Wednesday, February 8, 2017

The law will also will exclude those who experience mental illness or psychiatric conditions. It will also ban advance consent. That is, it won’t allow requests to end one’s life in the future.----------------Julie Ali · University of Alberta Death by doctor provides a route for citizens with insight (capacity) to die with dignity. Rules have to be followed in order to be processed in this way. The assisted suicide legislation does not allow citizens without capacity to have this option for good reason. However when we have "Do Not Resuscitate" (DNR) order on file--we do not have legislation governing this. Why is this? I find it incredibly lax to allow DNR designations without fixed rules in place. What happens to patients without insight who have a DNR placed inappropriately on their medical records? In the case of my handicapped sister a DNR order was placed on her medical records for years. We protested and nothing was done by Covenant Health in Alberta. The problems encountered by the family in advocating for her were very stressful and completely unnecessary. I feel that severely handicapped citizens in Alberta are at risk of such DNR orders for spurious reasons; lacking insight these citizens may not be able to advocate for themselves. Certainly without an advocate, such handicapped citizens are completely defenceless. This is not an acceptable situation and in my opinion--no checks and balances exist in the system in Alberta to ensure their safety. There needs to be legislation governing DNR orders, an independent appeal process if family wishes to challenge these orders and no unilateral DNR decisions without family / patient consent. I do not believe it is appropriate for doctors to unilaterally decide upon premature termination of severely handicapped citizens who have a personal directive indicating full resuscitation. These orders are basically death by doctor --but without the rigour of oversight of the assisted suicide law. Such DNR orders mean inevitable termination. In a recent study, only 1 out of 2,500 citizens with a DNR noted on file was resuscitated. https://secure.cihi.ca/.../advance_directive_often_do_not... A Snapshot of Advance Directives in Long-Term Care: How Often Is “Do Not” Done?… 2016 Canadian Institute for Health Information Key messages • Three-quarters of long-term care residents have a DNR directive. These directives appear to be well followed across the continuum of care, with only about 1 in 2,500 residents receiving resuscitation in hospital despite having a directive not to resuscitate. **** This information indicates how rare it is for any citizen with a DNR order on file to survive such an order. There needs to be public discourse not just on death by doctor which seems to be getting far more attention and funding than I expected. It seems like in Alberta they have increased health care staff to ensure that they keep up with the demand. In contrast we do not see similar attention with reference to keeping folks alive. Perhaps this is because keeping people alive is more expensive and demanding than providing them with the cheaper solution of assisted suicide. Other options which entail keeping folks alive such as appropriate integrated care planning for complex cases, the requirement to provide responsive, timely mental health care services and the absolute need for advocates when severely handicapped citizens without insight are receiving DNR orders should be considered. Like · Reply · 2 mins---




New assisted suicide law will be limited to Canadians to prevent suicide tourism

Rob Gillies, The Associated Press | April 14, 2016 8:26 AM ET
Canada’s justice minister is due to announce details on Thursday
FotoliaCanada’s justice minister is due to announce details on Thursday
TORONTO — Canada’s new assisted suicide law to be announced on Thursday will exclude non-Canadians, which means Americans won’t be able to travel to Canada to die.
A senior government official told The Associated Press late Wednesday the new law will exclude non-Canadians, precluding the prospect of suicide tourism from the U.S. and elsewhere. The official spoke on condition of anonymity because they were not authorized to discuss details ahead of the Thursday morning announcement.
The law will also will exclude those who experience mental illness or psychiatric conditions. It will also ban advance consent. That is, it won’t allow requests to end one’s life in the future.

Related

The Supreme Court last year struck down laws that bar doctors from helping someone die, but put the ruling on hold while the government came up with a new law. New Prime Minister Justin Trudeau’s Liberal government asked for a four month extension to come up with the new law. Canada’s justice minister is due to announce details on Thursday.
Assisted suicide is legal in Switzerland, Germany, Albania, Colombia, Japan and in the U.S. states of Washington, Oregon, Vermont, New Mexico and Montana. The Netherlands, Belgium and Luxembourg allow doctors, under strict conditions, to euthanize patients whose medical conditions have been judged hopeless and who are in great pain.
Canada’s Supreme Court declared last year that outlawing that option deprives dying people of their dignity and autonomy. It had been illegal in Canada to counsel, aid or abet a suicide, an offence carrying a maximum prison sentence of 14 years.





Trudeau \\\'optimistic\\\' assisted dying law... 1:09

Last year’s ruling immediately triggered emotional responses from both sides of the debate.
The decision was spurred by cases brought by the families of two British Columbia women, who have since died. The decision reversed a Canadian Supreme Court ruling in 1993. At the time, the justices were primarily concerned that vulnerable people could not be properly protected under physician-assisted suicide. But the top court said last year that doctors are capable of assessing the competence of patients to consent, and found there is no evidence that the elderly or people with disabilities are vulnerable to being talked into ending their lives.
It has been more than 20 years since the case of another patient with Lou Gehrig’s disease, Sue Rodriguez, gripped Canada as she fought for the right to assisted suicide. She lost her appeal but took her own life with the help of an anonymous doctor in 1994, at the age of 44.


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Julie Ali ·
Death by doctor provides a route for citizens with insight (capacity) to die with dignity. Rules have to be followed in order to be processed in this way. The assisted suicide legislation does not allow citizens without capacity to have this option for good reason.

However when we have "Do Not Resuscitate" (DNR) order on file--we do not have legislation governing this.
Why is this?
I find it incredibly lax to allow DNR designations without fixed rules in place. What happens to patients without insight who have a DNR placed inappropriately on their medical records?

In the case of my handicapped sister a DNR order was placed on her medical records for years. We protested and nothing was done by Covenant Health in Alberta.

The problems encountered by the family in advocating for her were very stressful and completely unnecessary. I feel that severely handicapped citizens in Alberta are at risk of such DNR orders for spurious reasons; lacking insight these citizens may not be able to advocate for themselves. Certainly without an advocate, such handicapped citizens are completely defenceless. This is not an acceptable situation and in my opinion--no checks and balances exist in the system in Alberta to ensure their safety.

There needs to be legislation governing DNR orders, an independent appeal process if family wishes to challenge these orders and no unilateral DNR decisions without family / patient consent. I do not believe it is appropriate for doctors to unilaterally decide upon premature termination of severely handicapped citizens who have a personal directive indicating full resuscitation. These orders are basically death by doctor --but without the rigour of oversight of the assisted suicide law.

Such DNR orders mean inevitable termination. In a recent study, only 1 out of 2,500 citizens with a DNR noted on file was resuscitated.

https://secure.cihi.ca/.../advance_directive_often_do_not...
A Snapshot of Advance Directives in Long-Term Care: How Often Is “Do Not” Done?…
2016 Canadian Institute for Health Information

Key messages
• Three-quarters of long-term care residents have a DNR directive. These directives appear to be well followed across the continuum of care, with only about 1 in 2,500 residents receiving resuscitation in hospital despite having a directive not to resuscitate.

****
This information indicates how rare it is for any citizen with a DNR order on file to survive such an order.

There needs to be public discourse not just on death by doctor which seems to be getting far more attention and funding than I expected. It seems like in Alberta they have increased health care staff to ensure that they keep up with the demand.

In contrast we do not see similar attention with reference to keeping folks alive. Perhaps this is because keeping people alive is more expensive and demanding than providing them with the cheaper solution of assisted suicide.

Other options which entail keeping folks alive such as appropriate integrated care planning for complex cases, the requirement to provide responsive, timely mental health care services and the absolute need for advocates when severely handicapped citizens without insight are receiving DNR orders should be considered.
LikeReply2 mins
Mari Irwin
I do not believe that it is possible for someone dying in extreme pain to be without psychiatric issues. Isolation alone creates many forms of mental illness. The most common, understandably, is depression. The right to give advance directives is imperative in light of the suffering endured by those affected by this bill.
UnlikeReply1Apr 27, 2016 9:39am
Julie Ali ·
Unfortunately doctors can and do ignore the advance directive. In Alberta, they ignored my handicapped sister's personal directive requiring full resuscitation repeatedly.
While the assisted suicide legislation forbids this choice to the mentally ill citizens, the DNR order can be imposed by doctors on citizens without insight and the GOA does nothing. It's pretty mind boggling.

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