outcomes.
posted by eviemath at 9:15 AM on July 27, 2016 [10 favorites]
Hoopo: It's not perfect but I'm not sure the bottom line is really as significant of a motivating factor in a system with universal access to health care.
Agreed, but some of the same attitudes are sometimes there within the Canadian healthcare system. With both my daughter (DD) and my mother (ALS), there was at least one healthcare worker who said, directly or indirectly, that keeping them alive wasn't worth it because of their diagnosis. Thankfully, though, those attitudes didn't drive the healthcare decisions that were made in the end.
posted by clawsoon at 9:22 AM on July 27, 2016 [2 favorites]
Agreed, but some of the same attitudes are sometimes there within the Canadian healthcare system. With both my daughter (DD) and my mother (ALS), there was at least one healthcare worker who said, directly or indirectly, that keeping them alive wasn't worth it because of their diagnosis. Thankfully, though, those attitudes didn't drive the healthcare decisions that were made in the end.
posted by clawsoon at 9:22 AM on July 27, 2016 [2 favorites]
I always liked Sue Rodriguez's take: it's about access to the same right to control your own body.
Until disable people have equal access in all areas of life, however, there is a risk that some will judge themselves to be done with life because society does not support truly equal access to all aspects of life.
posted by chapps at 9:29 AM on July 27, 2016 [6 favorites]
Until disable people have equal access in all areas of life, however, there is a risk that some will judge themselves to be done with life because society does not support truly equal access to all aspects of life.
posted by chapps at 9:29 AM on July 27, 2016 [6 favorites]
For the Canadian legal types.. am I right that the current status is that there is now law? And that a court ruling gas decriminalised euthanasia within certain circumstances?
I understood that the government did not pass a new law so we are currently in the "decriminalised" zone, kind of like abortion.
I've heard it suggested it would be good to leave it decriminalised, and not write a law, but I'm unclear what difference that might make in thus case.
posted by chapps at 9:32 AM on July 27, 2016
I understood that the government did not pass a new law so we are currently in the "decriminalised" zone, kind of like abortion.
I've heard it suggested it would be good to leave it decriminalised, and not write a law, but I'm unclear what difference that might make in thus case.
posted by chapps at 9:32 AM on July 27, 2016
am I right that the current status is that there is now law?
There is a law in force as of June 17, 2016.
And that a court ruling gas decriminalised euthanasia within certain circumstances?
To be clear, there is a distinction between assisted suicide and euthanasia, basically coming down to whether the dying person or another person ultimately causes the death (e.g. a person self-administering legally prescribed medication for the purpose of dying versus a doctor administering the same). Canada has legalized the former, not the latter.
But yes, there was a court ruling first and now there is a clear regulatory framework in accordance with that ruling.
posted by jedicus at 10:22 AM on July 27, 2016
There is a law in force as of June 17, 2016.
And that a court ruling gas decriminalised euthanasia within certain circumstances?
To be clear, there is a distinction between assisted suicide and euthanasia, basically coming down to whether the dying person or another person ultimately causes the death (e.g. a person self-administering legally prescribed medication for the purpose of dying versus a doctor administering the same). Canada has legalized the former, not the latter.
But yes, there was a court ruling first and now there is a clear regulatory framework in accordance with that ruling.
posted by jedicus at 10:22 AM on July 27, 2016
No, there is an actual law. A 2015 Supreme Court ruling overturned existing prohibitions on assisted dying, but suspended the ruling for a year to give Parliament time to pass new legislation (the deadline was later extended). A new law was passed last month which regulates assisted dying, but some folks believe that it's more restrictive than the Supreme Court ruling permits; hence the new court case in BC that clawsoon mentioned.
posted by Gerald Bostock at 10:24 AM on July 27, 2016 [1 favorite]
posted by Gerald Bostock at 10:24 AM on July 27, 2016 [1 favorite]
Not requiring a prognosis for at least a statistically likely short length of time to death seems to be a bit of a gap.
Most likely because of Alzheimer's. You can "live" terrified, unable to recognize your loved ones, and incontinent for several years with Alzheimer's.
posted by praemunire at 10:51 AM on July 27, 2016 [7 favorites]
Most likely because of Alzheimer's. You can "live" terrified, unable to recognize your loved ones, and incontinent for several years with Alzheimer's.
posted by praemunire at 10:51 AM on July 27, 2016 [7 favorites]
So this seems to be a battle disability rights advocates have already won, at least in terms of assisted suicide law, but I'll admit this is an area of the law that I am only moderately familiar with.
From where I'm sitting (working in an Alzheimer Society), there's going to be challenges to the law as it exists on three fronts:
1. The law requires death to be "reasonably foreseeable", which a lot of legal experts have argued is far more restrictive than what the language of the Supreme Court ruling was; the case in BC referenced above is the first challenge on this front.
2. The law excludes mental health/mental illness as a reason; I am aware of one case in Alberta where the individual has a mental health condition and had received assent for PAD from both the lower court and the provincial court of appeal upheld that decision after the feds appealed it. This was before C-14 passed; I don't know if the federal government will challenge the decision again.
3. Advance consent will be another fight; this refers to the idea that someone with a progress condition that will or might take away their capacity & ability to consent before death could create a document outlining when the procedure should be carried out, despite their lack of capacity at the time of the procedure. This is the one that is closest to home for the work that I do, and I think it's going to be an interesting discussion. But I also think it is a ways off.
All that being said, my concern (while I'm generally supportive of the idea overall) with this legislation all along has been that we need, as a society, to make sure that we provide appropriate care and resources for people, whatever their decision on this question. We're already not doing a great job for lots of people with disabilities, on palliative care, etc., and that needs to be addressed right alongside the questions of how we deal with this new right.
posted by nubs at 10:53 AM on July 27, 2016 [4 favorites]
From where I'm sitting (working in an Alzheimer Society), there's going to be challenges to the law as it exists on three fronts:
1. The law requires death to be "reasonably foreseeable", which a lot of legal experts have argued is far more restrictive than what the language of the Supreme Court ruling was; the case in BC referenced above is the first challenge on this front.
2. The law excludes mental health/mental illness as a reason; I am aware of one case in Alberta where the individual has a mental health condition and had received assent for PAD from both the lower court and the provincial court of appeal upheld that decision after the feds appealed it. This was before C-14 passed; I don't know if the federal government will challenge the decision again.
3. Advance consent will be another fight; this refers to the idea that someone with a progress condition that will or might take away their capacity & ability to consent before death could create a document outlining when the procedure should be carried out, despite their lack of capacity at the time of the procedure. This is the one that is closest to home for the work that I do, and I think it's going to be an interesting discussion. But I also think it is a ways off.
All that being said, my concern (while I'm generally supportive of the idea overall) with this legislation all along has been that we need, as a society, to make sure that we provide appropriate care and resources for people, whatever their decision on this question. We're already not doing a great job for lots of people with disabilities, on palliative care, etc., and that needs to be addressed right alongside the questions of how we deal with this new right.
posted by nubs at 10:53 AM on July 27, 2016 [4 favorites]
Everyone's "natural death is reasonably foreseeable"; how much of a statistical decrease in life expectancy is considered sufficient for this clause?
eviemath: This is the key safeguard (and the most controversial one, for people seeking a less restrictive law). It's not statistical. It's basically saying that you cannot legally receive medical assistance in dying unless you're already expected to be dead of natural causes in the near future. (Some jurisdictions use a six-month threshold -- that is, you're expected to be dead within six months -- but the Canadian government thought that would be too inflexible.)
Killing someone who's already dying -- basically, accelerating something that's already happening, cutting short someone's pain and suffering -- is very different, to the public (and to medical professionals), from killing someone who could otherwise expect to live for a long time. If you make a mistake, it's irreversible.
posted by russilwvong at 11:01 AM on July 27, 2016
eviemath: This is the key safeguard (and the most controversial one, for people seeking a less restrictive law). It's not statistical. It's basically saying that you cannot legally receive medical assistance in dying unless you're already expected to be dead of natural causes in the near future. (Some jurisdictions use a six-month threshold -- that is, you're expected to be dead within six months -- but the Canadian government thought that would be too inflexible.)
Killing someone who's already dying -- basically, accelerating something that's already happening, cutting short someone's pain and suffering -- is very different, to the public (and to medical professionals), from killing someone who could otherwise expect to live for a long time. If you make a mistake, it's irreversible.
posted by russilwvong at 11:01 AM on July 27, 2016
I think that oftentimes the conversation around euthenasia, like any conversation surrounding our bodies, ignores that our lives and our opinions about ourselves are deeply affected by politics and culture. The death with dignity movement is a bit like the abortion movement when it focused on fighting for a controversial choice without considering the fact that some people have access to a wider variety of choices than others. I hope that inclusion of the viewpoints of people with long-term and visible disabilities broadens and deepens what it means to live and die with dignity.
posted by muddgirl at 12:09 PM on July 27, 2016 [1 favorite]
posted by muddgirl at 12:09 PM on July 27, 2016 [1 favorite]
The bottom line definitely influences the administration of health care in Canada, generally. (My experience in Ontario is that the strain on resources means it does not even have the capacity to address ordinary things like thyroid issues and orthopedic problems in a timely and logical manner.)
Of greater concern to me, though, is the potential for well-meaning staff with firm views (some of whom may be burnt out by having to work within such an inefficient system, and may not be 100% reliable as a result) to pressure patients and family towards assisted suicide by biasing conversations around informed consent. (As happened to this Mefite, for example.)
posted by cotton dress sock at 12:30 PM on July 27, 2016 [1 favorite]
Of greater concern to me, though, is the potential for well-meaning staff with firm views (some of whom may be burnt out by having to work within such an inefficient system, and may not be 100% reliable as a result) to pressure patients and family towards assisted suicide by biasing conversations around informed consent. (As happened to this Mefite, for example.)
posted by cotton dress sock at 12:30 PM on July 27, 2016 [1 favorite]
Killing someone who's already dying -- basically, accelerating something that's already happening, cutting short someone's pain and suffering -- is very different, to the public (and to medical professionals), from killing someone who could otherwise expect to live for a long time.
Of course, from the point of view of some people seeking euthanasia, the fact that they might expect to live for a long time is the *problem*. That's the special horror of Alzheimer's -- that you might expect to live for decades with your self extinguished but your body healthy. Same for people with some forms of chronic degenerative diseases.
posted by tavella at 1:07 PM on July 27, 2016 [8 favorites]
Of course, from the point of view of some people seeking euthanasia, the fact that they might expect to live for a long time is the *problem*. That's the special horror of Alzheimer's -- that you might expect to live for decades with your self extinguished but your body healthy. Same for people with some forms of chronic degenerative diseases.
posted by tavella at 1:07 PM on July 27, 2016 [8 favorites]
(As happened to this Mefite, for example.)
To be clear, though, that was one rogue person who was acting unprofessionally and should have been reported to their superiors for that behavior. We cannot base law or ethics on anecdotes.
posted by Mental Wimp at 1:10 PM on July 27, 2016
To be clear, though, that was one rogue person who was acting unprofessionally and should have been reported to their superiors for that behavior. We cannot base law or ethics on anecdotes.
posted by Mental Wimp at 1:10 PM on July 27, 2016
Sure, Mental Wimp. Here's one paper suggesting the problem might be more widespread. (There are more, but I'm not going to link-bomb here.)
posted by cotton dress sock at 1:52 PM on July 27, 2016 [1 favorite]
posted by cotton dress sock at 1:52 PM on July 27, 2016 [1 favorite]
→ you might expect to live for decades with your self extinguished but your body healthy
And that's why, for me, I want the freest access to doctor-assisted suicide should I need it. There are already laws against euthanasia, and gumming up this Charter-required law with additional riders is nothing but cruelty.
I'm disappointed that the FPP links are to FB pages.
posted by scruss at 2:51 PM on July 27, 2016 [4 favorites]
And that's why, for me, I want the freest access to doctor-assisted suicide should I need it. There are already laws against euthanasia, and gumming up this Charter-required law with additional riders is nothing but cruelty.
I'm disappointed that the FPP links are to FB pages.
posted by scruss at 2:51 PM on July 27, 2016 [4 favorites]
The other question that needs to get addressed, and it was one I hadn't thought about until I sat down with some colleagues for a serious discussion of what this all meant, is what is going to happen for people who apply for PAD and don't meet the criteria/are turned down.
posted by nubs at 3:17 PM on July 27, 2016
posted by nubs at 3:17 PM on July 27, 2016
This is already happening. There were a couple people on Reddit (/r/CanadaPolitics) who said that they'd gone to their GP to talk about getting assisted suicide. In both cases their GP refused and terminated the doctor-patient relationship.
There's going to be a lot of able-bodied people seeking assistance from a doctor to commit suicide, simply because there's a lot of people who want to commit suicide, and medical assistance would make it easier and less risky (that is, less likely to fail). In 2012 there were about 3900 people who successfully committed suicide.
How many suicide attempts were there? For Alberta, there were about 500 successful suicides in 2010, and 5000 emergency-room visits related to a suicide attempt. If this ten-to-one ratio holds across Canada, that means that each year there'll be about 40,000 suicide attempts. That's a lot of people!
As I understand it, the Carter decision isn't intended to help able-bodied people commit suicide, as they're capable of doing it themselves.
posted by russilwvong at 4:51 PM on July 27, 2016 [1 favorite]
There's going to be a lot of able-bodied people seeking assistance from a doctor to commit suicide, simply because there's a lot of people who want to commit suicide, and medical assistance would make it easier and less risky (that is, less likely to fail). In 2012 there were about 3900 people who successfully committed suicide.
How many suicide attempts were there? For Alberta, there were about 500 successful suicides in 2010, and 5000 emergency-room visits related to a suicide attempt. If this ten-to-one ratio holds across Canada, that means that each year there'll be about 40,000 suicide attempts. That's a lot of people!
As I understand it, the Carter decision isn't intended to help able-bodied people commit suicide, as they're capable of doing it themselves.
posted by russilwvong at 4:51 PM on July 27, 2016 [1 favorite]
here were a couple people on Reddit (/r/CanadaPolitics) who said that they'd gone to their GP to talk about getting assisted suicide. In both cases their GP refused and terminated the doctor-patient relationship.
There's going to be a lot of able-bodied people seeking assistance from a doctor to commit suicide
Can we just get clear on terms here? As someone who has worked both in mental health & crisis intervention and now with terminal diseases, there is a pretty clear difference to me between suicide and PAD - one is a decision someone usually makes and attempts on their own (and their reasons for seeking it may be valid), and the other is now a right upheld by the courts to a process with medical professionals that involves assessment of their condition and allows for a person who can clearly decide (and the assessment process of that capacity is an important part of this) to request physician assistance in dying. The difference might seem subtle, but it really isn't from where I sit - that concept of undergoing an assessment and discussion with other people throughout the process is very different from suicide.
But that goes to the point I was trying to make about the people who get turned down; in the context of the discussion I was in, the concern there is that what the request reflects is not only the desire to die, but also that the system is proving inadequate in providing the care that the person needs for their condition; that the request itself is an indicator of the need for better/different treatment options as well as some potentially underlying mental health concerns (particularly depression) that should be attended to. And the reaction you've described - the termination of the doctor/patient relationship as a result - just underscores that problem. Carter and C-14 both address the need for physicians to be able to opt out, but they also make it clear that the doctor needs to refer in the face of the request; I would argue that (ethically, morally) includes dealing with requests from people who don't qualify (although in all honesty, the GP should be taking that as a signal and invitation for some deeper exploration of the issues and a need for referrals and consultations in general, not the termination of the relationship).
Carter and C-14 both clearly do not refer to able-bodied people, and I'm not really certain where you're going with that? Alberta, by the way, has the highest suicide rate in the country (or at least it did the last time I checked suicide rates, which is probably two-three years ago now). I would suggest that the numbers of attempts is an underestimate; there are many attempts that go unreported/unnoticed. Suicide is its own health crisis, and one that needs its own supports and interventions, which is again why I would ask that we be careful about our terminology here. I'm not saying that suicide is always wrong, but rather that suicidal people often benefit from discussion and assessment of their situation from an outside party - which is what PAD has as part of the process. The fact that our physicians and health care system have a hard time dealing with suicide on top of all the other issues they struggle with is, I guess, unsurprising but is part of the general conversation about how our system is failing people in need at multiple points in multiple ways. (Another point on language - in the context of suicide, we don't refer to "successful" attempts, but rather attempts that "completed" or "didn't complete".)
When I can take a step back from some of the personal and professional questions PAD provokes in my day to day life (and I have nothing on the people actually involved in implementation of the protocols right now), it is a rather fascinating chance to watch as our systems work to change themselves in the face of a new right; one colleague with a lot of years of service who was at a meeting where we discussed things both broad and specific said it reminded her a lot of the abortion debates and the changes to the system that happened then.
Sorry if I'm coming across as being pedantic or nitpicky, but this is a pretty charged topic and we're living through what will be some challenges in the understanding and implementation of the fallout from Carter, and I just think that being careful with the terms we chose might help with having the discussions we need to have about our health system, PAD, and the new issues it is going to expose.
posted by nubs at 6:35 PM on July 27, 2016 [3 favorites]
There's going to be a lot of able-bodied people seeking assistance from a doctor to commit suicide
Can we just get clear on terms here? As someone who has worked both in mental health & crisis intervention and now with terminal diseases, there is a pretty clear difference to me between suicide and PAD - one is a decision someone usually makes and attempts on their own (and their reasons for seeking it may be valid), and the other is now a right upheld by the courts to a process with medical professionals that involves assessment of their condition and allows for a person who can clearly decide (and the assessment process of that capacity is an important part of this) to request physician assistance in dying. The difference might seem subtle, but it really isn't from where I sit - that concept of undergoing an assessment and discussion with other people throughout the process is very different from suicide.
But that goes to the point I was trying to make about the people who get turned down; in the context of the discussion I was in, the concern there is that what the request reflects is not only the desire to die, but also that the system is proving inadequate in providing the care that the person needs for their condition; that the request itself is an indicator of the need for better/different treatment options as well as some potentially underlying mental health concerns (particularly depression) that should be attended to. And the reaction you've described - the termination of the doctor/patient relationship as a result - just underscores that problem. Carter and C-14 both address the need for physicians to be able to opt out, but they also make it clear that the doctor needs to refer in the face of the request; I would argue that (ethically, morally) includes dealing with requests from people who don't qualify (although in all honesty, the GP should be taking that as a signal and invitation for some deeper exploration of the issues and a need for referrals and consultations in general, not the termination of the relationship).
Carter and C-14 both clearly do not refer to able-bodied people, and I'm not really certain where you're going with that? Alberta, by the way, has the highest suicide rate in the country (or at least it did the last time I checked suicide rates, which is probably two-three years ago now). I would suggest that the numbers of attempts is an underestimate; there are many attempts that go unreported/unnoticed. Suicide is its own health crisis, and one that needs its own supports and interventions, which is again why I would ask that we be careful about our terminology here. I'm not saying that suicide is always wrong, but rather that suicidal people often benefit from discussion and assessment of their situation from an outside party - which is what PAD has as part of the process. The fact that our physicians and health care system have a hard time dealing with suicide on top of all the other issues they struggle with is, I guess, unsurprising but is part of the general conversation about how our system is failing people in need at multiple points in multiple ways. (Another point on language - in the context of suicide, we don't refer to "successful" attempts, but rather attempts that "completed" or "didn't complete".)
When I can take a step back from some of the personal and professional questions PAD provokes in my day to day life (and I have nothing on the people actually involved in implementation of the protocols right now), it is a rather fascinating chance to watch as our systems work to change themselves in the face of a new right; one colleague with a lot of years of service who was at a meeting where we discussed things both broad and specific said it reminded her a lot of the abortion debates and the changes to the system that happened then.
Sorry if I'm coming across as being pedantic or nitpicky, but this is a pretty charged topic and we're living through what will be some challenges in the understanding and implementation of the fallout from Carter, and I just think that being careful with the terms we chose might help with having the discussions we need to have about our health system, PAD, and the new issues it is going to expose.
posted by nubs at 6:35 PM on July 27, 2016 [3 favorites]
(And just to show how slippery the language can be, I believe the term has changed from PAD (Physician Assisted Dying) to MAID (Medical Assistance in Dying) and I keep reverting).
posted by nubs at 6:41 PM on July 27, 2016
posted by nubs at 6:41 PM on July 27, 2016
And just to correct myself again - Carter and C-14 both clearly do not refer to able-bodied people is a very poor, incorrect statement. Carter talks about "grievous and irremediable" conditions where suffering is "intolerable"; and C-14 wants death to be "reasonably foreseeable". Neither of those necessarily rule out the able-bodied, as you can be able-bodied but still meet these criteria. MAID is for people who meet those criteria being able to seek assistance to ensure that their death is carried out in a manner that is certain and doesn't prolong suffering.
Blah. I'm talking too much and will excuse myself from the thread for a time.
posted by nubs at 6:53 PM on July 27, 2016
Blah. I'm talking too much and will excuse myself from the thread for a time.
posted by nubs at 6:53 PM on July 27, 2016
as someone with severe mental health issues, and who mostly favours the radicial autonomy allowed by euthanasia, but is conerned about the state, i don't know what to do about suicide. i have had fights with ds scholars about thisl
posted by PinkMoose at 6:56 PM on July 27, 2016
posted by PinkMoose at 6:56 PM on July 27, 2016
scruss: I'm disappointed that the FPP links are to FB pages.
I was a little put off by that when I posted it, but it seemed like an important enough project that the forum they chose to create it in - the one that they felt was most accessible to them - shouldn't get in the way of me seeing it as something worthwhile to post and to talk about.
posted by clawsoon at 7:22 AM on July 28, 2016
I was a little put off by that when I posted it, but it seemed like an important enough project that the forum they chose to create it in - the one that they felt was most accessible to them - shouldn't get in the way of me seeing it as something worthwhile to post and to talk about.
posted by clawsoon at 7:22 AM on July 28, 2016
nubs, thanks for your thoughtful comments.
I was surprised to see a couple people saying that they'd already gone to their doctor to seek physician-assisted death. (To me, MAID sounds euphemistic.) After thinking about it, though, it's pretty obvious -- for anyone who's suicidal, PAD would be far preferable to do-it-yourself suicide, because it's painless and there's no risk of failure. Across Canada, that's tens of thousands of people, if not hundreds of thousands, who want PAD, or who even believe that they have a right to PAD (as was the case with the two Redditors I'm thinking of).
I would argue that [this responsibility] (ethically, morally) includes dealing with requests from people who don't qualify--
Prior to the legalization of PAD, if someone was suicidal, they could be committed against their will, to prevent self-harm. I'm not sure if legalizing PAD has changed this.
posted by russilwvong at 8:11 AM on July 28, 2016
I was surprised to see a couple people saying that they'd already gone to their doctor to seek physician-assisted death. (To me, MAID sounds euphemistic.) After thinking about it, though, it's pretty obvious -- for anyone who's suicidal, PAD would be far preferable to do-it-yourself suicide, because it's painless and there's no risk of failure. Across Canada, that's tens of thousands of people, if not hundreds of thousands, who want PAD, or who even believe that they have a right to PAD (as was the case with the two Redditors I'm thinking of).
I would argue that [this responsibility] (ethically, morally) includes dealing with requests from people who don't qualify--
Prior to the legalization of PAD, if someone was suicidal, they could be committed against their will, to prevent self-harm. I'm not sure if legalizing PAD has changed this.
posted by russilwvong at 8:11 AM on July 28, 2016
as someone with severe mental health issues, and who mostly favours the radicial autonomy allowed by euthanasia, but is conerned about the state, i don't know what to do about suicide. i have had fights with ds scholars about this
PinkMoose, I'm having some difficulty parsing your comment, - are you talking about suicide as a personal decision or in the larger sense of is suicide ever an ethical, justified act?
Prior to the legalization of PAD, if someone was suicidal, they could be committed against their will, to prevent self-harm. I'm not sure if legalizing PAD has changed this.
PAD shouldn't affect it much, if at all; certification (forced hospitalization) occurs under the Mental Health Act (at least in Alberta, and I'm going to presume the same for other Canadian jurisdictions). It should only happen if the physician, after an exam, believes the person is suffering from a mental disorder and is likely to cause harm to themselves or others or suffer a serious mental or physical deterioration if they aren't hospitalized. There does need to be a lot of work done to clarify when and where PAD should be available to a person with mental health issues, but the difference here would appear to be the person having a plan to harm themselves and being willing to act on it, usually imminently; PAD should start with the person making a request of their doctor and starting a process as a result (and as noted above, we need to provide a process/guidelines for people making requests who don't meet the criteria). And a mental disorder does not necessarily reflect a mental illness being present; there are other situation and conditions that can create a disordered mental state. In my experience, most people taken to the hospital under the MHA because of suicidal ideation usually sit for hours before being seen, at which point they are promptly discharged because either (a) their mental state has changed enough that they are no longer likely to harm themselves; or (b) they are able to present to a (usually) busy doctor who doesn't have the time for a full assessment as being alright, just a little down.
The presence of suicidal ideation (the thought of committing suicide) on its own isn't ( & shouldn't) be sufficient for certification; it's so common in the general population that we'd have to lock everybody up. It's the presence of a mental disorder (basically, that the person isn't able to think clearly/rationally for whatever reason at that time) combined with not just suicidal ideation but also a plan and a clear intention to follow that plan that is what elevates the risk level. Assessing for suicide risk is usually an involved process; the question of "are you thinking about suicide" is the critically important starting point because it creates the opening for the conversation, but an answer of "yes" doesn't mean anything in terms of assessing the actual risk to the person.
There does need to be work done to create some better understanding of how PAD is going to deal with mental health issues, because mental health issues don't necessarily occur on their own, and what does the system do with someone who is bipolar and has terminal cancer and makes a request?
posted by nubs at 5:40 PM on July 28, 2016
PinkMoose, I'm having some difficulty parsing your comment, - are you talking about suicide as a personal decision or in the larger sense of is suicide ever an ethical, justified act?
Prior to the legalization of PAD, if someone was suicidal, they could be committed against their will, to prevent self-harm. I'm not sure if legalizing PAD has changed this.
PAD shouldn't affect it much, if at all; certification (forced hospitalization) occurs under the Mental Health Act (at least in Alberta, and I'm going to presume the same for other Canadian jurisdictions). It should only happen if the physician, after an exam, believes the person is suffering from a mental disorder and is likely to cause harm to themselves or others or suffer a serious mental or physical deterioration if they aren't hospitalized. There does need to be a lot of work done to clarify when and where PAD should be available to a person with mental health issues, but the difference here would appear to be the person having a plan to harm themselves and being willing to act on it, usually imminently; PAD should start with the person making a request of their doctor and starting a process as a result (and as noted above, we need to provide a process/guidelines for people making requests who don't meet the criteria). And a mental disorder does not necessarily reflect a mental illness being present; there are other situation and conditions that can create a disordered mental state. In my experience, most people taken to the hospital under the MHA because of suicidal ideation usually sit for hours before being seen, at which point they are promptly discharged because either (a) their mental state has changed enough that they are no longer likely to harm themselves; or (b) they are able to present to a (usually) busy doctor who doesn't have the time for a full assessment as being alright, just a little down.
The presence of suicidal ideation (the thought of committing suicide) on its own isn't ( & shouldn't) be sufficient for certification; it's so common in the general population that we'd have to lock everybody up. It's the presence of a mental disorder (basically, that the person isn't able to think clearly/rationally for whatever reason at that time) combined with not just suicidal ideation but also a plan and a clear intention to follow that plan that is what elevates the risk level. Assessing for suicide risk is usually an involved process; the question of "are you thinking about suicide" is the critically important starting point because it creates the opening for the conversation, but an answer of "yes" doesn't mean anything in terms of assessing the actual risk to the person.
There does need to be work done to create some better understanding of how PAD is going to deal with mental health issues, because mental health issues don't necessarily occur on their own, and what does the system do with someone who is bipolar and has terminal cancer and makes a request?
posted by nubs at 5:40 PM on July 28, 2016
Sure, Mental Wimp. Here's one paper suggesting the problem might be more widespread. (There are more, but I'm not going to link-bomb here.)
Thank you for that link. I know it wasn't intended to be exhaustive, but being a guy hungry for real evidence, I took pains to read and vet that article. It turns out to be somewhat duplicitous, however. The very first alarming statement it makes is:
My main concern is that people are not facing up to this issue honestly. They (people on both sides) come to it with predispositions and prejudices that lead to cherry-picking and Texas-sharpshooting to unprecedented degrees (even, apparently, in peer-reviewed articles). There are real concerns with legalizing PDA and euthanasia, but I hope we can honestly examine the benefits and harms comprehensively and use those to make informed choices.
posted by Mental Wimp at 11:05 AM on July 29, 2016 [1 favorite]
Thank you for that link. I know it wasn't intended to be exhaustive, but being a guy hungry for real evidence, I took pains to read and vet that article. It turns out to be somewhat duplicitous, however. The very first alarming statement it makes is:
In 2005, a total of 2410 deaths by euthanasia or PAS were reported, representing 1.7% of all deaths in the Netherlands. More than 560 people (0.4% of all deaths) were administered lethal substances without having given explicit consent7.Reference 7 indeed supports that, but the context in reference 7 is that in 2005 after the law was passed, this number (0.4%) went down compared to 2001 before the law went into effect (0.7%). So the risk of undocumented euthanasia is actually higher without the law. Reference 7 is actually evidence for the benefit of the law, not an argument against it. There are other examples in your cited paper that I won't bore you with.
My main concern is that people are not facing up to this issue honestly. They (people on both sides) come to it with predispositions and prejudices that lead to cherry-picking and Texas-sharpshooting to unprecedented degrees (even, apparently, in peer-reviewed articles). There are real concerns with legalizing PDA and euthanasia, but I hope we can honestly examine the benefits and harms comprehensively and use those to make informed choices.
posted by Mental Wimp at 11:05 AM on July 29, 2016 [1 favorite]
It's the presence of a mental disorder (basically, that the person isn't able to think clearly/rationally for whatever reason at that time) combined with not just suicidal ideation but also a plan and a clear intention to follow that plan that is what elevates the risk level.
Thanks, nubs. Thinking about it from the doctor's point of view, the fact that someone is asking for PAD would indicate that the person has suicidal ideation, but lacks a do-it-yourself plan. So there's some risk (they're serious enough to make the request), but it's not in itself risky enough on its own to justify certification. And as you say, the mental disorder is also a critical piece of the risk assessment.
posted by russilwvong at 11:11 AM on July 29, 2016
Thanks, nubs. Thinking about it from the doctor's point of view, the fact that someone is asking for PAD would indicate that the person has suicidal ideation, but lacks a do-it-yourself plan. So there's some risk (they're serious enough to make the request), but it's not in itself risky enough on its own to justify certification. And as you say, the mental disorder is also a critical piece of the risk assessment.
posted by russilwvong at 11:11 AM on July 29, 2016
→ the forum they chose to create it in - the one that they felt was most accessible to them …
Yes, I understand that, but I don't want FB's algorithm to think I want to see more of this.
posted by scruss at 7:28 AM on July 30, 2016
Yes, I understand that, but I don't want FB's algorithm to think I want to see more of this.
posted by scruss at 7:28 AM on July 30, 2016
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Specifically, the law allows a person to received medical assistance in dying if, in addition to several other requirements, they have "a grievous and irremediable medical condition", which in turn requires all of the following conditions to be met: (emphasis added). So this seems to be a battle disability rights advocates have already won, at least in terms of assisted suicide law, but I'll admit this is an area of the law that I am only moderately familiar with.
And to be clear, I agree that there is tremendous value (and work to be done) in the larger struggles for the rights of the disabled and inculcating a culture of respect and equality for disabled people. Struggles that are very much a matter of life and death, as the mass killing of the disabled in Japan recently demonstrated.
posted by jedicus at 8:20 AM on July 27, 2016 [16 favorites]