Medical assistance in dying (MAID)

This discussion was created from comments split from: End of life care.

Comments

  • CaissaCaissa Shipmate
    The issue of MAID, competence and spousal input is before the Nova Scotia courts.
    https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-medical-assistance-in-dying-supreme-court-injunction-1.5691456
  • Caissa wrote: »
    The issue of MAID, competence and spousal input is before the Nova Scotia courts.
    https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-medical-assistance-in-dying-supreme-court-injunction-1.5691456

    That's terrible, that it is in court. As someone who fundamentally disagrees with active euthanasia, and sees the legalization of MAID in the broader context of lack of palliative care, proper medical addressing of pain and fear. I agrees with palliative sedation as described by the founder of palliative care Dr. Balfour Mount.

    A problem with MAID is that it always seems to be discussed by healthy people who think of themselves as having the same cognitive, emotional and mental status when in terminal illness situations as they do when discussing it. I'd prefer no law enabling MAID and full funding of palliative and end of life care.

    <I'm going to message hosts that this may be a tangent>
  • CaissaCaissa Shipmate
    It MAID not a form of end of life care? I am not sure you needed to message the hosts.
  • LeafLeaf Shipmate
    I support robust palliative care programs, and also MAID.

    I support MAID for the same reason I support pro-choice: a person should have the right to do as they wish with their own body (this is a simplified form of a longer statement). If that is true of abortion, which involves the potential life of another, how much more ought it to be true of decisions involving one's own life?

    Deaths differ. Not everybody goes gently into that good night. Some deaths are pointless protracted horror shows, events which do not change the outcome but inflict pointless prolonged trauma on everybody involved. When a person's demise has every reasonable likelihood of following that trajectory, I can't blame them for seeking to avoid a pointless protracted horror show of a death.

    There's a reason some palliative beds have burgundy sheets. The death will likely involve bleeding out, profusely and everywhere. If family are present, the idea is that the blood will not show as terribly on burgundy sheets as on white sheets. One young woman of my acquaintance died such a death, from cancer, before MAID was available. Her parents were in deep denial about her condition, expecting that she would "get better", despite every clear communication from the medical team. The parents witnessed her death which included bleeding out from everywhere including her eyes. If MAID had been available, what would have been the point of enduring that kind of death?

    One data point to consider, for those who are anxious about health authorities seeking to use MAID as a cost-cutting measure: Covid-19 offers the perfect opportunity to off old people cheaply. Health authorities have not chosen that route. Instead they have gone to expensive lengths to preserve the lives of the old and infirm.
  • A problem with MAID is that it always seems to be discussed by healthy people who think of themselves as having the same cognitive, emotional and mental status when in terminal illness situations as they do when discussing it.

    So as I understand it, the open question is whether the gentleman in question is "in his right mind", in which case Canadian law will permit him medical assistance to end his life, or is suffering from a mental illness to the extent that he is not "in his right mind" on the matter.

    I don't think it's possible to discuss this properly without placing it in the wider context of suicide. We know that many people who attempt (or succeed) to commit suicide do so as a cry for help, or in some sort of short-term despair, and many of those who do not succeed in killing themselves are subsequently glad of the fact.

    But don't people who request MAID need to make that request in a sustained fashion? Isn't the idea of this to largely shield against the sort of suicidal impulse that the person would regret.


  • LeafLeaf Shipmate
    I meant to add to my list that I support robust mental health care and palliative care. Depression alone is not a reason to request MAID and AIUI, MAID will not be allowed in such cases.
    I don't think it's possible to discuss this properly without placing it in the wider context of suicide.

    I don't think that's quite right. Or at least, the kind of death involving MAID is of a small and particular subset of suicides. It reminds me of the kind of "suicide" foreseen and even enabled in spies wearing cyanide caplets. In the event of a forced choice between a relatively quick and painless death, and a prolonged, agonized, traumatic death, a reasonable person of sound mind might conclude that the former is a reasonable choice.

  • I'm going to link Palliative Sedation because I have felt that this often .is missing from discussions of MAID: https://en.wikipedia.org/wiki/Palliative_sedation . Quoting from the wikipedia article below.
    Considering the amount of intolerable pain the person must face, palliative care if necessary, palliative sedation can provide a more peaceful and ethical solution for such people.[1]

    Palliative sedation is an option of last resort for the people whose symptoms cannot be controlled by any other means. It is not a form of euthanasia or physician-assisted suicide, as the goal of palliative sedation is to control symptoms, rather than to shorten or end the person's life

    I personally don't agree with active ending of human life. Passively allowing things to take their natural course is not an issue, i.e. not doing aggressive care. It's my philosophical and moral position derived from being with a limited group of 5 people while they've died. I don't agree with uncontrolled symptoms. I find specific "horror stories" troubling, and they suggest mostly to me that there are always testimonies which will support the position that not having MAID causes suffering. I agree about the suffering needing to be addressed, which I think the answer is the palliative sedation when needed.
  • LeafLeaf Shipmate
    I personally don't agree with active ending of human life.
    In that case, you might want to revisit your stance on palliative sedation. From your link:
    Titrated sedation might speed death but death is considered a side effect and sedation does not equate with euthanasia.

    I am not a medical person; my information is second-hand.

    It is my understanding that morphine, for example, actively suppresses respiration. At the end of life, greater and greater amounts of morphine given for pain relief also have the effect of hastening death. IMO it's a bit of an ethical fig-leaf to imagine that pain relief comes without other effects which hasten death. I suspect the fig-leaf is in place to protect the feelings of grieving family members, who do not want to bear the guilt and shame of knowing a procedure actually hastened their loved one's death.

    The medical team's position is generally: Your loved one died of the [underlying illness], not of a morphine overdose, even when the palliative sedation of morphine hastened the death.

    I might add that IME when a family member asks if their loved one died peacefully, the medical team will always answer yes whether that is true or not. The medical team knows there is no point in telling you, "Well actually, your loved one died in an agonizing seizure, during which she pulled out all her tubes and shit herself." No one wants to imagine their loved one dying like that, and no good will come of telling the truth.
    I find specific "horror stories" troubling, and they suggest mostly to me that there are always testimonies which will support the position that not having MAID causes suffering. I agree about the suffering needing to be addressed, which I think the answer is the palliative sedation when needed.
    You should be troubled, because the fact of these kind of deaths upsets the notion that really palliative sedation is the only possible ethical measure. Explain to me how palliative sedation prevents death by exsanguination (bleeding out.) If someone chooses not to experience that, or put their loved ones through it, that seems reasonable to me.

  • CaissaCaissa Shipmate
    My mother was receiving palliative sedation for the last days of her life.
  • Leaf wrote: »
    I personally don't agree with active ending of human life.
    In that case, you might want to revisit your stance on palliative sedation. From your link:
    Titrated sedation might speed death but death is considered a side effect and sedation does not equate with euthanasia.

    Nope, not revisiting. It's "might".
    -also, this is from wikipedia because we're not likely to have a reading list here.
  • LeafLeaf Shipmate
    NOprophet_NØprofit: Depending on the medication and amount used, there is no "might" about it. As I said, in the case of morphine, my understanding is that it definitely does hasten death. I'm not sure how to communicate that any more clearly. Therefore it is the very thing to which you object: an active medical intervention which will hasten the death of a terminally ill person.

    I think we are reading the quoted sentence differently. "Titrated sedation might speed death but death is considered a side effect and sedation does not equate with euthanasia." You read it as if it says "Titrated sedation might or might not speed death but death is considered a side effect etc." I read it as saying, "Although titrated sedation speeds death, death is considered a side effect etc."
  • Barnabas62Barnabas62 Purgatory Host, 8th Day Host, Epiphanies Host
    edited August 20
    Caissa wrote: »
    My mother was receiving palliative sedation for the last days of her life.

    So was mine. At 100, faced with permanent loss of mobility and sure she didn't want to go on with the unequal struggle, she expressed a wish for purely palliative care for developing pneumonia. The consultant checked with my brother and me. We said yes.

    Personally, I doubt the value of the law getting involved in these situations. It was obvious what was kind.
  • Leaf wrote: »
    I don't think it's possible to discuss this properly without placing it in the wider context of suicide.
    I don't think that's quite right. Or at least, the kind of death involving MAID is of a small and particular subset of suicides. It reminds me of the kind of "suicide" foreseen and even enabled in spies wearing cyanide caplets. In the event of a forced choice between a relatively quick and painless death, and a prolonged, agonized, traumatic death, a reasonable person of sound mind might conclude that the former is a reasonable choice.

    I don't disagree. I think basically all proponents of MAID want people in the sort of case you describe to be able to access medical assistance, while the sort of people who might otherwise be standing on the edge of a tall building or bridge get counselling, rather than assistance killing themselves. That's why I think the discussion is tied to suicide - because you want to ensure the latter group of people get the right kind of help.
  • Leaf wrote: »
    NOprophet_NØprofit: Depending on the medication and amount used, there is no "might" about it. As I said, in the case of morphine, my understanding is that it definitely does hasten death. I'm not sure how to communicate that any more clearly. Therefore it is the very thing to which you object: an active medical intervention which will hasten the death of a terminally ill person.

    I think we are reading the quoted sentence differently. "Titrated sedation might speed death but death is considered a side effect and sedation does not equate with euthanasia." You read it as if it says "Titrated sedation might or might not speed death but death is considered a side effect etc." I read it as saying, "Although titrated sedation speeds death, death is considered a side effect etc."

    I'm not proof texting wikipedia.
  • I’m with @NOprophet_NØprofit in that excellence in palliative care should be the aim. Fear of dying in agony and distress encourages the desire for an earlier death. The last days in someone’s life can be precious opportunities and special memories, or recurrent nightmares and damaged memories, depending upon how well they are cared for medically and spiritually.
  • LouiseLouise Epiphanies Host
    Hi Leaf,
    for medical findings could you maybe find a more authoritative or expert source than Wikipedia? Perhaps something from a medical journal or an expert in the field, or a very well researched article where a journalist has talked to experts? We do encourage people to use high quality sources where controversial issues come up. While wiki can be very good, it's usually possible to dig a bit deeper.

    Thanks very much
    Louise
    Epiphanies host
  • Louise wrote: »
    Hi Leaf,
    for medical findings could you maybe find a more authoritative or expert source than Wikipedia? Perhaps something from a medical journal or an expert in the field, or a very well researched article where a journalist has talked to experts? We do encourage people to use high quality sources where controversial issues come up. While wiki can be very good, it's usually possible to dig a bit deeper.

    Thanks very much
    Louise
    Epiphanies host

    Please note that I'm at fault here for linking to Wikipedia in the first place. I wanted something informative generally and went to this "universal source of incomplete wisdom".
    I would certainly like to emphasize in this discussion that I am drawing a line between deliberate assistance to die and care aimed at relieving suffering. I fully acknowledge that palliative sedation could be done in ways which inadvertantly cause or hasten death. My limited experience has not seen it. I have had discussion with nurses, doctors and other staff both when I've been at a palliative care ward for other reasons and when I've been at hosp for people I know (I had a certified therapy dog for a dozen years and palliative was a frequent requested stop in this volunteer work; it's hard not to talk to everyone when you have a doggie with you in a hospital.)
  • CaissaCaissa Shipmate
    An update on the NS case. The husband is arguing that his wife's church community is influencing her intervention. https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-medical-assistance-in-dying-bridgewater-couple-court-1.5700203
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