The BC Supreme Court decided to eliminate the ban on Physician Assisted Suicide last month. In the aftermath it appears that there is considerable confusion on the definition of Physician Assisted Suicide as well as related terms. I felt it was important for me to provide clarity on some of these issues.
It is essential that we help students and health care staff to understand the following terms:
- Allow natural death
- Do not resuscitate
- Palliative sedation therapy
- Assisted suicide
1. Simply put, “ALLOW NATURAL DEATH,” indicates that the person does not want artificial means to keep them alive. What does this look like?
When they are no longer able to eat solids, do not put in a feeding tube.
If they are no longer able to swallow fluids try thicker fluids.
If they are not able to swallow thickened fluids, provide mouth care.
If they can not breathe independently do not put them on a respirator.
When their heart stops beating they do not attempt to resuscitate them.
It does not mean withholding comfort measures. Ideally the person’s Advance Care Plan will inform their substitute decision makers if they want treatments such as antibiotics for an infection.
2. Do NOT resuscitate – should more accurately be “Do NOT ATTEMPT resuscitation“. Far too often I hear people ask “If you die do you want to be resuscitated?” We can not in truth offer this! We can only offer to ATTEMPT resuscitation.
And of course, the other piece of information that we should provide is the correct information on how often CPR is effective for someone with their condition, and what the negatives effects of performing CPR on this person would be. For example, this procedure can be invasive, result in broken bones, and can interfere with the family being able to share a more gentle style of being with and caring for a person in the last moments and being with them following death.
3. Sedation or Consequential Sedation… (also known as drowsiness) is a common side effect of medications for symptom management. Sometimes the person receiving the medication, (example – Morphine), may be drowsy for a few days after starting the medication or following the increase in dose. This is a normal side effect.
If the person is not dying, then the side effect usually wears off within about 3 days.
If the person is dying, then they will be sleeping more because of the dying process, not because of the medication. This is very important for families and staff to understand. Far too often family think their loved one is dying or has died because of medication. They need good information sharing to understand that the normal dying process includes increase in sleeping, and to discuss the effects of medication. This is different than Palliative Sedation Therapy.
4. Palliative Sedation Therapy is an emerging therapy used in the last days when death is imminent and when symptoms are not able to be controled by other means. Medications are provided to manage the symptoms and the person is deeply sedated through to time of death. Guidelines for Palliative Sedation Therapy are being developed. This is not the same as sedation that results when a person’s symptoms are being managed, and person is drowsy as a side effect (as above).
5. Physician Assisted Suicide is when a person requests assistance in dying. They may do this because they have a terminal illness and are not sure that they will be able to carry out the suicide without assistance. This is legal in a few states. If this become legalized in Canada, guidelines will outline the procedures to follow.
6. Euthanasia is when people are terminated without their request. Over the years there has been concern expressed about the “slippery slope”, concern that people who do not ask for assisted suicide will be euthanized. Groups that are particularly concerned about this are those who protect the rights of peple with disabilities, the elderly, and other vulnerable populations.
7. Finally, there are people who wonder if Hospice Palliatiave Care is a form of Physician Assisted Suicide.
Hospice Palliative Case is all about improving the quality of living: It is not about hastening death.
In Physician Assisted Suicide, medication is given to terminate a life, to achieve death: In Hospice Palliative Care, medication is given to provide comfort, to achieve comfort. There is a difference. On a practice level there is a difference.
The proponents of Physician Assisted Suicide and the philosophy and goals of Hospice Palliative Care share some similarities. Both desire to provide, or help provide a death with dignity. It is inaccurate for the media to portray that death without Physician Assisted Suicide is not dignified.
This quote from the Canadian Hospice Palliative Care Association is appropriate:
“In the hospice palliative care experience, the process of dying has meaning and purport for the person as well as his or her loved ones. As a field of practice, we have the responsibility to ensure that all those involved in providing hospices palliative care have the knowledge (including an understanding of the alternatives to physician-assisted suicide), attitude and skills to help people at end-of-life manage both physical and emotional suffering, and to support family members. We also have a responsibility to ensure that patients seeking physician-assisted suicide are aware of other options.”
For further information, discussion paper of issues related to Physician Assisted Dying, and defintions of terms
What terms do you feel need to be defined or clarified?