Physician assisted death cartoons for babies
Ellen Wiebe is pictured in her Vancouver office on March 9, With medically assisted death now legal in Canada, doctors need access to drugs that will quickly and effectively terminate the lives of eligible individuals. TORONTO -- With medically assisted death now legal in Canada, doctors need access to specific drugs that will painlessly and humanely terminate a suffering patient's life. But just what are these drugs and what do they cost? And most importantly perhaps, who will cover that cost? One week after the ban on physician-assisted suicide and euthanasia was officially lifted under the Supreme Court of Canada's mandate, doctors, provincial health ministries, private insurers and the pharmacy sector are still trying to sort out the answers.
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Content:
- Children and Teens
- Physician-assisted Suicide: The Wrong Approach to End of Life Care Gloth RLP 2003
- PHYSICIAN-ASSISTED SUICIDE: LEGALITY AND MORALITY
- 'Grace & Frankie' Gets This Painful Subject Right
- Many conditions could prompt parents to seek assisted death for children: doctor
- Signs of Grief in Children and How to Help Them Cope
- Euthanasia and Physician Assisted Suicide
- SickKids grapples with medically assisted dying
- Doctor of MAID: New memoir tells story of Island pioneer in assisted dying
Children and Teens
The Northern Territory likes to think of itself as frontier country - it is certainly at the forefront of the international debate over euthanasia. On 25 May it became the first jurisdiction in the world to pass laws allowing a doctor to end the life of a terminally ill patient at the patient's request.
In doing so, the law permits both physician-assisted suicide and active voluntary euthanasia in some circumstances. However, under the Rights of the Terminally Ill Act NT strict conditions apply: it is neither an unqualified 'licence to kill' nor an unqualified affirmation of a competent adult patient's right to assistance in dying.
The Act has caused a furore nationally and internationally, with both extensive criticism and extensive support for the Rights of the Terminally Act from politicians, health care professionals, religious groups, 'pro-life' and 'pro-choice' pressure groups, academics, the media and members of the general public.
The law has already survived attempts to repeal it in the Northern Territory Legislative Assembly, and a challenge to its validity in the Northern Territory Supreme Court.
Leave is being sought to challenge the Act in the High Court. The Commonwealth has the power to enact its own legislation overriding Territory law under section of the Constitution. It has been reported that the Leader of the Opposition, Mr Kim Beazley personally opposes euthanasia but that members of the ALP will also have a conscience vote. No-one has yet used the Territory legislation, perhaps in part, because medical practitioners are afraid they could be charged with murder if it is subsequently overturned.
This paper, the second in a four-part series on euthanasia, examines the Northern Territory legislation in the wider national and international context, including the approach taken to active voluntary euthanasia in the Netherlands, England, the United States and Canada. Under English common law, a doctor is prohibited from taking active steps to end a patient's life - but there is an exception. A doctor who administers a pain killer to a terminally ill patient in great suffering, knowing an incidental effect will be to shorten the patient's life, will be safe from criminal liability, providing the primary reason for giving the pain killer was to relieve suffering, not to cause death.
However, it is unclear whether Australian doctors have the same protection. No doctor has faced criminal prosecution here under those circumstances.
Under Australian homicide laws, a doctor may be guilty of murder if he or she administered drugs knowing they might cause death, and they did in fact cause death - even if the doctor did not intend the patient to die. South Australia is the only state to have clarified the law on this issue.
It appears to have followed the English common law lead. The Netherlands has a unique approach to regulating active voluntary euthanasia and physician-assisted suicide. It is often held up as a jurisdiction in which euthanasia has been decriminalised.
This is not an accurate description of the Dutch legal situation. Active voluntary euthanasia and physician-assisted suicide are both prohibited under the Dutch Penal Code. However, doctors have been guaranteed immunity from prosecution providing they have complied with a number of 'rules of careful practice'. The acceptance of active voluntary euthanasia and physician-assisted suicide in the Netherlands is largely due to a unique combination of social and cultural attitudes including:.
In , the Dutch Government set up the Remmelink Commission to investigate 'the practice of action and inaction by a doctor that may lead to the end of a patient's life at the patient's explicit and serious request or otherwise. That study found that in the Netherlands in there were:. No similar studies have been done in Australia.
A number of studies however, about the attitudes, experiences and practices of health professionals have been conducted. One in South Australia 5 found that 45 per cent of doctors sampled supported the legalisation of active voluntary euthanasia in certain circumstances. Another, of doctors in New South Wales and the ACT 6 found majority support for changes to the law to allow active voluntary euthanasia. In one survey of Victorian nurses, it was found that about 75 per cent of those taking part in the survey favoured law reform to enable doctors to perform active voluntary euthanasia in some circumstances.
Sixty-five per cent of the nurses said they would participate in active voluntary euthanasia if it were legal. However, 50 per cent favoured law reform to enable doctors to take active steps to bring about a patient's death in some circumstances.
This paper is the second in a series discussing the Australian law relating to euthanasia in an international context. This paper discusses the Australian law relating to the second of these categories: active voluntary euthanasia. Comparison is made with the approaches to active voluntary euthanasia developed in a number of other legal systems: in the Netherlands, the United States of America, England and Canada.
The law in relation to the first category, passive voluntary euthanasia, is discussed in an earlier paper. A competent patient's common law 'right to bodily self-determination' 10 only extends to refusal of treatment; a patient cannot require any doctor to administer any treatment or medical procedure that the patient requests. Thus a patient cannot compel an unwilling doctor to perform such procedures or otherwise to help the patient die. Even if a doctor wishes to accede to a patient's request to perform acts that would hasten the patient's death, the criminal law generally prevents the doctor from doing so.
In every Australian jurisdiction, except the Northern Territory, 12 the crimes of murder and assisting suicide prohibit a doctor from complying with a patient's request to take active steps with the aim of bringing about the patient's death.
It is useful to examine three different situations in which a competent patient requests and a doctor provides assistance to end the patient's life, to discover whether the doctor would be criminally liable in each situation:. Situation One: The patient is in excruciating pain and asks the doctor for release from that pain; the doctor administers increased doses of pain-killing drugs; this hastens the patient's death.
Situation Two: The patient wants to die and asks the doctor for assistance; the doctor assists by for example prescribing drugs, setting up a mechanism, providing advice about effective means; but the lethal act is performed by the patient rather than by the doctor. Situation Three: The patient wants to die and asks the doctor for assistance; the doctor assists by performing the lethal act for example, by administering a lethal injection.
Situation One - The patient is in excruciating pain and asks the doctor for release from that pain; the doctor administers increased doses of pain-killing drugs; this hastens the patient's death. English courts have stated that the criminal law will not intrude here if the doctor's intention can be described as an intention to relieve pain rather than as an intention to end the patient's life. In such a case the law characterises the patient's death as a mere 'side effect' of the use of drugs to relieve pain and suffering:.
Such a decision may properly be made as part of the care of the living patient, in his best interests; and, on this basis, the treatment will be lawful. If the first purpose of medicine, the restoration of health, can no longer be achieved, there is still much for a doctor to do, and he is entitled to do all that is proper and necessary to relieve pain and suffering, even if the measures he takes may incidentally shorten life.
This legal principle will not protect a doctor from criminal liability in every circumstance where a patient's death results from the administration of drugs in response to a patient's request for pain relief. The principle appears to be confined to situations where the patient has a terminal illness and has reached a stage where there is no hope of recovery. A doctor will be exposed to criminal liability if the doctor's primary purpose in administering drugs is to hasten the patient's death.
A court is more likely to conclude that this was the doctor's primary purpose if: the doctor does not use a standard pain killing drug; the doctor uses a standard pain killing drug but could instead have employed safer pain relieving alternatives; the doctor administered a larger dose of pain killing drug than was necessary to reduce the patient's pain to acceptable levels; or the doctor otherwise departed from accepted professional standards of palliative care.
An important case illustrating the application of this legal rule is the English case of R v. Ms Boyes was 70 years old and had been Dr Cox's patient for thirteen years. She was suffering from rheumatoid arthritis complicated by internal bleeding, gangrene, anaemia, gastric ulcers and pressure sores.
As a result she was in acute and constant pain from which standard pain-killing drugs did not offer relief. During the last few days before her death, she repeatedly asked Dr Cox to end her life. He reassured her that her last hours would be as free of pain and as dignified as possible. He injected her with a potentially lethal dose of potassium chloride, a drug without recognised pain killing properties. She died within minutes of the injection.
Dr Cox was prosecuted for attempted murder. Professional disciplinary proceedings were also taken against Dr Cox. The Professional Conduct Committee of the General Medical Council admonished Dr Cox for his conduct in this case, describing it as 'both unlawful and wholly outwith a doctor's professional duty to a patient'.
The Professional Conduct Committee nonetheless expressed its 'profound sympathy' for his situation and declined to suspend his registration or take further action against Dr Cox. The health authority who employed Dr Cox, however, refused to allow him to return to work unless he complied with certain conditions. These included the requirement that he receive further training in palliative care. Any or all of the following rationales may underpin this 'exception' under English law to the legal prohibition against performing acts that will kill a patient:.
These rationales have been criticised as relying on 'illogical legal fictions' 22 and 'fine and arguably unworkable distinctions'. It has been further claimed that this leads to hypocrisy on the part of doctors who cannot admit that their intention when administering pain relief is in many cases to hasten death, as well as to relieve pain and on the part of society which does not wish criminal sanctions to apply to doctors who hasten their patient's death in this way.
Everything ultimately turns on what the doctor claims he was trying to achieve. As long as he uses the right verbal formula and records it in the patient's notes and to be on the safe side does not use too unusual a drug, he will stay within the law. Knowing how to play the game becomes the crucial determinant of criminal liability, rather than what objectively is done or what results.
When the crime is murder, this can hardly be satisfactory. The current state of the law endorses, indeed entrenches, hypocrisy. Alternatively, the law encourages casuistry, as those who are anxious to do right by their patients, as they see it, feel compelled to resort to subterfuge out of fear of prosecution.
Fear of prosecution is of course eminently desirable when designed to deter what is accepted as wrong. But when it is neither the means nor the end which is regarded as wrong but rather the absence of the attendant rhetoric or ritual, such fear becomes itself a wrong.
The claim that the legal authorisation of 'unintentional' deaths as the result of pain relief is being used to disguise situations involving criminal behaviour ie situations where death results from the actions of a doctor whose primary intention is to bring about that death 26 is not uncontroversial. The claim nonetheless deserves serious attention, particularly as it is often associated with a further claim: that some doctors hasten their patients' deaths on request in situations where the doctors' behaviour is clearly not associated with any attempt at pain relief.
These charges of hypocrisy and reliance on damaging legal fictions might be deflected, however, if the law acknowledged an alternative rationale for the 'exception' outlined in the English case law. That rationale is the legal doctrine of 'necessity'. The sophistication of modern methods of pain relief would mean, however, that explicit legal recognition of a 'necessity' defence in these terms would only justify intentional administration of life-shortening pain relief by a doctor in the most exceptional circumstances.
In developing such criteria the crucial question would be exactly where the law should draw the line between life-shortening behaviour that is criminal and behaviour that is not. This would lead inevitably beyond consideration of when it should be lawful to administer pain-relieving drugs in potentially fatal doses, to the broader question of whether the law should ever permit a doctor to perform any act that amounts to 'physician-assisted suicide' i.
There have been no criminal prosecutions of doctors in Australia in relation to their administration of pain relieving drugs that have hastened death. In the absence of such clarification it may not be safe to assume that the legal 'exception' articulated in the English case law is part of the criminal law of Australia.
It has been suggested that, under a strict interpretation of the relevant Australian homicide laws, a doctor actually may not be immune from liability for murder, in respect of the death of a patient resulting from the administration of pain killing drugs, simply because the situation can be characterised as one where the doctor did not intend to cause the death.
Rather, the doctor may be potentially liable for murder if the doctor administered the drugs in the knowledge that the patient might die as a result and if the drugs did in fact hasten the patient's death. Although it appears to be widely accepted amongst the medical profession that the administration of life-shortening palliative care is ethical and constitutes legitimate medical practice, it is open to question whether this practice is in fact lawful. It should also be noted that, even if an Australian court did reach the same result as the courts in England, it might not necessarily adopt the same legal rationale s for doing so.
It therefore is possible that an Australian court would express this legal exception in terms of the doctrine of necessity, in preference to any rationale that depends upon an absence of intention to hasten the patient's death. In the Law Reform Commission of Western Australia expressed concern at the uncertainty of the legal position when death is hastened by the administration of pain relieving drugs. Accordingly it recommended that legislation be introduced to protect doctors from liability 'for administering drugs or other treatment for the purpose of controlling pain, even though the drugs or other treatment may incidentally shorten the patient's life, provided that the consent of the patient is obtained and that the administration is reasonable in all the circumstances'.
Only South Australia has statutory provisions that clarify the law on this issue. The relevant provisions seem to confirm the applicability in South Australia both of the English legal rules and of their dependence on the doctor's primary intention being to relieve pain.
Section 17 1 of the new Consent to Medical Treatment and Palliative Care Act SA applies to the situation where a doctor, or other health care professional acting under a doctor's supervision, administers medical treatment 'with the intention of relieving pain or distress', even though 'an incidental effect of the treatment is to hasten the death of the patient'. This legislation also provides that the administration of medical treatment for the relief of pain or distress in accordance with these conditions 'does not constitute an intervening cause of death' for the purposes of South Australian law.
Physician-assisted Suicide: The Wrong Approach to End of Life Care Gloth RLP 2003
Founder of children's hair salon chain has donated thousands to Planned Parenthood, pro-assisted suicide group. America's leading physician-assisted suicide advocacy group has tapped a Planned Parenthood of Illinois board member to help lead the organization. Gordon told the Washington Free Beacon the issue of assisted suicide is "close to my heart. Rachel MacNair, vice president at the Consistent Life Network, said she is not surprised that a prominent abortion supporter would also become a cheerleader for assisted suicide. For pro-choicers, it's choice and bodily autonomy either way and done on similar reasoning. Democratic governor J. Pritzker signed the Reproductive Health Act in , which repealed a state ban on partial-birth abortion—in which doctors artificially deliver unborn children before terminating them.
PHYSICIAN-ASSISTED SUICIDE: LEGALITY AND MORALITY
The debate over physician-assisted suicide has never been a simple one, and in the 48 states where the practice remains illegal, the issue has only grown more complicated in recent years. Assisted suicide is legal in Oregon and Washington, but elsewhere around the nation, the right-to-die movement has struggled to make many inroads. Since , efforts to legalize the practice have failed in California, Michigan, Maine, and most recently, in Massachusetts. Meanwhile, 41 states have passed laws making it a crime to assist in a suicide, legislation that has led many who want help dying deeper into the shadows. For example, what does it mean to actually assist in a suicide? Who, if anyone, should be allowed to pursue aid in dying, and what safeguards should be in place in states where the practice is legal? We asked six experts to watch the film and wrestle with these questions. Here is what they had to say:. I should begin by admitting to my bias. When my mother contracted ovarian cancer at 56, she was very clear that she wanted to be able to depart the world with dignity.
'Grace & Frankie' Gets This Painful Subject Right
Minor is first to be granted doctor-assisted death since Belgium passed voluntary euthanasia law for children in A terminally ill child has become the first minor to be helped to die since Belgium voted to allow voluntary euthanasia for children in Belgium legalised euthanasia in and two years ago amended the rules to become the first country in the world to permit doctors to help terminally ill minors of any age to die. Children of any age are allowed to choose to end their suffering, as long as they are able to make rational decisions and are in the final stages of an incurable disease. Any request for euthanasia must be made by the minor, be studied by a team of doctors and an independent psychiatrist or psychologist, and have parental consent.
Many conditions could prompt parents to seek assisted death for children: doctor
R min Horror, Sci-Fi, Thriller. A freak storm unleashes a species of bloodthirsty creatures on a small town, where a small band of citizens hole up in a supermarket and fight for their lives. PG min Drama, Romance. A girl in a small town forms an unlikely bond with a recently-paralyzed man she's taking care of. Not Rated min Drama, Romance, Thriller. A haunting portrait of Lucy, a young university student drawn into a mysterious hidden world of unspoken desires.
Signs of Grief in Children and How to Help Them Cope
Download this document in PDF. Order now. IAHPC permits educational and scientific use of this publication. IAHPC prohibits the commercial use or reproduction and distribution of this material without authorization. If it is performed at the dying person's request, it is voluntary; otherwise, it is non-voluntary. Physician-assisted suicide PAS is defined as the provision of help by a doctor to a competent patient who has formed a desire to end his or her life Walton, In PAS, the physician provides the necessary knowledge and means equipment, drugs but the act is completed by the patient.
Euthanasia and Physician Assisted Suicide
By Nellie Andreeva. He was rescued by the Station 19 crew and taken to Grey Sloan Memorial where he was treated for his extensive injuries, including to his spine and a shattered leg. He underwent a successful emergency surgery on both. Amid the joy, there was heartache too.
SickKids grapples with medically assisted dying
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Doctor of MAID: New memoir tells story of Island pioneer in assisted dying
A society where bright, efficient end-of-life parlors were an accessible option? Or one dominated by care homes full of lonely, desperate people wishing for a way out? In this country, access to physician-assisted death is available only in a few jurisdictions and it is limited to the terminally ill. Consider this reaction from reader Dan Baker in Surprise to a column I recently wrote about the topic:. My wife died in What else do I have to live for? I like that.
In a sense it all began here, in a bar in Singapore in , when a young Englishwoman met a Cuban jazz musician and, despite her not being able to speak a word of Spanish and him not being able to utter a word of English, they fell in love. Debbie Purdy had already begun to experience early symptoms of Multiple Sclerosis when she met Omar Puente, but in the first flush of their relationship, any thought of death and disease must have been the furthest thing from their minds. One would hope that they look back on their time in Singapore as a brief stop in paradise, given how much they have endured together since.
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