Wednesday, December 3, 2008

10 Euthanasia Questions Worthy of Reflection

Thought we'd try something a little different and really give you the reader a chance to ponder and weight in on some interesting questions pertaining to the topic of euthanasia and assisted suicide.

1. If euthanasia and assisted suicide were to become legalized in Canada, what role should doctors play? Should they be limited to deciding who’s eligible? Prescribing the fatal dosage? Administering the fatal dose? Or perhaps, some combination of all three?

2. If euthanasia and assisted suicide were to become legalized in Canada, how would the cost be covered? Would it be covered under provincial health plans or would it be user pay?

3. Is someone who’s sentenced to death in the US and refuses to appeal actually partaking in assisted suicide? According to the current legislation the appeal is mandatory because to do otherwise would be considered assisted suicide.

4. If euthanasia and assisted suicide services become readily available, will the poor who can’t afford palliative care be overrepresented in those choosing to be euthanized?

5. Why is suicide legal and assisted suicide illegal in Canada? Do the two acts not share the same principal of one person wanting to end their life and that that those using assisted suicide are just physically unable to kill themselves without help?

6. If euthanasia and assisted suicide were to become legalized in Canada, should mental pain and physical pain be considered equal under the law?

7. If euthanasia and assisted suicide were to become legalized, would people convicted of second-degree murder for performing euthanasia or aiding in suicides be released from prison?

8. If euthanasia and assisted suicide services become readily available, will elderly who otherwise would have fought to survive elect for euthanasia to avoid feeling burdensome?

9. If euthanasia and assisted suicide were to become legalized in Canada, would you assist someone who was terminally ill? Would you want someone to assist you if you were terminally ill?

10. Should euthanasia and assisted suicide be legalized in Canada and if so, under what circumstances?

Case Study: Tracy & Robert Latimer

Tracy Latimer was born November 23, 1980 in Saskatchewan, Canada. As a result of oxygen deprivation during birth, she was born with cerebral palsy. Her cerebral palsy was characterized by severe mental and physical disabilities and seizures. She possessed little or no voluntary control of her muscles, was forced to wear diapers, and could not walk, stand, or talk.

Throughout her life she had to undergo many serious surgeries including one to lengthen tendons and release muscles, and another where she had metal rods inserted in her back for her scoliosis. Further adding to her troubles was a dislocated hip that she was unable to take painkillers for because of potentially serious complications with her anti-seizure medications. In 1997, The Supreme Court of Canada noted that she was in "undisputed constant pain."

On October 24, 1993, Tracy was almost thirteen years only when her father Robert killed her by tubing carbon monoxide poisoning into his truck. Robert claimed his actions were merciful and what he believed to be Tracy’s best interest. Included below is a time line of the relevant events following Tracy’s death.

Nov. 1994
Robert Latimer is convicted of second-degree murder.

July 1995
Latimer appeals the decision, but Saskatchewan Court of Appeal upholds verdict by 2-1 vote.

Oct. 1995
It’s revealed that prosecution unlawfully asked jurors during selection about religion, abortion and mercy killing..

Feb. 1997
Supreme Court orders a re-trail new due to jury interference.

Nov. 1997
Latimer again found guilty of second-degree murder. Jury recommends parole eligibility after one year.

Dec. 1997
Judge issues Latimer a "constitutional exemption", and he’s sentenced to less than two years (one of which is to be spent in the community).

Nov. 1998
Saskatchewan Court of Appeal fails to acknowledge his constitutional exemption and upholds his mandatory sentence of at least 10 years.

Jan. 2001
Supreme Court agrees to hear Latimer appeal but upholds initial sentence of no parole for at least 10 years.

Dec. 2003
Although jailed for the last 9 years for killing his daughter, Latimer acknowledges that he still feels what he did was right.

Dec. 2007
Despite serving 13 years of his minimum 10 years sentence, Latimer is denied day parole.

Feb. 2008
Latimer appeals the decision of the National Parole Board and is released on day parole.

This was a marquee case in Canadian euthanasia history and demonstrates the intolerance of it in the Criminal Code. The debate rages on whether Robert Latimer was given too harsh a sentence, or whether he was deserving of the punishment. How do you feel about this particular case? Let us know!

DNR Orders & Euthanasia

A Canadian element of euthanasia we haven’t really touched on is the issue of do not resuscitate orders (DNR). Some may argue that DNR is not a form of euthanasia and should be classified as something entirely different. However, before we get to that argument a brief explanation of what a DNR order refers to is necessary.

A DNR order is a legal document that instructs medical practitioners to not attempt any revival techniques on a particular person if their breathing or heart stops. Fortunately, not just anyone can request a DNR order on your behalf. Only two people can do this; the individual who does not want to be revived, and in situations where someone is of diminished capacity, those with their Power of Attorney (almost always family). However, once a DNR order has been granted, a person is able to change their mind and have it withdrawn at anytime.

Now that the basics of DNR orders has been clarified, would you consider a physician who doesn’t attempt to save a patient in cardiac arrest as someone practicing assisted suicide or euthanasia? Technically, adhering to DNR orders is legally justifiable, but at the same time it should be considered a form of passive euthanasia. As mentioned in previous posts, in contrast to what is typically considered euthanasia, passive euthanasia does not involve any actions that induce death. Passive euthanasia is actually characterized by but failing to attempt potentially life saving techniques. Considering this definition, it is clear how allowing someone in cardiac arrest to pass into death without attempting to revive them is a form of passive euthanasia.

Considering the different natures of passive and active euthanasia, we believe that perhaps some who do not support “typical” euthanasia may in fact be accepting of DNR orders. Please feel free to weigh in on your thoughts, whether you feel DNR orders are the same as euthanasia or if you see them in an entirely different light. Comments are always welcomed.

Tuesday, December 2, 2008

Euthanasia &Assisted Suicide Techniques

We’ve covered a lot of topics in this euthanasia/assisted suicide blog, but we’ve barely discussed the methods of aiding these people reach death. A variety of devices and options exist, but is there one which is more appropriate than the others, or is it the final outcome that matters most? Regardless, here is a list of techniques currently being utilized:

1. Barbiturates: Are drugs that act on the central nervous system that when taken in a specified way can cause death. Barbiturates can only be acquired with a prescription. Typically patients have to administer the barbiturates to themselves orally. Two types are used more commonly than others and are Seconal and Nembutal.

Seconal is considerably the less expensive of the two, costing about $125 for a lethal dose (10 grams). This dosage comes in the form of 100 individual caplets. The caplets are typically cracked open resulting in approximately three tablespoons of lethal powder. which must be cracked and which comes in the form of 100 individual caplets that must be broken apart to produce about three tablespoons of powder. The Seconal powder is than usually mixed with mater or pudding/apple sauce to camouflage the bitter taste.

After consuming the Seconal powder, the individual slips into a coma within five minutes and usually dies with thirty minutes. However, it has been said that healthy/in-shape and extremely over-weight patients can take up to forty-eight hours to die.

Although Nembutal comes in a more convenient liquid form, a lethal dose costs upwards of $1,000. The benefit of this more expensive drug is that death is guaranteed quicker and more imminent.

2. “The Mercitron”: Is a Dr. Jack Kevorkian invention that used to induce voluntary death. As the picture shows ( ), the mercitron consists of a metal frame supporting three canisters which feed into a single IV. This IV is hooked into the person’s blood stream so the contents of the canisters can be administered quickly.

The contents of the three containers are saline, barbiturates (to induce sleep), and a lethal mixture of potassium chloride (immediately stops the heart) and muscle relaxants (prevents spasms during death). Once saline administration is started by Kevorkian, it is the patient’s responsibility to tug a string in order to begin the flow of barbiturates. Once the barbiturate flow starts, a timer begins which dictates when the lethal drugs and issued. Ideally, the potassium chloride is not supposed to entry the blood stream until the patient has already been put soundly asleep by the barbiturates. Death usually occurs after only two minutes.

3. Gasses

Carbon Monoxide: A tight sealing mask covers the patient’s mouth and nose and is feed lethal carbon dioxide through a tube attached to a canister. The gas will not flow until a valve is turned. In situations where patients are not able to do this on their own, the valve will be left in the open position with a clamped clothespin restricting the gas from flowing through the tube. As a result the patient simply has to pull the clothespin off to induce death. The entire process from start to death usually takes approximately 10 minutes and the use of sedatives to induce a sense of calm is encouraged.

Inert Gases (e.g. Helium): Masks similar to those used to induce death in carbon dioxide poison are used with inert gas poisoning. The benefits of inert gas include easier breathability (odorless, tasteless) and that the death process is reduced to only five minutes. The entire apparatus and inert gas canisters can usually be purchased for slightly more than $20.
The major drawback with the use of any poisonous gas as opposed to the previous methods is that if the procedure is interrupted or if the individual changes their mind, brain damage is likely to occur.

4. “The Debreather”: Has been used at least ten times in the US effectively. Similar to poisoning via carbon dioxide and inert gases, the debreather also consists of a masked hooked to a canister via a rubber tube. In contrast to those procedures, rather than dying from inhalation of poisoning fumes, the person dies from lack of oxygen.

Every breath the individual takes seems normal, however, they’re actually breathing in air devoid of oxygen. The canister is actually filled with a variety of chemicals which “cleanses” the air of all oxygen being fed through the tube. The person attached to the debreather can survive for four to ten minutes before they die of anoxia (body’s oxygen starvation). Death is said to be quick and painless.

Monday, December 1, 2008

Religion & Euthanasia - Wrap-up

Euthanasia can be a very sensitive issue for some people and it generates a lot of strong opinions. Religion is another sensitive issue for some people and individuals can have very conflicting views in regards to the religions they choose. This blog has been giving people an opportunity to compare some aspects of religion (refusal of medical procedures) with passive euthanasia and initially we thought that some people may take it the wrong way. However, our pun people to make comments in a respectful manner has been reassured. All of the comments were very insightful and even if people were unsure of their stance on the topic, they still commented in a respectful and non-judgemental fashion.

As was mentioned in our last entry on religion & euthanasia, we do not feel that this particular debate will come to an end anytime soon. There are just too many variables in place and everyone has a different viewpoint. The Health Care Consent Act, the responsibility of the medical profession to protect human life, the personal right that an individual has to decide what happens to their body, varying religions with differing views on what is considered proper treatment and a host of other issues related to individual and societal morals all come into play when discussing religion and euthanasia.

Currently euthanasia, regardless of the method, is considered illegal in Canada and an individual who has a hand in it can be prosecuted. The legal system has already distinguished between passive euthanasia and refusal of medical treatment on religious grounds, basing the difference on intent. So technically....the legal system has already solved this dilemma and can focus their attention on other important issues. However, we still felt that there was a need for some open debate on the topic. After all, why is it considered ok to refusal potentially life-saving medical treatment due to religious beliefs and no ok to say “I have a terminal illness and know that I am going to die, so just kill me now”? Nobody has the right answer to this situation and it’s for a very clear reason...because there is no right answer. Our initial premise for this blog was not to be right or wrong or to take a stance and convince everyone who set their eyes on our blog that we are right and everybody else is crazy. We simply just wanted to provide a forum for people to discuss the issue and once again we thank you for your interest.

Resources to Implement Alternate Policy - Euthanasia in the Law

Due to the shift in attitudes towards euthanasia in Canada, the issue has developed to the point where policies are starting to be considered. Some call this the ‘emerging policy’ phase, in the natural course of a social issue. To this extent, it becomes very important to identify resources and possible allies that can encourage this ‘emerging policy’, because shifting the current entrenched policy will likely require a great deal of time and pressure.

Due to the rather controversial and innately moral aspects of the issue and based on the current trends in parliament regarding such issues, it is likely that any changes made to policy (the Canadian Criminal Code) will likely be put to a free vote by Prime Minister Stephen Harper. This pattern of free votes over extremely controversial issues has been the precedent under Stephen Harper (ex. gay marriage) and even under former Prime Minister Jean Chretian (who actually had a free vote over euthanasia).

This being said a large public campaign would likely be necessary in order to raise public awareness and get the public to make their opinions known to their representatives in the House of Commons. Potentially potent allies in this would be organizations like the Right to DIe Society of Canada and the Dying with Dignity Society, who have approximately ten thousand members within their ranks. They have previously run such campaigns regarding the right to die and are likely in a good position to launch another one. They likely also can provide appropriate content for such a campaign.

Additionally, one would also need the support of a member of parliament to actually introduce an amendment to the Canadian Criminal Code. In our case, Francine Lalonde, a current MP from Quebec and a member of the Bloc Quebecois, has promised to reintroduce legislation to decriminalize euthanasia. She would be an ideal candidate for our efforts to introduce our alternate policy to mainstream Canada. She was previously responsible for Bill C - 407, a bill upon which our alternate policy was based.

Mobilizing public opinion would be difficult and the political procedure surrounding the introduction of a bill would be arduous, but with the aid of these two groups of individuals and an MP in parliament it will be made possible.