Monday, October 28, 2013

Quebec Euthanasia, putting the elderly at risk: A personal experience.

The following article was written by Irene Ogrizek and published on her blog on October 26, 2013.
Author’s disclosure: I have no religious affiliation and my politics, if you are new to this site, are left of centre. In online debates about this topic, two assumptions are frequently made about me: that I have conservative politics and am against Bill 52 on religious grounds. (Bill 52 will introduce euthanasia to Quebec.) My concerns are secular: I worry about the effect this bill will have on the elderly and the vulnerable in Quebec.
Irene asks: This is my picture now,
What will I be worth at 75?
The current euthanasia debate in Quebec frightens me. As a woman of a certain age, I fear I am heading into a future where I may lose meaningful control of my life. Whether I live or die may hinge on the kindness of individuals unknown to me, perhaps nurses or doctors, who will be put in the position of determining my worth. If I’m lucky and live past my retirement, evidence of all the things I’ve accomplished in my career will be gone. How will I look as a 75 year-old to myself and others? How will I be judged?
When it comes to euthanasia, the slippery slope aspect of it keeps being swept under the carpet. For me, it is the single most compelling reason not to go forward and here’s why: I have seen the slippery slope played out in the care my mother receives at her nursing home.
First I’d like to say that I chose this nursing home carefully; the staff to resident ratio was good and the building was clean and bright. It is located in a large Canadian city and is part of a government network of homes. My mother’s pension plan covers her monthly bill, so I use leftover money to pay for extras, like paid companions, to visit her. She has been disabled by a stroke and needs help wheeling herself around.
Despite having helpers, my mother has experienced three bouts of unauthorized medicating. I believe she has been given medications that make her drowsy and docile and are not included on her chart. Because of her fragile health, and the fact that she tires naturally, I had some difficulty, at least initially, detecting the problem.
The first time I noticed something was awry, it took a few visits to make sure I wasn’t catching my mother during an unstable phase in her health. When I saw her drowsiness was ongoing, however, I brought it up with a nurse, who said my mother was simply tired. I asked to see her chart anyway, just in case her medications had been changed and they’d forgotten to tell me.
The nurse promised to leave a note for the doctor, reporting my mother’s lethargy and asking him to examine her. I didn’t hear back from anyone, but on my next visit, my mother was back to her old self, sharp as a tack and telling me I needed to do a better job combing my hair before I left the house. It was a good sign and when I asked about the doctor’s examination, I was told it had been conducted and that there were no new developments. I let the matter go, but of course wondered.
The next time it happened, the drowsiness was far more pronounced. Using my phone, I took videos of my mother having lunch and then supper every day for several days. At lunch she was her usual chipper self; at supper she was unconscious. When I presented my evidence to the head nurse, he didn’t even try to deny it. He said he would take care of it internally – under his authority, that is – and that I could trust him when he said it would stop. I did trust him and it did stop. However, he resigned a few months later.
That was a year ago and I have just come off the third round of this same problem. Starting a few weeks ago, I kept finding my mother unaccountably drowsy, asked for a doctor to examine her and, within days, she had miraculously recovered. Earlier in the month, her eyes had been glassy and unfocused and she could barely communicate. Fearing the worst, I had called her partner, who is now living near his children, to come and say goodbye.
Now, I am sympathetic to nursing and personal support care staff. I took care of my mother for some time before she went into a home and so have a realistic idea of the energy it takes to care for her properly. There’s no doubt about it: it’s hard work. 
However, what is important, for the purposes of this discussion, is the phenomenon of rogue healthcare workers. I believe this last bout of over-medicating came about because there is probably one newly-placed employee, on the morning shift, who wants to decrease his (or her) workload and this is how he is doing it. The problem is that the oversight at the home is adequate: it has a good reputation deservedly. It’s just that elderly residents like my mother are expected to be poorly at times. Drugging her, under these circumstances, is easy.
I am worried about legalizing euthanasia because the chances are excellent that similar patterns will arise but with graver circumstances. Think of administrators being to urged to open beds in hospitals or nursing homes. Imagine they are being asked to clear out the most “expensive” patients. They would not have to euthanize, necessarily. They could present an elderly patient in a drugged state and convince a family that a catastrophic neurological event had happened. They could also claim a sedated patient was simply withdrawing from life. Having just seen my mother in this condition, without any medications on her chart to explain it, I know it could happen. It’s sad, but not all families are engaged enough to question an institution’s findings.
The elderly are the most vulnerable to the unethical use of “voluntary” euthanasia. They have financial and material wealth younger relatives may covet, and they are more likely to be nudged into this kind of “beyond hope” scenario. A little Benadryl or Dilaudid is all it would take.
These problems will touch the rest of us. I keep hearing over and over again, from supporters of euthanasia, how “It’s my life; I have a right to take it if I want.” It’s true people have a right to commit suicide. However, what I object to is the involvement of healthcare staff. As someone who has seen abuse in the system, I do not want a doctor who believes in euthanasia. I do not want this because if I am given a bad diagnosis, he or she may push me toward it and away from a more expensive life-saving option. This could be accomplished by exaggerating the difficulties facing me; I could be told I’m going to suffer a protracted and painful death.
And there are more complications.
Given the protectionism I’ve seen among most (although not all) doctors, I don’t think it likely Quebecers will be told which doctors are practicing euthanasia. I suspect the doctors who choose to do it will not, perhaps for reasons of safety, be putting their names out in the public sphere. Despite the fact that users of the system have a right to know, I doubt we will.
So for all the cries of “It’s my life; I can do what I want with it,” I say this: involving a doctor, a doctor in a pool of doctors we all use, contaminates and compromises their decision-making and contaminates and compromises our ability to trust them. In a sense, by insisting on your rights to such an individualistic extent, you are peeing in our pool.
Another argument I keep hearing is this: why would you insist on making someone suffer through unimaginable pain? How can you truly know what another person is feeling? Here’s my answer: I believe my mother was deliberately under-treated by a physician who tried to make a life and death decision for her. Perhaps it’s because he heard my mother had been athletic and decided she should not live out her years in a wheelchair. I suspect important procedures had been postponed — too often — because he had prioritized younger patients and de-prioritized her. Ironically, those postponements are what led to her poor condition in the end.
And that’s the problem. Assumptions were made in my mother’s case too. Healthcare workers saw her future and decided it would be “cruel” to let her live. This was said to me even after my mother had been told of her prognosis, accepted her fate and told me she wanted to go on. However, had she not become conscious when she did, and insisted on that right, I have no doubt the infection she was suffering from would have been allowed to take its course.
I’ve got a phrase for this: I call it euthanasia by attritionWhere my mother was concerned, it was a back-room decision that could not have been undone. In my view, the suffering of a small percentage of patients, at the end of their lives, is not worth the taking of another life arbitrarily. Even if my mother is sick and elderly, she still has rights, including the right to go on living.
Here’s my final argument. Every time my mother has been drugged, I myself was going through a down period, a period, in other words, when my energy was flagging and I scheduled my visits in the evenings and made them quick. I am the sole caregiver for my mother and after years of taking care of her, there are just times when I need to go easy on myself.
It’s been at those times that the illicit medicating started. So if this pattern of events is anything to go by, a heightened vigilance is what is needed for me to prevent yet another episode. However, this is easier said than done.
Being vigilant takes time and energy and is not always possible, for individuals like myself and institutions like hospitals. It’s this kind of naive faith – that we have the time, energy and resources to oversee euthanasia – that is an illusion. It’s this same naive faith – that the paperwork controlling euthanasia will do its job – that is equally illusory. The controls will slip. Crack open a history book is what I want to say when I hear euthanasia supporters accusing me of being a holy-roller and going on about their rights.
That’s right, a history book. Our province’s future, when it comes to euthanasia, is in one.

Irene Ogrizek teaches English literature at the CEGEP level in Montreal Quebec, Canada 

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