Daily Archives: September 12, 2021

As a medical doctor I have, with some worry, followed the assisted dying debate that regularly hits headlines in many parts of the world. The main arguments for legalisation are respecting self-determination and alleviating suffering. Since those arguments appear self-evident, my book Euthanasia and the Ethics of a Doctors DecisionsAn Argument Against Assisted Dying1 aimed to contribute to the international debate on this matter.

I found it worthwhile to look into the arguments for legalisation more closely, with the hope of sowing a little doubt in the minds of those who exhibit absolute certainty in the matter. This essay focuses on one point: the concept of autonomy.

(While there are several definitions of voluntary, involuntary, and non-voluntary euthanasia as well as assisted dying, assisted suicide, and physician assisted suicide, for the purposes of brevity in this essay, I use assisted dying throughout.)

Currently, in richer countries, arguments for legalising assisted dying frequently refer to the right to self-determinationor autonomy and free will. Our ability to self-determine seems to be unlimited and our right to it inviolable. The publics response to opinion poll questions on voluntary euthanasia show that people can scarcely imagine not being able to make up their own minds, nor can they imagine not having the choice. Moreover, a healthy person answering a poll may have difficulty imagining being in a predicament where they simply would not wish to be given the choice.

I question whether self-determination is genuinely possible when choosing your own death. In my book, I explain that the choice will always be made in the context of a non-autonomous assessment of your quality of lifethat is, an assessment outside your control.1

All essential decisions that we make are made in relation to other people. Our decisions are affected by other people, and they affect other people. Although healthy people find it difficult to imagine themselves in situations where they do not decide freely, it is also true that all of us are vulnerable and dependent on others.

Yet autonomy in relation to assisted dying is often viewed in the same way as our fundamental right to choose our own course in life. If we are able to control our lives, then surely we can also control our death. Autonomy with respect to your own death, however, is already halved: you can choose to die if you dont want to live, but you cannot choose to live if you are about to die.

Decisions about your own death are not made in normal day-to-day contexts. The wish to die arises against a backdrop: of desperation, a feeling of hopelessness, possibly a feeling of being superfluous. Otherwise, the wish would not be there. Thus, it is under these circumstances that the right to self-determination is exercised and the decision is made. Such a situation is a fragile basis for autonomy and an even more fragile basis for decision making. The choice regarding your own death is therefore completely different from most other choices usually associated with the concept of autonomy.

Here are just some of the critical matters that would arise if assisted dying were legalised.

The possibility of choosing to die would inhabit everyones consciousnessthe patient, the doctor, the relatives, and the care staffeven if not formulated as an out-and-out offer. But if a law on assisted dying gives the patient a right to die, that right may turn into a duty to die. How autonomously can the weakest people act when the world around them deems their ill, dependent, and pained quality of life as beyond recovery?

Patients can find themselves directly or indirectly under duress to choose that option if they consider themselves sufficiently pained and their quality of life sufficiently low. Patients must be at liberty to choose assisted dying freely, of coursethat is how it is presentedbut the point is that the patient cannot get out of having to choose. It has been called the prison of freedom.

Pressure on the patient does not have to be direct or articulated. As pointed out by the US professor of biomedical ethics Daniel Sulmasy it may exist as an internalised external pressure.2 Likewise, the French bioethicist Emmanuel Hirsch states that individual autonomy can be an illusion. The theologian Nigel Biggar quotes Hirsch saying that a patient may truly want to die, but this desire is not the fruit of his freedom alone, it may beand most often isthe translation of the attitude of those around him, if not of society as a whole which no longer believes in the value of his life and signals this to him in all sorts of ways. Here we have a supreme paradox: someone is cast out of the land of the living and then thinks that he, personally, wants to die.3

An inherent problem of autonomy in connection with assisted dying is that a person who uses his or her presumed right to self-determination to choose death definitively precludes himself or herself from deciding or choosing anything. Where death is concerned, your right to self- determination can be exerted only by disposing of it for good. By your autonomy, in other words, you opt to no longer have autonomy. And those around must respect the right to self-determination. The respect refers to a person who is respected, but this is precisely the person who disappears.

Danish philosopher Johannes Slk, who supported legalisation, said, The actual concept of death has no content, for death is the same as nothing, and one cannot choose between life and nothing. Rather, therefore, one must speak of opting out; one opts out of life, without thereby choosing anything else. Death is not something other than life; it is the cessation or annihilation of life.

Autonomy is a consistent principle running through the care and management of patients and is enshrined in law. However, a patients autonomy means that he or she has the right to decline any treatment. It does not entail a right to have any treatment the patient might wish for. Patients do not have the right to demand treatment that signifies anothers duty to fulfil that right. If that were so, autonomy would be the same as autocracyrule of the self over others. Even though patients have the right to reject any intervention, they do not have the right to demand any intervention. Rejecting any claim that the person might make is not a violation of a patients self- determinationfor example, there may be sound medical reasons for not complying with a demand. The doctor also has autonomy, allowing him or her to say no. Refusing to kill a person or assist in killing cannot be a violation of that persons autonomy.

Assisted dying requires the doctors moral and physical help. It is a binding agreement between two people: the one who is to be killed and the one who is to kill or assist in killing. But our society does not condone killing as a relationship between two legally competent, consenting people. Exemptions from the killing ban involve war or self-defence and are not justified on the grounds that the killing is done for the benefit of someone else.

If the action is to be decriminalised, as some people wish, it means the doctor will have to enter into deliberations and arguments for and against a request for assisted dying each time. That is, whether he or she is willing to grant it. The alternative would be to refer the patient to another doctor who might be willing to helpthat doctor would still have to assess whether the patients life was worth preserving.

Thus, autonomy is not the only factor or even always the key factor when deciding whether assisted dying can be granted. It is not only the patients own evaluation that is crucial. The value of the patients life must also be assessed as sufficiently low. This demonstrates the limitation of the patients self-determination.

If a competent and legally capable person must have the option of voluntarily choosing assisted dying in the event of unbearable suffering, why does suffering have to be a requirement? The answer is straightforward: our concepts of assisted dying imply that compassion must form a crucial aspect of the decisionmercy killing and compassionate killing are synonyms. But this leads instantly to the question of why we should not also perform assisted dying on people who are not in a position to ask for it themselves but are also suffering.

Some people find the reasoning unproblematic. It stands to reason that relieving suffering is a duty after all. But in this context it is not unproblematic, because it effectively shifts the focus from the autonomy claimed. According to prevailing ideas about autonomy, patients initially evaluate their quality of life themselves, but ultimately it is those around them who end up gauging that quality and the value of their life. That is to say, the justification for assisted dying is borne on the premise that certain lives are not worth living rather than the presence of a request. The whole point is that in the process, respect for the right to self-determination becomes relative.

Autonomy is largely an illusion in the case of assisted dying.1 A patient overwhelmed by suffering may be more in need of compassion, care, and love than of a kind offer to help end his or her life. It is not a question of whether people have a right to say that they are unworthy. It is a question of whether they have a right to be believed when saying it.

Ole Hartling is a physician of over 30 years standing, doctor of medical sciences at the University of Copenhagen, professor of health promotion at the University of Roskilde, and an author and co-author of several books and scientific articles published mainly in Scandinavia. Between 2000 and 2007 he was a member of the Danish Council of Ethics and its chair for five years. During this time, the council extensively debated the ethics of euthanasia and assisted dying.

Original post:

Euthanasia and assisted dying: the illusion of autonomyan essay by Ole Hartling - The BMJ

What contempt the Queensland Government must have for Christians that they have chosen the middle of a pandemic to pick an ideological fight with the church that provides 20 per cent of the states hospital and aged care beds.

Queensland Labor will soon introduce a euthanasia bill that, if passed, will compel Catholic care facilities to permit terminally ill patients to be killed.

Why the ALP would require such a thing of Christians, let alone at a time when the state most needs the Catholic health system, is a mystery.

Perhaps the Palaszczuk government has grown so used to pushing citizens around over the past 18 months that it now believes it can get away with murder.

Could it be that the premier does not realise Catholic hospitals are run by Catholics?

Maybe she is unaware of an idea held by Catholics common amongst Christians but evidently quite rare in the modern Labor Party called sanctity of life.

Queensland Deputy Premier Stephen Miles has dismissed such concerns, insisting that euthanasia in faith-run facilities would be very, very rare.

Ohhhhh, well if the residents of Catholic nursing homes are onlyoccasionallyput to death

Inconveniently for Miles, Christians cannot pick and choose when life is sacred and when it is expendable.

Christian doctrine, unlike Labor policy, doesnt change according to the fancies of this weeks focus group.

But what about compassion? Thats all the Labor Party is seeking. A bit of compassion for people wanting to be euthanised but not well enough to be moved from a Christian facility to a state-based hospital where there is more you know flexibility, when it comes to respect for life.

Whatever the reason for the governments desire to make Christians an accessory to euthanasia, it is not compassion.

Remember, this is the compassionate government that, just days ago, refused entry to Queensland for a four-month-old baby who needed vital brain scans.

The government had to protect its citizens from Covid, you see. A baby just south of the border was not a person to be helped, but a hazard to be locked out.

Speaking of Coronavirus, its hard to square the Queensland Governments insistence that not one person must be allowed to die from Covid, no matter the cost, with its insistence that assisted dying must be continually promoted and any obstruction criminalised.

Catholics fell into line when the government told them they could not sing for fear of spreading Covid.

And Catholics fell into line when the government told them they could not meet for fear of hosting a super spreader event.

But Catholics have told the government they will not, indeed they cannot, obey a law that requires them to assist in the provision of euthanasia at their facilities.

The government should not force Christians to become accessories to other peoples deaths. That would impose a burden of conscience impossible to bear.

And impossible for Queensland to bear would be the economic burden if, by its own pigheadedness, the government forced the closure of faith-based hospitals and aged care facilities and was therefore required to fill the gap.

Indeed, they could not. The health system would collapse. And all in the middle of a pandemic.

This was the very dilemma faced in June by South Australian politicians who, at the last moment, blinked and changed their legislation to exempt faith-based providers from being a party to assisted dying.

Right now though, Miles is speaking from on high as one whose words are written in stone.

I expect all of our healthcare providers and aged-care providers will comply with the law, he told The Australian, brooking no exceptions.

The open hostility to people of faith is an affront to citizens everywhere.

If the state cares so little as to completely dismiss a Catholics conscience on something as fundamental as the sanctity of life, more fool you if you think you have any rights at all.

Christians, Jews and Muslims believe Thou shalt not kill was written in stone and by none other than the finger of God long before Queensland Labor started peddling pro-death policies.

The Catholics, like them or not, are right now about the only institution prepared to stand up to the state.

We should all pray they hold their nerve.

More here:

Why has Queensland Labor declared war on Catholic healthcare over euthanasia? - The Spectator Australia

Queensland is set this week to become the fifth state in the country to legalise voluntary euthanasia for terminally ill patients.

The journey to change the law has been long, including a year-long parliamentary inquiry in 2019, referral to the Queensland Law Reform Commission, and the introduction of a bill in May to meet a Labor election pledge.

If the voluntary euthanasia laws pass, they are expected to come into effect in January 2023.Credit:JasonSouth

A parliamentary committee last month recommended the bill pass, although LNP MP Mark Robinson, a devout Christian, said it should not pass, or if it did, should be amended to allow health practitioners who conscientiously object to also refuse to refer patients to someone who would provide the service.

Under the proposed bill, which will be debated in Parliament this week, Queensland adults must have been diagnosed with a disease, illness or medical condition that is advanced, progressive, will cause death within 12 months, and is causing intolerable suffering.

The person must be assessed by two doctors, make three separate requests, and they can change their mind at any time.

Private hospitals and residential aged care facilities run by religious organisations will have the right to conscientiously object and choose not to provide euthanasia, but they must not hinder a persons access to it.

But opponents, such as Catholic Health Australia, do not want to be forced to allow euthanasia on their premises, and they have raised concerns that people would not need to see a specialist doctor before ending their own lives.

St Vincents Health Australia, which runs three hospitals in Queensland, was also pushing for amendments, including preventing VAD-approved doctors and nurses from entering hospitals unannounced to assist patients with euthanasia.

On the other hand, a survey of Queensland Nurses and Midwives Union members in February found almost 87 per cent supported voluntary assisted dying, while YouGov polling from last year, commissioned by the Clem Jones Trust, found 77 per cent of Queenslanders were in favour.

View post:

Voluntary euthanasia set to become law in Queensland this week - Brisbane Times

This past year I cared for a young woman in her early 20s. Carole (pseudonym) has extreme anxiety and depression which has been going on for years. Carole is a community worker who works with the homeless. During the COVID pandemic her symptoms were exacerbated to the point that she has become anorexic. Unfortunately access to dieticians, psychiatrists and psychologists has been extremely difficult and limited. By seeing her on a regular basis and making myself readily available, I have kept her from giving up hope. Because of her long term psychological suffering, the recent law of Medical Assistance in Dying [MAID] could make Carole a candidate for euthanasia.

The Canadian Parliament passed Bill C-7 in February, 2021 adding mental illness as a criterion for MAID [coming into effect in 2023].

Accordingly, those who only have mental health problems and no physical ailments with years to live could be euthanized.

I recently participated at Quebecs Parliamentary hearings with Montreal attorney Me Natalia Manole. http://m.assnat.qc.ca/fr/video-audio/archives-parlementaires/travaux-commissions/AudioVideo-90901.html%5D Mental illness includes the following disorders: anxiety, depression, bipolarity, obsession-compulsion, psychosis, substance abuse, anorexia, and Aspergers syndrome spectrum.

The causes of these mental disorders include: stress, substance abuse, low self-esteem, difficulty in adapting, personal loss, abuse, homelessness, isolation, job loss, and low income. Treatment of mental illness includes social supports, psychotherapies and psychiatric medications. A 2017 Canadian Psychiatric Association study indicates that only 29% of Canadian psychiatrists support MAID in cases of mental illness.

Even in the Netherlands, where euthanasia is practiced on the mentally ill, two-thirds of psychiatrists are opposed to it. In addition, studies show that at least 90% of people who have ended their lives by suicide were affected by mental health problems. Needless to add, most people who have attempted or committed suicide do not necessarily want to die; rather, they want to escape from their overwhelming emotional pain.

In order to be euthanized, you must give a free and clear consent. But how can a mentally ill person give a free and clear consent when the desire to die is a symptom of mental illness? Even for basic contracts such as buying a car or renting an apartment, the contract can be cancelled because of the absence of free and clear consent of a mentally ill person.

According to a study from Harvard School of Public Health, 9 out of 10 people who attempted suicide and failed in their attempts and subsequently survived did not ultimately kill themselves following treatment. [https://www.hsph.harvard.edu/means-matter/means-matter/survival/]. There would have been no survivors if they had been euthanized. MAID is a road of no return. There are no survivors and no second chances to be treated and live.

We need to communicate to those contemplating suicide that we do not want them to die, that they are valuable to us, there is always a reason to live, and we will help them solve their problems. We need to provide more psychological, social and financial help for those who are in distress. We must improve their living conditions by providing affordable housing, food, and basic life supports. Those with dependency problems need access to care. We need to care for those with mental health problems- not support or endorse MAID.

Dr. Paul Saba is a family physician practicing in Montreal, co-founder of Physicians for Social Justice and author of Made to Livehttps://www.madetolive.com/.

See the original post:

The mentally ill should not be euthanized | OP / ED | thesuburban.com - The Suburban Newspaper

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South Louisiana, especially Down the Bayou, is in extreme need of relief and recovery aid in the aftermath of Hurricane Ida. So instead of the usual pithy Bon Vivant fodder, todays post is dedicated to people and organizations with boots on the ground helping in real time. There are so many worthwhile individuals and entities helping in the affected areas, so please feel free to donate to your favorite if you can help. But if you arent sure where to donate, heres a list to get you started, including a summary (mostly from each organizations website or donation page) of the groups mission or group it supports.

New Orleans Musicians Clinic Hurricane Ida Relief: This group is feeding its members, getting them their medicines and medical attention, assisting with FEMA claims and many other services post-hurricane. It describes its work as providing comprehensive medical care and social services to local musicians, performing artists, cultural workers, and tradition bearers.

Feed the Second Line: Post-hurricane, Feed the Second Line is providing food, supplies and assistance in New Orleans and Down the Bayou. From its site, We support culture bearers by purchasing groceries and other essentials, we create job opportunities for culture-bearers, we provide general support for those who make our city culturally rich place.

Zeus Rescues: Zeus volunteers have been rescuing pets left behind or lost during the storm, on the day-to-day however this is what the group does: It is the mission, duty, and purpose of Zeus Rescues to eradicate pet homelessness and euthanasia within the New Orleans metro area. The organization is further committed to community-building and pet education with a focus on children and the elderly.

Habitat for Humanity New Orleans: Habitat has a fund specific to Hurricane Ida relief. Its overall mission is To responsibly build communities where families can thrive, in homes they can afford.

Second Harvest Food Bank: For its Hurricane Relief fund, Second Harvest says, Thousands have been impacted and displaced by Hurricane Ida. Every $1 donated helps Second Harvest provide 4 meals to our neighbors facing hunger. Meanwhile the group says it leads the fight against hunger in South Louisiana by providing food access, advocacy, education, and disaster response.

Bayou Fund: This Go Fund Me was established by Chef Melissa Martin of Mosquito Supper Club in New Orleans through the Helio Foundation to help people Down the Bayou in her native Terrebonne Parish.

Cajun Navy Relief: Simply put, TheCajun Navy Relief and Rescueis here to help those in need. If you are unfamiliar with the group, its volunteers go into disaster areas to rescue people and pets, as well as offer supplies and other aid.

United Houma Nation: Also assisting tribal members and others in the hurricane affected areas, from its site, The United Houma Nation is a 501c3 nonprofit organization The Tribe survives and thrives on financial contributions to support general daily operations as well as programmatic support.

World Central Kitchen: Chef Issac Toups of Toups Meatery in New Orleans, as well as other chefs throughout South Louisiana are serving hot meals to people in need in partnership with World Central Kitchen. Many people know World Central Kitchen through its founder Chef Jos Andrs. The group offers culinary training and education as well as other initiatives, but also serves meals in the aftermath of disasters. Andrs is often somehow, remarkably the first on the ground after a crisis and South Louisiana was no exception.

The homes and livelihoods of thousands of people have been destroyed so if you live in South Louisiana or have ever visited here and fell in love with the beauty, food, art, music, history, mystery, parades, animals, landscape and people that create New Orleans and Louisiana culture and lore, and you have cash to spare, please make a donation to one of these worthwhile organizations or one that isnt on this list.

Originally posted here:

Relief and Recovery: Helping People Affected by Hurricane Ida - My New Orleans

The companionship of animals brings much pleasure into many peoples lives. Pets help us to be physically and mentally healthy, and they support us emotionally, offering us a type of unconditional love that can be hard to find elsewhere.

But there is one big downside: its likely that your pet will reach the end of their life before you, so one day youll be faced with deep sadness at their loss.

As a vet, this is something I need to deal with nearly every day. Its the most challenging part of my job. The day you take on a pup or a kitten, you are signing up for a deal which means that you are going to be upset one day in the future, when its their time to go.

Death is inevitable. As has been said in the past grief is the price we pay for love.

We are fortunate that we are able to choose to end the lives of animalsbefore they start to suffer. We can ensure that pets end their lives peacefully, in a controlled way, surrounded by the people that they love.

Vets are allowed to carry out euthanasia, a word which is derived from the Greek for good death. In contrast, human doctors have to allow their patients to carry on until the end.

I feel blessed to be able to release my patients before they suffer discomfort, pain, confusion, or agitation.

One of the big challenges for pet owners is choosing the right moment. It can be difficult to see a situation objectively when you are emotionally involved, and vets try to offer advice and tools to make this easier.

Some people find it helpful to write two columns on a page: on the left, you write down all of your pets favourite activities when they were in their prime. On the right, you tick the ones they can still do. When its obvious that there are no enjoyable activities left in your elderly, ailing, pets life, it can make it easier to make that difficult decision to say goodbye.

There are also online guides (eg at petfix.com) that help analyse quality of life, looking at a wide variety of factors such as mobility, appetite, pain and hygiene. These guides allow you to calculate a numerical score which helps you to understand your pets degree of suffering.

Everybody is different, but the important message is that there are ways that you can be helped to make the difficult decision that its time for euthanasia.

Its important to understand beforehand what happens during euthanasia: a detailed conversation with your vet is helpful, so that you are completely clear about what to expect.

The procedure is usually done at the vet clinic, although a house call may sometimes be preferable.

The euthanasia drug is a potent version of a general anaesthetic: its injected into your pets vein painlessly, and within seconds, they fall deeply unconscious. A few moments later, their heart stops, and their life draws to a peaceful close.

They are entirely unaware that this is happening: in this regard, its similar to being given an overdose of an anaesthetic. Theres no fear, no pain, just the smooth, calm, and permanent removal of consciousness.

Traditionally, vets give the drug by intravenous injection using a syringe and needle, after removing a little fur from a front leg. Sometimes an intravenous cannula may be placed beforehand, removing the risk of being unable to find a vein in an elderly, weakened animal.

Occasionally a sedative may be given earlier, if an animal is nervous about being handled. In some cases, the injection may be given in a different location. There should be no surprises: ask your vet beforehand about what is planned.

Most owners choose to stay with their pets during the euthanasia process, but not everybody feels that they wish to do this, and thats fine. A false myth was shared on social media last year suggesting that pets get upset if their owners leave them at this time. This is not true. I have euthanased many pets in the absence of their owners, and I have never witnessed them being upset at being on their own. Animals dont know what is happening at the time of euthanasia: as far as they are concerned, they are at the vet, being helped as in the past, and thats as much as they understand.

Its all over very quickly: sometimes, animals give a few gasps in the minutes after theyve passed away, and these involuntary movements can be upsetting if you dont expect them. Animals eyes dont close when they die, and some people find this disconcerting too. Often your vet will use their stethoscope to confirm that your pets heart has stopped beating, and that their life has definitely ended.

You then have the difficult decision about what to do with your pets remains. Burial at home may be possible in some cases, but the practicalities can be challenging, and local authority rules vary around the country.

Most people choose to have their pets cremated, with nearly all vets offering this option. Pets remains are usually left at the vet clinic, from where they are taken to the pet crematorium. Some owners dont want to have their pets ashes returned to them afterwards while others do: its a personal choice. Theres often a range of caskets to choose from for the ashes. Again, clear communication with your vet about your wishes is important.

Death can be so very sad, but remember: a life of love is a wonderful gift, and thats what good owners give to their pets. Theres much to celebrate amongst the grief.

Link:

Pete the Vet: How do you know when its time to let go? - Irish Examiner