This site is in the mist of a remodel.
Please let us know if you need anything.
-Choice is an Illusion.
Thursday, December 19, 2013
Euthanasia: Where there's a Will, there's relatives
By Dee Burton (excerpt)
I liken the death experience to birth when talking to the elderly people I work with - it can be so hard to go through, yet is inevitable.
None can know for absolute sure what, if anything, lies on the other side. Euthanasia promoters make some assumptions about 'nothing' or 'peace', Christians talk of hell for those who have rejected a loving God who lives in heaven.
My biggest concern however is something we do know about - relatives who are keen to get their hands on what is left behind. We've all seen and heard of the acrimony and greed of relatives and lawyers and the pressure they can put on the execution of the Will.
My fear is that legalising of euthanasia will have that pressure put on the dying relatives, and it is so obvious that this will occur.
"I was afraid to leave my husband alone"
When my husband was seriously ill several years ago, I collapsed in a half-exhausted heap in a chair once I got him into the doctor's office, relieved that we were going to get badly needed help (or so I thought).To my surprise and horror, during the exam I overheard the doctor giving my husband a sales pitch for assisted suicide. 'Think of what it will spare your wife, we need to think of her' he said, as a clincher.
Now, if the doctor had wanted to say 'I don't see any way I can help you, knowing what I know, and having the skills I have' that would have been one thing. If he'd wanted to opine that certain treatments weren't worth it as far as he could see, that would be one thing. But he was tempting my husband to commit suicide. And that is something different.
I was indignant that the doctor was not only trying to decide what was best for David, but also what was supposedly best for me (without even consulting me, no less).
We got a different doctor, and David lived another five years or so. But after that nightmare in the first doctor's office, and encounters with a 'death with dignity' inclined nurse, I was afraid to leave my husband alone again with doctors and nurses, for fear they'd morph from care providers to enemies, with no one around to stop them.
It's not a good thing, wondering who you can trust in a hospital or clinic. I hope you are spared this in Hawaii.
Kathryn Judson, Oregon
Published in the Hawaii Free Press, February 15, 2011.
To view as published, click here and scroll down towards the bottom of the page.
Wednesday, December 18, 2013
"But Doctor, I Want To Live": The Other Side Of The "Dignified Death" Debate
http://www.forbes.com/sites/davidshaywitz/2013/12/18/but-doctor-i-want-to-live-the-other-side-of-the-dignified-death-debate/
The emerging narrative about “Do Not Resuscitate” (DNR) orders is that they are not utilized frequently enough.
Doctors, it is said, are reluctant to have this discussion with patients, and patients are typically unlikely to
initiate such a
conversation with their physician. As a result, there are dreadful
stories of dying patients who suffer excruciating, highly-medicalized deaths rather than one with the dignity the sufferers might have preferred. Such deaths, policy experts note, would also seem to constitute a regrettable waste of healthcare resources.
This is a powerful storyline because in many cases, it’s unfortunately true. Many patients have experienced precisely the sort of end-of-life care they never would have wanted. In some cases, these patients never formally codified their wishes, in other instances, patient wishes were tragically, at times incomprehensibly disregarded by the healthcare system.
Many have also complained (I’m one of them) that an ACA provision that would have allowed Medicare reimbursement for a proactive doctor-patient conversation about end-of-life care was withdrawn due to the misguided uproar ignited by some vocal critics.
But there’s another perspective as well, one highlighted by a recent experience I just learned about, involving the mother of a friend.
The patient in question is a 97 year old crusty Italian lady who had been living on her own, in generally good health, for a long time. A month or so ago, her primary care doctor diagnosed her with anemia, and transfused her but didn’t initiate a workup, apparently assuming it wouldn’t be indicated in a patient of this age. Shortly thereafter, the elderly woman presented to the emergency room with more severe anemia, and evidence of a GI bleed.
The woman was stabilized with transfusions, and as usual, entirely lucid. The doctors told her they assumed she wouldn’t want a workup or any interventions, and would prefer to be made comfortable.
No, she said, I’m OK with interventions.
Then, the topic of DNR: interventions might be dangerous in a patient of her age, the doctors told her. If an intervention occurs, and something goes wrong, we assume you wouldn’t want extraordinary measures?
No, that would be OK too, she told them.
Really? You realize how violent and painful these might be, they asked, employing the same scare tactics I remember from my medicine residency, when overworked surgical consultants would occasionally try to talk a patient out of getting a procedure like a sinus tap.
That’s OK, she said. I want to live.
In the end, the woman was scoped and discovered to have an easily-treated lesion (an arterial-venous malformation), which was quickly cauterized. The woman tolerated the procedure well, is recovering nicely, and is slated to return home shortly.
This story deeply resonated with me, evoking my own experience with my Uncle Marvin – see here and here. It also doesn’t strike me as all that unusual or exceptional, and highlights with unusual clarity the potential hazards of the push towards DNRs.
The big concern is that virtuous physicians – perhaps intending to do good for the patient, perhaps (in the context of “parsimony”) intending to conserve societal resources and do good for the world at large – will undervalue a patient’s will to live or right to live.
Unfortunately, it’s probably not all that uncommon for a doctor to pressure a patient into making a decision the doctor earnestly believes is best; some would say it happens every day.
Both my uncle and the elderly lady profiled above were able to resist unreasonable physician pressure and successfully exert their autonomy. What about the many other patients who are persuaded –bullied? — by their doctor into declining treatments they might actually desire?
I appreciate the importance and virtue of proactive DNR conversations between patient and doctor, and recognize the good that can, should, and must emerge from these essential conversations.
What worries me, however, is the righteousness driving some of the doctors who are leading these discussions – a deep-seated conviction that they’re better positioned than patients to know what’s the right choice for patients, and perhaps even “ethically” obliged to guide patients in this direction.
It’s arrogance masquerading as virtue, and endangers patient autonomy.
Doctors, it is said, are reluctant to have this discussion with patients, and patients are typically unlikely to
 |
| David Shaywitz, MD |
This is a powerful storyline because in many cases, it’s unfortunately true. Many patients have experienced precisely the sort of end-of-life care they never would have wanted. In some cases, these patients never formally codified their wishes, in other instances, patient wishes were tragically, at times incomprehensibly disregarded by the healthcare system.
Many have also complained (I’m one of them) that an ACA provision that would have allowed Medicare reimbursement for a proactive doctor-patient conversation about end-of-life care was withdrawn due to the misguided uproar ignited by some vocal critics.
But there’s another perspective as well, one highlighted by a recent experience I just learned about, involving the mother of a friend.
The patient in question is a 97 year old crusty Italian lady who had been living on her own, in generally good health, for a long time. A month or so ago, her primary care doctor diagnosed her with anemia, and transfused her but didn’t initiate a workup, apparently assuming it wouldn’t be indicated in a patient of this age. Shortly thereafter, the elderly woman presented to the emergency room with more severe anemia, and evidence of a GI bleed.
The woman was stabilized with transfusions, and as usual, entirely lucid. The doctors told her they assumed she wouldn’t want a workup or any interventions, and would prefer to be made comfortable.
No, she said, I’m OK with interventions.
Then, the topic of DNR: interventions might be dangerous in a patient of her age, the doctors told her. If an intervention occurs, and something goes wrong, we assume you wouldn’t want extraordinary measures?
No, that would be OK too, she told them.
Really? You realize how violent and painful these might be, they asked, employing the same scare tactics I remember from my medicine residency, when overworked surgical consultants would occasionally try to talk a patient out of getting a procedure like a sinus tap.
That’s OK, she said. I want to live.
In the end, the woman was scoped and discovered to have an easily-treated lesion (an arterial-venous malformation), which was quickly cauterized. The woman tolerated the procedure well, is recovering nicely, and is slated to return home shortly.
This story deeply resonated with me, evoking my own experience with my Uncle Marvin – see here and here. It also doesn’t strike me as all that unusual or exceptional, and highlights with unusual clarity the potential hazards of the push towards DNRs.
The big concern is that virtuous physicians – perhaps intending to do good for the patient, perhaps (in the context of “parsimony”) intending to conserve societal resources and do good for the world at large – will undervalue a patient’s will to live or right to live.
Unfortunately, it’s probably not all that uncommon for a doctor to pressure a patient into making a decision the doctor earnestly believes is best; some would say it happens every day.
Both my uncle and the elderly lady profiled above were able to resist unreasonable physician pressure and successfully exert their autonomy. What about the many other patients who are persuaded –bullied? — by their doctor into declining treatments they might actually desire?
I appreciate the importance and virtue of proactive DNR conversations between patient and doctor, and recognize the good that can, should, and must emerge from these essential conversations.
What worries me, however, is the righteousness driving some of the doctors who are leading these discussions – a deep-seated conviction that they’re better positioned than patients to know what’s the right choice for patients, and perhaps even “ethically” obliged to guide patients in this direction.
It’s arrogance masquerading as virtue, and endangers patient autonomy.
Sunday, December 15, 2013
Judge dismisses appeal; Montana group pleased that court addressed Baxter
Helena Montana - On December 13, 2013, District Court Judge Mike Menehan dismissed MAAS's appeal with the Montana Medical Examiners Board. The order ruled that the appeal was moot due to the Board's having recently rescinded "Position Statement No. 20." (Order, pp. 5-8). The order also refers to Montana's assisted suicide case, Baxter v. State, as providing a defense to a homicide charge, as follows:
Since Baxter, there have been two bills proposed in the Montana Legislature to legalize assisted suicide. Both bills, SB 167 and SB 220, have failed. Assisted suicide is not legal in Montana.
MAAS is disappointed with the dismissal, but pleased with that the order addresses Baxter, over which there is ongoing controversy as to its meaning. MAAS will likely appeal.
* * *
For information about problems with assisted suicide and how it puts people at risk, see http://www.montanansagainstassistedsuicide.org/p/quick-facts-about-assisted-suicide.html
On December 31, 2009, the Montana Supreme Court issued its opinion in Baxter v. State, 2009 MT 449, 354 Mont. 234, 224 P.3d 1211, in which it held that under section 45-2-211 MCA, a terminally ill patient's consent to physician aid in dying constitutes a statutory defense to a physician charged with the criminal offense of homicide. (Order, page 2, lines 17-21).This part of the order is consistent with Greg Jackson's and Matt Bowman's article, Baxter Case Analysis, Spring 2010 ("the Court's narrow decision didn't even "legalize" assisted suicide"). Available at http://www.montanansagainstassistedsuicide.org/p/baxter-case-analysis.html
Since Baxter, there have been two bills proposed in the Montana Legislature to legalize assisted suicide. Both bills, SB 167 and SB 220, have failed. Assisted suicide is not legal in Montana.
MAAS is disappointed with the dismissal, but pleased with that the order addresses Baxter, over which there is ongoing controversy as to its meaning. MAAS will likely appeal.
* * *
For information about problems with assisted suicide and how it puts people at risk, see http://www.montanansagainstassistedsuicide.org/p/quick-facts-about-assisted-suicide.html
Saturday, December 14, 2013
Montana Judge Hears Assisted Suicide Arguments
http://www.kxlf.com/news/montana-judge-hears-assisted-suicide-arguments/
Posted: Dec 11, 2013 4:38 PM by Sanjay Talwani - MTN News
HELENA - The issue of physician assisted suicide was in court Tuesday [December 10, 2013]
 |
| Judge Michael Menehan |
Montanans Against Assisted Suicide is arguing that a policy position by the Montana Board of Medical Examiners implies that physician assisted suicide may be legal.
A lawyer for the Board says that the position - since rescinded, says no such thing. Michael Fanning says the group bringing the lawsuit has no real case is trying to force the issue to the Montana Supreme Court.
The position paper, written in response to doctor inquiries, said that the board would handle complaints related to assisted suicide on a case-by-case basis as it would other cases.
 |
| Margaret Dore Attorney for Montanans Against Assisted Suicide (MAAS) |
Margaret Dore, an attorney for MAAS, said the paper overstepped the Board's authority and implied to many that assisted suicide was legal in Montana.
"They are a board that is comprised of 11 doctors and two members of the public," she said. "It has no expertise to be making a pronouncement, that aid in dying is legal in Montana. That's the role of the legislature or a court and they are neither."
She said that such an understanding had huge implications in devaluing the lives of the sick and elderly.
That position paper - in response to the lawsuit - has since been rescinded by the Board and scrubbed from its website. But Dore said court action was still needed to prevent the Board from reinstating such a position.
She repeatedly asked District Judge Mike Menahan to weigh in on a Montana Supreme Court ruling known as Baxter, that envisions potential defenses to doctors charged with homicide for assisting with suicide.
But Menehan said it wasn't the role of a district judge to rule on a Montana Supreme Court order.
 |
Craig Charlton
Attorney for MAAS
|
Michael Fanning, an attorney for the Board, said MAAS had no standing to bring the lawsuit, has suffered no damages from the Board's rescinded position and was simply jockeying to get the case before the Montana Supreme Court in hopes of overturning the Baxter ruling.
"This most certainly is a political question, a philosophical question or an academic debate, but it is not a lawsuit," he said. "In fact, this is a feigned case. It was contrived simply to bring this matter before you."
Menahan did not immediately rule on the case.
[Montanans Against Assisted Suicide is also represented by attorney Craig Charlton].
Subscribe to:
Posts (Atom)