Religion & Euthanasia - So how can we solve this dilemma?

Ok...we have spent a lot of time in this section of the blog talking about some of the dilemmas that can arise from mixing religion and euthanasia. We have gotten a lot of comments regarding the subject and we want to take this opportunity to thank those who have commented thus far. For the most part, we have focused on how religion can conflict with the medical field regarding the types of treatments that are performed on patients. However, one of the comments that we have received on this topic really caught us off guard and it touched on how religion can actually build upon medical intervention.

To make a long story short, the comment was basically saying that religion is often used by individuals as a pillar of strength while receiving medical treatment. The person was saying that religion can help someone to overcome their fear or doubts about receiving medical treatment and that religion can be used to help the patient to have faith in the doctors and their abilities. This provided a very different perspective on the topic and it sort of seemed like this person was thinking outside of the box. So on one hand, it can seem like religion is in total conflict with the medical field, but on the other hand religion can act as an ally to the medical field. It’s just very interesting to see how people can take the same topic (religion & euthanasia) and come to the table with very different perspectives. This is why we have encouraged everyone to bring their comments to the table which is this blog. We enjoy seeing all of the different perspectives on the topic.

Anyways, the initial purpose of this blog entry was not talk about all of the comments that we have received (which we would if we could), but we wanted to take a moment to perhaps discuss a solution to this dilemma regarding religion and medical treatment. How can we solve the problem (if you view it that way) of people refusing potentially life-saving medical procedures because of their religious beliefs? We spent a lot of time brainstorming ideas on how we could solve this dilemma and after hours of deliberation this is what we came up with...........nothing! We aren’t really sure that you can do anything that isn’t currently being done to deal with the situation. The way it currently works is that if a patient does not want to receive a medical procedure, then the doctors must respect their wishes and leave the patient without treatment...even if it results in death. Trying to force a patient to receive any medical treatment would involve changing the basic right that a person has to decide what happens to their body. If someone was bold enough to try and legally abolish this right (for the sake of solving the religion/medical treatment dilemma) that every person has, it would have to involve them making a change to a document that all Canadians cling to dearly...The Charter of Rights and Freedoms. Anytime you talk about changing The Charter it can be a very sensitive subject for some and most people would never agree to make any sort of change to the document.

So how can we solve this dilemma? Is there any sort of solution to the issue? Would it be unethical to force someone to undergo a procedure on their body, even if it could save their life? Maybe we missed something and we are calling out to everyone reading to lend us their ideas on how we can approach this situation?

Religion & Euthanasia - Cases (Continued)

Ok...so for those who didn’t read our last blog on Religion & Euthanasia here is a quick recap of the case before we move on:

A 14 year old boy from Seattle who was diagnosed with leukemia in early November 2007 died at the end of that month after refusing a blood transfusion (citing religious beliefs-Jehovah’s Witness). The state took legal action and attempted to force the boy to have a blood transfusion, but the Supreme Court denied the motion and the boy died shortly thereafter. The judge felt that the boy was mature enough to make decisions regarding the type of medical treatment that he received and also felt that he was not being coerced by anyone in any sort of fashion. The judge also said that the boy knew he was basically giving himself a death sentence by refusing the blood transfusion.

Alright, so now that everyone is caught up...here is the new twist:
At the time the boy was residing with his Aunt in Seattle. His aunt had custody of him and she was also a Jehovah’s Witness. His birth parents however, were not Jehovah’s Witnesses and they wanted him to have the blood transfusion. They felt that his decision to refuse the blood transfusion was a result of his aunt influencing him and they even went to the hearing in an attempt to change the judge’s decision. Did the parents have a valid point? Should they of had a say in the medical treatment for their son?

What this case shows is how difficult these cases can get when you are talking about ‘children’ making decision regarding their medical treatment. Not all kids follow the same religion of their parents and it makes these cases so tough when there are differences in religious views. Depending on the location, you are usually considered an adult between 16 & 18 and your parents are basically in control of you until then....from a legal standpoint. So how come at 14 you can make major decisions regarding medical treatment? You would think that this type of privilege (or right depending on your viewpoint) would come when you are granted the rest of your major privileges like drinking, licence, etc. Now we’re not saying that the judge was right or wrong in this case, we just feel that the ruling may be a little incongruent with the other laws or rights that are given to kids once they pass a certain age. The issue of his parents being against the ruling is another issue.

First and foremost, they do not have custody of the boy so in the legal world their opinions would count for less when compared to the opinion of the aunt. However, they are still his birth parents and they probably cared for his well-being. Personally, I do not know how I would feel in this type of case. I’d probably be really upset that my child was allowed to make this type of life altering decision without my consent. For a parent that must be hard to have to sit by and watch as your child basically gives themself a death sentence. Thoughts??

Development of an Alternate Policy - Euthanasia in the Law

Based on concerns raised in our last blog entry regarding the alternate policies that have recently been developed surrounding euthanasia in Canada, we have developed our own set of recommendations. Using Bill C - 407 as a template we have created our own Bill regarding euthanasia in Canada.

Changes we did and did not make:

-Initially some of our group members wanted to ensure that all treatment options must have been tried in order to receive euthanasia. However, we did not include this option because it violated our freedom to consent to medical procedures and if it was enacted, the new policy would likely have been struck down as unconstitutional (Refer to previous post “Religion and Euthanasia - Intro” and "Religion and Euthanasia - Legislation")

-We have limited the practice of euthanasia solely to medical practitioners in order to prevent potential abuses of the system. The practice and execution (no pun intended) of euthanasia is highly complicated and many different issues are at stake. By making physicians the sole profession that can perform assisted suicide, we have helped to ensure that careful and educated consideration will be given to all issues at stake. This is an assumption on our part, but we believe it is a reasonable one.

- In our formulation of our new euthanasia policy we have also stipulated that the supervising medical practitioner must have been familiar with the case for at least 3 months. This helps to ensure that the medical practitioner is making informed and well balanced choices when he or she agrees to euthanize a patient. It also allows them a greater opportunity to perform their “due diligence” when assessing the patients request for assisted suicide. This familiarity with the patient hopefully means that they will be more aware of any external issues or pressures that may be influencing the patients decision.

It should also be noted that this particular guideline also limits “death tourism” to a large extent. It will make it very difficult for individuals outside the country to come to Canada to be euthanized. We would argue that Canadians are not interested in a “death tourism” industry and that this provision is in our best interests.

- The word lucid has also been more heavily defined in this amendment to the Canadian Criminal Code. Now someone's “lucidness” has to be determined by a registered psychologist or psychiatrist and their assessment must conform to the definition provided in the bill. The wording in the bill effectively allows the mental health professional involved the power to block approval for assisted suicide. This was determined to be a necessary concession to the possible psychological issues at stake in such an emotionally charged decision. (Refer to previous post on “Euthanasia and Depression”)

It is important to understand that this restricts eligibility for euthanasia to some extent for those who are suffering from mental anguish. However, due to the issues mentioned above this was a necessary sacrifice. This more conservative approach also makes it more likely that people will be more accepting of a bill surrounding euthanasia. (See previous post Assisted Suicide Eligibility Criteria - Some Thoughts)


- We have also stipulated that a hospital review board determine whether or not the assisted suicide conforms to the appropriate legal standards outlined by this amendment and we have given them the role of determining the most humane form of death for the patient. This allows the doctor who receives the euthanasia request some security and comfort, in that they know their actions have been verified by several other professionals who would support them should legal issues be raised during these proceedings.  

Although Canada is currently run out of a conservative government that does not mean we have to always think 'conservatively'. Canada is unique, and each individual in this country is unique as well; All with their own values, beliefs, and destinies.

Religion & Euthanasia - History of Important Cases (Part 2)

All of the cases that we have talked about to this point have involved adults making decision regarding the type of medical treatment that they receive but we would like to look at the topic from a different perspective.

What about children deciding the type of medical treatment that they receive? Part of the ‘Health Care Consent Act’ states that in order to decide on consent, a person must be ‘competent’ and know all of the risks going into the decision. This stipulation is not an issue when it comes to adults who are considered competent, but what about children. When are kids considered ‘able’ to decide on a major life decision such as the refusal of medical treatment? Generally, we are told that we reach adult between the ages of 16-21 and a lot of rights and privileges are given to us at this point. We can emancipate from our parents, drive a car, get into most clubs, drink legally, smoke, get married and even join the army. But when do we get to the point when we can refuse medical procedures without our parents consent.

Here is a case to consider (2007):
A 14 year old boy from Seattle was diagnosed with leukemia in early November of 2007. He began chemotherapy at a children’s hospital in the area but had to stop the treatments because his blood count was too low. The doctors wanted to give him a blood transfusion but the boy refused citing religious beliefs (Jehovah’s Witness). The case was taken to trial and the state tried to force the boy to take a blood transfusion. The case was heard at the Skagit County Superior Court and a judge ruled that the boy was within his rights to refuse the blood transfusion. The judge felt that the boy was mature, not being coerced and that he knew all of the risks involved with his decision. The judge also stated that the boy knew “he was basically giving himself a death sentence”. The boy died a few hours after the ruling from the court. Doctors stated that the boy would’ve had a 70% chance of surviving the next five years with the blood transfusion and other medical interventions and this also weighed into the court’s ruling.

Do you think this child was within his rights to make such a decision? Do you think he was too young to understand the consequences? What if this was your child making this decision.

Other aspects of this case will be looked at in our next entry...
-Information regarding the case taken from cbsnews.com

The World is Changing....

All over the world, hundreds and thousands of people are in coma’s, on life support, or suffering in pain in hospital beds. Recently, as in the last 10 years or so, there have been many stories published in international newspapers, about terminal ill people and the choices they make along with their family and religious advisors, on how their life should end.

It is interesting that these stories are travelling so fast, and from around the world. Most North American papers are publishing stories that have taken place in Europe or Australia, about an individual’s fight to die. Most recently, on November 13, 2008 in The Toronto Star, we see such a story.

This story was titled ‘Woman in Vegetative State Allowed to Die’ and is the story of a comatose woman in Rome, and her family’s struggle to give her what she wanted, a peaceful death…16 years ago.

“Courts, politicians and the Vatican have weighed in on the fate of Eluana Englaro, who fell into a vegetative state following a car accident in 1992, when she was 20. The Court of Cassation said it had rejected an appeal by prosecutors against a lower court ruling in July in favour of Beppino Englaro. The father had said his daughter visited a friend in a coma shortly before her accident and expressed the will to refuse treatment in the same situation.”

Italy does not allow a living will, and although a patient can refuse treatment, it has to be voiced directly from the patient. In this case, Eluana’s father was pleading to be her voice, and he tried very hard. Beppino Englaro had fought a decade-long court battle to disconnect his daughter's feeding tube.

Catholic and anti-euthanasia groups had protested the ruling. Conservative politicians reacted angrily to the ruling as well, saying that the courts had overstepped their bounds. Some had even voiced their opinions in comparing it to a death sentence.

This article was also compared to a separate American case as well. Throughout our entire blog we have presented many cases that touch on people’s will to choose their own destiny. We also see how the legal systems in each country/state, do not grant this freedom and there have been countless trials and appeals. The amount of money, time, pain and stress that go into making personal choices has been outstanding.
There are so many levels, sides and perspectives in discussing euthanasia. There are several situations where one would see it as appropriate or inappropriate. It’s hard to generalize the issue of euthanasia, and so it is important to see it as a personal choice, in a personal circumstance.

Washington & Oregon Laws...

As proud Canadians, let us look over to the United States. In 1994, voters in Oregon legalized euthanasia under limited conditions. Under the Death With Dignity law, a person who sought physician-assisted suicide would have to meet certain criteria:
• The person must be terminally ill.
• The person must have six months or less to live.
• The person must make two oral requests for assistance in dying.
• The person must make one written request for assistance in dying.
• The person must convince two physicians that he or she is sincere and not acting on a whim, and that the decision is voluntary.
• The person must not have been influenced by depression.
• The person must be informed of "the feasible alternatives," including, but not limited to, comfort care, hospice care, and pain control.
• The person must wait for 15 days.

Under the proposed law, a person who met all requirements could receive a prescription of a barbiturate that would be sufficient to cause death. Physicians would be prohibited from inducing death by injection or carbon monoxide. (http://law.jrank.org/pages/6602/Euthanasia-Oregon-s-Euthanasia-Law.html)

Oregon was one of the first in the world to promote death with dignity, and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death. In 1997, there was a ballot referred by the state legislator that sought to repeal the Death with Dignity act, but it was rejected by 60% of voters.

Initiative 1000 (I-1000) was an adopted ballot measure dealing with aid in dying that was passed in the US state of Washington in the November 4, 2008 general election. The effort was started by former Governor Booth Gardner.
The measure was approved in the November 4, 2008 general election. 57.84% votes were cast in favor, 42.16% votes were against. (Washington Secretary of State – statistics website)

"This measure would permit terminally ill, competent, adult Washington residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician. The measure requires two oral and one written request, two physicians to diagnose the patient and determine the patient is competent, a waiting period, and physician verification of an informed patient decision. Physicians, patients and others acting in good faith compliance would have criminal and civil immunity."
Provisions in the law include:
• The patient must be an adult (18 or over) resident of the state of Washington
• The patient must be mentally competent, verified by two physicians (or referred to a mental health evaluation)
• The patient must be terminally ill with less than 6 months to live, verified by two physicians.
• The patient must make voluntary requests, without coercion, verified by two physicians
• The patient must be informed of all other options including palliative and hospice care
• There is a 15 day waiting period between the first oral request and a written request
• There is a 48 hour waiting period between the written request and the writing of the prescription
• The written request must be signed by two independent witnesses, at least one of whom is not related to the patient or employed by the health care facility
• The patient is encouraged to discuss with family (not required because of confidentiality laws)
• The patient may change their mind at any time and rescind the request
("Initiative Measure 1000 "The Washington Death with Dignity Act"". Secretary of State of Washington (2008-01-24).)

This past November, this law went into affect. The people that were against it included the Coalition Against Assisted Suicide and other ‘Pro-Life’ groups. However, there were many groups that encouraged the law, most of which stemmed from different long-term illness support groups, as well as the Washington Chapter of the National Association of Social Workers. We’re so curious to see, which country or state will be next…

Euthanasia & Depression

We’ve noticed lately that the blog has taken on somewhat of a pro-euthanasia vibe and in an attempt to give equal play to both sides of the debate. We feel it is important to discuss one of the major arguments against its legalization. As the title foreshadows, this argument centers around the mental health of those who seek assisted suicide and euthanasia.

If someone who is terminally ill, or is paralyzed from the neck down in an accident requests for someone to help them die, it is automatically attributed to their illness or disability. When a healthy, non-disabled person attempts suicide, it is seen as a cry for help, a sign that they require psychological assistance. Is it possible that the ill and disabled who wish to die are also crying out for help in the same manner and that society is too preoccupied with what they already “know” to get them the help they need?

We don’t need to tell you that once a person is euthanized there is no going back, the process cannot be undone and life cannot be restored. This is relevant because recent research argues that many who seek euthanasia suffer from mental illness and might chose to reverse their decisions if they were to receive proper psychological treatment.

Under the Death with Dignity Act in Oregon, only those with terminal illnesses can apply for aid. The policy also specifically states that candidates can’t be suffering from any impairment. Although it is not specifically expressed in the policy, I would tend to believe that suffering from a mental illness such as depression would cloud one’s judgment and leave them impaired. This stance would explain why In Oregon, doctors are required to refer patients applying for “death with dignity” to a psychiatrist if they appear to have a mental illness.

The above argument may seem to counteract the argument that euthanasia is killing those with depression considering the listed safeguards. However, a study conducted by researchers at Oregon University found that as many as 25% of those successfully taking advantage of Oregon’s Death with Dignity Act meet the standards for clinical depression and are never referred to a psychiatrist. Although doctors are intelligent people they lack the specific training to recognize the signs of depression or other mental illness in just a single appointment.

A similar study conducted in Oregon found that 28 out of the 58 person sample who ended their lives under the Death with Dignity Act met the criteria for a mental illness (15 depression, 13 anxiety). Of these 28, none were referred to a psychiatrist by their doctor before they were supplied with the necessary materials to kill themselves.

A Canadian study found results supporting the argument that many euthanasia seekers are suffering from depression. Two hundred terminally ill patients were interviewed and 59% of those wishing to die were depressed, compared to only 8% of those not interested in hastening their death.

All of this is interest but it raises a very important question, if treated for mental illness, would their spirits and hopefulness improve to the point where they would no longer desire death? Well the same Canadian study reported that that when re-interviewed two weeks later after receiving psychology treatment, 4 out of every 6 patients who had previously wanted to die, had changed their minds.

A second major point of contention in this topic, is whether or not depression truly impairs mental competence. Some people may argue that it does not cause psychosis or severe disruption of brain functioning. However, it has been shown to clearly impact mood in a negative manner and has been linked to low self-esteem, feelings of self-blame and worthlessness, and feelings of hopelessness which is the primary trigger for suicides.

Lastly, I will point out one common sense argument that make every argument I’ve just made seem kind of silly. Then there are the realists who point out that depression is to be expected from this population, these people are dying after all. When viewed from a common sense perspective, it only seems rational that most terminally ill people who apply for euthanasia services would meet the criteria for a diagnosis of depression. As one author puts it, “you’re dying and you’re in pain, but you’re too depressed for assistance”. Seems kind of silly doesn’t it?

There is no right and wrong when it comes to this topic, but both sides can present formidable arguments as seen above. Feel free to comment and let me know how you view the issue and as always no judgments, just good discussion :)

http://www.portlandtribune.com/news/story.php?story_id=122342291083984500

http://www.nrlc.org/euthanasia/asisuid1.html

http://www.hospicecare.com/Ethics/RWethics1.htm