Do we have the right to die in the way we want, when we want and how we want ? The Supreme Court gave our parliament until June 6, 2016 to pass a law allowing physician assisted dying. As a nurse, wife, mother, Christian and Canadian citizen, I am at two minds about this legislation. However, our Canadian policy makers seemed to have put together a decent bill with some safeguards in it.
First let’s look at this bill
Who can access this “right “? A person must have:
- an incurable illness or disability
- An advanced state of irreversible decline
- be in intolerable suffering
- natural death must be “reasonably foreseeable”
So what does this actually mean ? It means that this law is actually for the “dying patient”. It is not for those who are suffering and wish their life over, and where death is not an inevitability in the near future. As predicting how long someone has left in their life is a very non scientific, and sometimes a guessing game, the fact that the arbitrary 6 months to live or other parameters were not put in this bill can be troubling for some, it makes sense to me. The person must also be in “intolerable suffering” – which really can only be judged by the dying person themselves, yet will have to be decided by two physicians. That may be problematic. Irreversible decline – tells me that the health status must be worsening and death is the only outcome. Incurable is easy to define in most circumstances.
What other safeguards are in this law ?
- The person must request this in writing (can use acceptable methods of consent that is in place in all medical procedures if they cannot sign themselves)
- The person must be able to express their own wishes – this cannot be a family or friends’s request.
- There is a 15 day waiting period after consent
- They must take the medication themselves
- They must have Canadian Healthcare ( no tourism for this ! )
The bill addresses some of my concerns – but leaves some unknowns in the minds of those looking at it.
- Can a person declare in advance their wishes should they become in this state and be unable to say what they wish ? Most provinces have an Advance Directive law.
- Can a person have a mental illness that fits these criteria ? ( I think not )
- As our health care is provincially administrated, will access be different in various Provinces in our country.
- Some say that the 15 day rule can be problematic, but in my experience, I have seen patients demand to die when in intractable pain, yet more settled in the dying process when pain and symptom measures are in place. Would we have robbed that person of some very important final goodbyes if requests could have an immediate effect. To me, as a health care professional, this safeguard is quite vital
I have seen irrational thoughts when someone is in horrible pain, and those thoughts dissipate when pain is relieved. Heck, when a friend was in labour she threatened to jump out the window to stop the pain. Right to die legislations must never come before good palliative care. Good palliative care assists a person in their dying process with the aim of pain and symptom management with clarity of mind. Sometimes a hard balance, but most times it can be done.
The fifteen day window may cause concern for some. I think it provides a good safeguard, but will eliminate some from being eligible. Sometimes it is the last week or two of life that are more painful and troubling. I think it is a good start. Good research following this becoming law would be important- so we can know if indeed this is a good clause.
Right to die legislation is not new. Switzerland, the Netherlands, Belgium and Luxembourg in Europe, and several states in the USA have these legislations. Some date as far back as 1949. Most US states with legislation says there has not been abuse of this law. In most of those countries/states, the number of patients enacting this right is rising steadily. Some statistics say that many more ask than actually enact the decision in their lives.
I was asked as a member of the Saskatchewan Registered Nurses Association to fill in a survey re our concerns as nurses. I had to say that good policy development and education for all that may have to know and enact this law and wonder how to deal with it. I also have a great fear of our equality mentality that will bring someone who feels that they cannot ( due to moral or religious grounds ) assist a person to commit suicide. As we read the International Nurses Pledge at our reunion banquet recently, I thought of what we were pledging and how that fit. Can I pledge to “refrain from any action which might endanger life or health” and still follow this law ? Physicians would have a similar dilemma, having sworn their own oath. I hope that the law makers and the law enforcers will remember that some of us came from the era where our oaths and pledges meant so much to us.
I do fear that we are going down a slippery slope but one that we have been sliding on for some time. Change is hard and I am really not sure where I sit with this new law. There are a lot of worries of what will come next, and sometimes I don’t think we need to “go there.” The law will soon be in effect, so lets try to live within it.
For now, I will watch and wait and hope that for those that are dying, we look to pain and symptom management while supporting families in good hospice settings or hospice like settings, helping people to understand the process, and helping them to accept the dying – and to say goodbye. I will hope that pain medications will never be spared, and doses titrated up to ones that may seem astronomical but are needed. I will hope that anxiety will be relieved, and restlessness settled. I will hope that nurses will educate themselves on palliative medications as some drugs used in palliative care are frowned upon. I will also hope that they will have a good nurse to hold their hand – who because she/he believes in and loves palliative care, stops in her/his busy day to remember the reason she/he is there.
And if someone asks for the tools to quicken that process, that the policies and education and safeguards are known, that the decision is discussed, counselled and supported so that this death can have the same caring at the end as those that die in a more ” natural way.”
I will also try to remember that as they say ” there are no atheists in foxholes” and we cannot know until confronted with our own inevitable death what we might want or do. Knowing this, and knowing that I agree with withdrawal of life support when that becomes burdensome or a body is brain dead or end of life, puts me in that ” two sides of the fence” type of thinking on this law.
I look forward to your thoughts !