Monday, July 30, 2018

Ontario family appealing brain death decision. Is Taquisha McKitty alive?

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The daughter of Taquisha McKitty
Taquisha McKitty (27) of Brampton Ontario, who was declared brain dead on September 20, last year, after having a cardiac arrest on September 14 related to a drug overdose. On October 17, Hugh Scher, the lawyer for Taquisha's family, asked the court for more time for medical tests to prove that Taquisha is alive.

On June 26 Ontario Superior Court Justice, Lucille Shaw, ordered that McKitty was to have the Life-Support withdrawn in a month.

McKitty's family appealed the decision, last Thursday, preventing the removal of life-support and challenging the brain death designation.

Reporting for the Brampton Guardian, Marco Chown Oved outlines the reasons given for the appeal. According to Hugh Scher, the lawyer for the McKitty family:

...Justice Shaw erred “by applying a legal definition of death that fails to conform with a biological definition of death.” 
...the court further erred by not allowing independent experts to videotape or assess McKitty’s movements, which “differ in nature, quality and duration from spinal cord reflexes.” 
Shaw’s ruling stated that the Charter of Rights and Freedoms does not apply to McKitty, because it only protects “persons,” and McKitty, because she is clinically brain dead, is not legally a “person.” 
This puts the cart before the horse, Scher argues in the appeal, because McKitty’s Charter rights were breached in order to pronounce her dead. 
“The Court’s predetermination of Taquisha’s death to justify non-application of the Charter of Rights and Freedoms ... dehumanizes Taquisha as a non-person from the outset,” Scher wrote. “Taquisha is an individual under the law deserving of Charter protection.” 
Hugh Scher
In her decision, Justice Shaw also focused on financial reasons for withdrawing treatment from McKitty. Scher stated in an interviewed by CBC news in May 2018 that:
"It (the case) raises a serious question as to what is death in Ontario and in Canada. There is no statutory legal definition," said Scher on Metro Morning Tuesday. "We're hopeful this case will provide some guidance." 
Scher and the McKitty family say that beyond breathing and having a heartbeat, Taquisha shows other signs of life — like moving her legs — that prove she's still biologically alive. 
"She eats, she drinks, her organs function," said Scher, comparing her to "many other people with a severe neurological impairment."
The McKitty case questions whether a person, who has been declared brain dead, is actually dead.

Hugh Scher was also the lawyer in the Shalom Ouanounou case in Toronto. 

British Supreme Court sets a dangerous precedent by ruling that doctors can withdraw food and fluids from brain injured patients without court permission.

The following article was published by Peter Saunders on his blog on July 30, 2018

Dr Peter Saunders
By Dr Peter Saunders

My Radio Four Today programme interview on this case is here. Five Live here.

Should doctors be able to withdraw food and fluids from severely brain-damaged people who are not imminently dying? And if so, in what circumstances?

The answer to these questions has changed significantly today because of a decision by the Supreme Court.

Patients with permanent vegetative state (PVS) and minimally conscious state (MCS) can now be effectively starved and dehydrated to death if the medical staff and relatives agree that this is in their ‘best interests’.

People with PVS (awake but not aware) and MCS (awake but only intermittently or partially aware) can breathe without ventilators but need to have food and fluids by tube (clinically assisted nutrition and hydration or CANH).

These patients are not imminently dying and with good care can live for many years. Some even regain awareness. But if CANH is withdrawn, then they will die from dehydration and starvation within two or three weeks.

Until last year all cases of PVS and MCS have had to go to the Court of Protection before CANH could be withdrawn.

Under the old rules, only about 100 applications to stop tube feeding have been made in more than 20 years, since the Tony Bland case created the precedent in 1993. But this could now hugely increase.

In two cases last year (known as M and Y) the High Court ruled that if the relatives and medical staff agreed that withdrawal of CANH was in the patient’s ‘best interests’ then the court need not be involved.

Three medical bodies - the BMA, RCP and GMC - issued interim guidance in line with this decision last December and at the same time the Court of Protection similarly changed its rules.

The Official Solicitor appealed this decision to the Supreme Court in a hearing in February. The Supreme Court has only just issued its judgement today effectively upholding the decision of the High Court.

Lady Black
giving her judgement, Lady Black, with whom the other four Supreme Court judges fully agreed, made three critical rulings.

First, she argued that ‘there may come a time when life has to be relinquished because that is in the best interests of the patient’.

Second, she said that that there is no difference in principle between turning off a ventilator and removing a feeding tube as both are ‘forms of medical treatment’.

Third, she said patients with PVS and MCS should be treated in the same way as people with ‘severe stroke’ a ‘degenerative neurological condition’ or ‘other condition with a recognised downward trajectory’ where ‘decisions to withhold or withdraw CANH are made on a regular basis without recourse to the courts’.

In making these declarations Lady Black has dramatically moved the goalposts on end of life decision-making.

Once we accept that death by dehydration is in some brain-damaged people’s ‘best interests’ we are on a very slippery slope indeed.

There is a clear difference between turning off a ventilator on a brain-dead patient and removing CANH from a brain-damaged patient. In the first case the patient dies from their underlying brain injury. In the second they die from dehydration and starvation.

Similarly, PVS and MCS differ from conditions with a ‘downward trajectory’ because they are not progressive and do not in themselves lead inevitably to death.

British Supreme Court
The Supreme Court has set a dangerous precedent. Taking these decisions away from the Court of Protection removes an important layer of legislative scrutiny and accountability and effectively weakens the law.

It will make it more likely that severely brain-damaged patients will be starved or dehydrated to death in their supposed ‘best interests’ and that these decisions will be more influenced by those who have ideological or financial vested interests in this course of action.

Prof Derick Wade, a consultant in neurological rehabilitation based in Oxford, estimates there could be as many as 24,000 patients in the NHS in England either in PVS or MCS, with most of them in nursing homes.

Given that it costs about £100,000 per year to care for a person with PVS or MCS the potential ‘saving’ for the NHS could be as much as £2.4 billion annually if most seek to go down this route. This is not a temptation we want to put before medical staff and administrators given current financial pressures.

But it is also bad medicine.

There are still significant uncertainties about diagnosis and prognosis in both PVS and MCS. These have increased rather than decreased in the last 20 years and this is why continued court oversight is necessary.

Making judgements about diagnosis, prognosis and best interests in these cases is fraught with difficulty and should be carried out only by those with specialist experience.

The Court of Protection has already overturned some doctors’ decisions in previous cases and some patients have recovered awareness months or even years after being diagnosed with PVS or MCS. This is more common after traumatic brain injury than after oxygen deprivation.

There are also advances being made in the treatment of some acute brain injury because of brain cooling techniques, intracranial pressure monitoring and neurosurgery.

But most seriously there is the real risk that those who have vested ideological, financial or emotional interests in a person’s death could exert undue influence.

Recent experiences around the Liverpool care pathway, and in the Gosport hospital, should make us wary of leaving doctors without proper regulatory and legal oversight.

When difficult medical decisions are left to doctors who are inexperienced, inadequately trained or working under intense pressure bad decisions can be made.

When they are left to those who believe that brain-damaged patients are better off dead then we are in a very dangerous place indeed.

It is just possible that today’s Supreme Court decision will not change medical practice in this area. But I am not holding my breath.

The full judgement is available here and the press summary of the judgement here.

Two Misleading Assisted Suicide Myths

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Dr Cynthia Geppert
The Journal, Psychiatric Times, published an insightful article on July 18 titled: Two Misleading Myths Regarding "Medical Aid in Dying" written by Cynthia M. A. Geppert, MD, PhD, MPH and Ronald W. Pies, MD examing issues of autonomy and the definition of terminal illness.

Based on the first question the authors examine the traditional definition of autonomy and write:
Even a casual perusal of most MAID/PAS legislation—modeled closely on the 1997 Oregon “Death with Dignity” statute—reveals that these statutes provide nothing remotely resembling “autonomy” for the patient, in either the procedural or personal sense. Patients who wish to avail themselves of prescribed, lethal medication must clear a number of procedural and administrative hurdles that depend entirely on the diagnostic, prognostic, and prescriptive authority of the patient’s physician. The controlling decisions regarding the patient’s diagnosis; the need for a consultant to confirm the diagnosis; the putative “terminal” nature of the illness; the completion of required certification forms; and, finally, the writing of the lethal prescription are all exercises of the physician’s autonomy.

Of course, there is much more at stake in this debate than mere procedural autonomy (ie, the ability to “command and control” a particular sequence of events or procedures). At issue is what we would call authentic autonomy, which reflects both the psychology and the core internal values of the person. How, then, is the patient’s authentic autonomy assessed under current PAS statutes? To what degree is the patient’s genuine informed consent ensured? And are there sufficient safeguards under current PAS statutes to ensure that the patient does not have a psychiatric disorder that would impair understanding and undermine informed consent? Can a person in such existential distress truly exercise the voluntarism that is integral to authentic autonomy? We believe that, under current MAID/PAS regulations, these critical issues have not been given serious moral consideration.
Dr Ronald Pies
The authors then evaluate the concerns related to depression and mental illness and they state:

Furthermore, it is not true that under current PAD statutes “. . . mental illness that would affect the rationality of decision-making is screened out,” as erroneously claimed in a position paper from the American Association of Suicidology. One of the most profound and misunderstood limitations of statutes modeled after the Oregon Death with Dignity Act is that they do not require examination by a mental health professional, except when the participating physician is “concerned” and decides to do so. In fact, in Oregon, 204 patients were prescribed lethal drugs in 2016 under the “Death with Dignity” statute, yet only 5 patients were referred for psychiatric or psychological evaluation.
They then conclude their concerns by outlining how assisted suicide laws do not ensure autonomy:
Rather, current PAS statues create a superficial “pseudo-autonomy” that is, at best, cosmetic in nature. Procedural boxes may be checked, but the underlying conscious and unconscious motives of those involved are virtually ignored. In particular, the role of transference, countertransference, and coercion in PAS decisions has been sorely neglected, as have the unconscious fears and fantasies of the patient requesting PAS. Indeed, “. . . coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide.”
The second misleading myth that the authors examine is the definition of terminal illness. The authors examine how the terminal illness has been re-defined in Oregon:
Most PAS legislation applies to an adult with a terminal illness or condition predicted to have fewer than six months to live. The common interpretation of this phrase would be, “six months to live even with treatment,” often with the assumption that there is no further or additional therapy capable of halting or reversing the disease process. Good law and sound public policy both depend upon clear and cogent definitions. Yet, incredibly, “terminal illness” is never defined at this level of detail in existing PAS statutes (ie, with respect to treatment vs no treatment). Nevertheless, in Oregon and Washington State, nearly identical criteria are interpreted to mean fewer than six months to live without treatment. Thus, an otherwise healthy 20-year-old with insulin-dependent diabetes could be deemed “terminal” for the purpose of Oregon’s “Death with Dignity Act,” since, without insulin, the patient would probably die within six months.

So, too, patients refusing appropriate treatment may be deemed “incurable” or “terminal” under current interpretation of the Oregon law. Thus, a patient with anorexia nervosa who refuses treatment could be eligible for PAS under Oregon law, even though she has never tried a course of intensive, evidence-based therapy. By this Orwellian logic, an individual with pneumonia who refuses to take antibiotics could be deemed “incurable” and qualify for physician-assisted suicide!
The authors then examine the communication between Craig New, Research Analyst with the Oregon Health Authority and Fabian Stahle, a Swedish investigator. The authors write:
In a remarkable, notarized exchange with the Oregon Health Authority, Mr. Stahle posed the following questions:
In the [Oregon] law, “terminal disease” is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment (in the opinion of the patient’s attending physician and consulting physician), produce death within six months. Is this rule interpreted as “without administration of life-sustaining treatment”?
Craig New, ... replied as “ . . . your interpretation is correct. The question is: should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months?” [emphasis added]
Stahle then posed a follow-up question to Mr. New:
If a patient with a chronic disease (for instance, diabetes) by some reason decides to opt out from the life-sustaining medication/treatment and by doing so is likely to die within 6 months, thereby transforming the chronic disease to a terminal disease—does he/she then become eligible to take use of the act?
New replied that, yes, indeed—the patient would qualify for assisted suicide. In New’s words, the Death With Dignity Act “. . . does not compel patients to have exhausted all treatment options first, or to continue current treatment . . . [and] if patient's decide they don’t want treatment, that is their choice.”
The authors then conclude their article by stating:
There is certainly room for debate regarding the role of the physician in “end-of-life” care. Nonetheless, as psychiatrists and medical ethicists, we believe that so-called “medical aid in dying” (physician-assisted suicide) is a serious boundary violation and an unethical act. This is consistent with the historical positions of the American Medical Association, the American Psychiatric Association (based on the AMA Code of Ethics), the American College of Physicians, the World Medical Association, and the American Nurses Association.

Whatever individual physicians decide with respect to MAID/PAS, it must be based on a clear-eyed understanding of current statutes and legislation. This means exposing the myths that surround these statutes. Among these are the commonly-received notions that patients choosing PAS act “autonomously” and have a demonstrably incurable condition. In truth, current PAS statutes produce a form of pseudo-autonomy that enshrines the supreme authority of the physician, and re-defines “incurable” to mean almost anyone who is seriously ill.
Thank you to Cynthia M. A. Geppert, MD, PhD, MPH and Ronald W. Pies, MD for examining these issues in a clear and direct manner.

Friday, July 27, 2018

Dutch doctor reprimanded for euthanasia without consent of woman with dementia who resisted.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The case of the Dutch doctor who forced euthanasia on a patient with dementia who resisted is back in the media after the Netherlands Euthanasia Commission censured the doctor.

In January 2017, a Netherlands Regional Euthanasia Review Committee decided that the forced euthanasia done on a woman with dementia, where the doctor sedated the woman by secretly putting the drugs in her coffee, and then asked the family to hold her down in order to lethally inject her, was done in "good faith." 

The committee chair, Jacob Kohnstammhad, urged that the case be reviewed by the court, but urged that the doctor not be punished, but rather to set a precedent concerning these acts.

According to the article by Sanay Boztas for the Telegraph the doctor was reprimanded but the Netherlands Public Prosecutor has not decided if the doctor will be prosecuted. The article states:

The case is the first time since the Dutch euthanasia law was passed in 2002 that a practitioner has been formally censured. According to the Dutch NOS broadcaster, the public prosecutor will announce after the summer if the doctor will face criminal prosecution.
The Telegraph article stated that the reaction to the censure of the doctor has been mixed:
Some doctors have reacted positively to the ruling, saying it provides more clarity in a complex area. Bert Keizer, a doctor who works for the End of Life Clinic, told NOS: “At last there is clarity. But for people with a living will who want to die if they have advanced dementia, this is a negative ruling. If they can no longer indicate that they still want to die, they will have to drink the cup [of sedative] otherwise they will not receive euthanasia.”
In March we learned that the Netherlands Public Prosecutor was examining several euthanasia cases

The DutchNL news reported in March that the regional euthanasia review committee's annual euthanasia report indicated that the number of assisted deaths increased by another 8% to 6585 reported assisted deaths in 2017.

The DutchNL news, indicated that the number of assisted deaths for dementia or psychiatric reasons also increased with 169 people dying by euthanasia for dementia (3 were advanced dementia) and 83 people dying by euthanasia for psychiatric reasons. 
The DutchNL article indicated that 12 of the euthanasia deaths were questionable:
Twelve cases were labeled by the monitoring committee as not being carefully carried out – these were mainly problems with medical care or not having an independent second opinion.
The New England Journal of Medicine (NEJM) (August 3, 2017) published a study titled: End-of-Life Decisions in the Netherlands over 25 years.

Netherlands euthanasia study uncovered abuse of the law. The study indicates that in 2015 there were 7254 assisted deaths (6672 euthanasia deaths, 150 assisted suicide deaths, 431 terminations of life without request).

Thursday, July 26, 2018

Belgian euthanasia not just slippery slope but ripe for abuse.

The following article was published by OneNewsNow on July 26, 2018

Many euthanasia deaths in Belgium have a cloud of mystery surrounding them with no chance of ever being solved.

The latest report for 2017 shows a 14-percent increase (2309) in euthanasia deaths over 2016 but a staggering 242-percent jump in seven years.
Alex Schadenberg of the Euthanasia Prevention Coalition says what bothers him most in the report is the expansion of the practice.
"They've added a new category called 'conditions' like sight or loss of incontinence," he warns, "basically its for elderly or disabled people who are not terminally ill but have chronic conditions."
Alex Schadenberg
Three children have been killed via euthanasia as well as the elderly, the mentally ill, including people who are autistic.

The latter hits home with Schadenberg because he has an autistic son.

Sadly, he says, the survey can only quote stats on euthanasia cases that are reported.
"And as those who follow the euthanasia debate realize that there's been several studies in the last few years showing the high numbers of unreported euthanasia deaths in Belgium," he says.
By comparison, he tells OneNewsNow, Netherlands has also become notorious for unreported euthanasia cases but Belgium is the "king of unreporting" in Europe.

And he says that is the real danger: no one really knows how many cases, or the circumstances behind them, on what he calls a slippery slope of death.

Tuesday, July 24, 2018

Belgian 2017 euthanasia report. Deaths by euthanasia continue to increase and children are being killed.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The media is reporting that the Belgian euthanasia data has been released. The data shows that the number of euthanasia deaths continues to increase, euthanasia deaths for conditions related to aging have skyrocketed and three children died by euthanasia. 

There is no sign that the problems of euthanasia without request and unreported euthanasia deaths has been reduced.

The basic data. In 2016 there were 2028 reported euthanasia deaths up from 2021 in 2015 and in 2017 there were 2309 reported euthanasia deaths, a 14% increase from the previous year. There were 954 reported Belgian euthanasia deaths in 2010 representing a 242% increase in 7 years.

Since 2010, Belgium has expanded euthanasia to include children, people with mental or behavioral conditions and people who are not dying but have chronic conditions. The data indicates that in 2016/17 there were, reportedly, 3 children who died by euthanasia, 77 people with mental or behavior conditions and 710 people with sight loss or incontinence or conditions related to disability or age.

When releasing the 2015 euthanasia data, Wim Distelmans, the chairman of the Euthanasia Evaluation and Control commission told the media that they cannot say for certain the actual number of euthanasia deaths. Distelmans stated:
"Remember, there could be some euthanasia cases carried out but which are not declared so we cannot say for certain what the number is,"
Distelman's comments were based on the research published in the New England Journal of Medicine (NEJM) (March 19, 2015) on the euthanasia practice in Belgium that found
  • 4.6% of all deaths in 2013 in the Flanders region were euthanasia.
  • .05% of all deaths in 2013 in the Flanders region were assisted suicide.
  • 1.7% of all deaths in 2013 in the Flanders region were hastened without explicit request.
By comparing the data from the 2013 NEJM study to the official 2013 Belgian euthanasia commission data it is clear that almost half of the euthanasia deaths in 2013 were not reported to the commission.

A significant and continuous problem in Belgium is the number of assisted deaths without explicit request. According to the NEJM study:
In 2007, 1.8% of all deaths were hastened deaths without explicit request while in 2013, 1.7% of all deaths were hastened deaths without explicit request.
Ludo Vanopdenbosch
Last year, Dr Ludo Vanopdenbosch, a palliative care specialist, resigned from the Belgian euthanasia commission after the commission approved the death of a person who could not have consented to euthanasia. 
Vanopdenbosch explained in his resignation letter that:
The most striking example took place at a meeting in early September, ... when the group discussed the case of a patient with severe dementia, who also had Parkinson's disease. To demonstrate the patient's lack of competence, a video was played showing what Vanopdenbosch characterized as "a deeply demented patient."  
The patient, whose identity was not disclosed, was euthanized at the family's request... There was no record of any prior request for euthanasia from the patient.
Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen said:
"It's not euthanasia because the patient didn't ask, so it's the voluntary taking of a life,"
This appalling case of euthanasia without request is not the first dispute. The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont's patients might have been killed without meeting all the legal requirements. Prompted by the AP's reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.

Euthanasia is out-of-control in Belgium. Some day the people will wake-up and realize how crazy the euthanasia ideology is and recognize the social and human destruction euthanasia has caused.

Will Oregon's plan to eliminate opioid prescriptions for chronic pain medicaid patients increase the requests for assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Steven Ariens (Pharmacist)
The National Pain Report published an article by pharmacist Steven R Ariens examining the policy of the Oregon Health Authority to stop prescribing opioids to chronic pain medicaid patients in 2019.

The article outlines the issue:

A proposed policy that would restrict Oregon chronic pain patients on Medicaid access to opioids for chronic pain as reported by the National Pain Report and others have created a stir in the chronic pain community. Columnist Steve Ariens, a retired pharmacist and spouse of a chronic pain patient submitted this opinion.

Oregon is set to eliminate all opiates from being prescribed for all chronic pain and Fibromyalgia patients on Medicaid by 2019. The Oregon Health Authority is considering expanding coverage for alternative therapies like aqua therapy, mindfulness and acupuncture.
Ariens argues that there is not enough data proving the effectiveness of alternative therapy but there is significant data proving the effectiveness of opioid use for chronic pain:
“They” tend to ignore and/or discount studies that have found that patients were found to be functioning quite well after 10 or more years on generally stable opioid dosages, with the vast majority of patients able to care for themselves, drive their cars etc.
“They” also tend to discount the reports that opiate prescriptions are down about 25% from their peak in 2011-2012.  While during the same time opiate OD’s have almost DOUBLED and the typical OD has 4 to 7 different substances in their toxicology report–including illegal Fentanyl analog, Heroin and Alcohol for “starters”. Most likely those ODs are not chronic pain patients who are using the opioid therapy to improve their individual quality of life.
Ariens then makes two points that are crucial to the issue, that being assisted suicide is legal in Oregon and the Oregon budget has a $1 Billion shortfall. Ariens states:
Also, Oregon is one of a handful of states that has a “death with dignity” law allowing terminal patients to elect to end their life with assistance from their prescriber. When pain is not treated, bad things can happen. It can delay healing, decrease appetite, increase stress, disrupt sleep and ultimately cause anxiety and depression While these adverse physical health outcomes may make the patient eligible for using Oregon’s “death with dignity law”. Of course, if a Medicaid patient elects to go down this path, the Medicaid system stands to save untold tens of thousands of dollars in expenditures for these patients if they did not exercise for this option.  

It is reported that Oregon has a $1-billion annual budget shortfall. Are these bureaucrats in Oregon working under the false pretense that if they curtail the prescribing/dispensing of legal opiates it will cause a dramatic reduction in the demand and addiction to opiates?
I am convinced that ending opioid prescriptions for medicaid patients in Oregon will lead to more requests for assisted suicide. When pain is not effectively controlled, people will experience greater levels of illness which will often lead to people becoming more desparate.

Assisted suicide is a cheaper alternative to treatment. Dead people don't require care.

Monday, July 23, 2018

3 Tips for Safeguarding Your Loved One in a Nursing Home

This article was written and published by Nancy Valko on July 22, 2018

Nancy Valko
have had many relatives and friends who lived in nursing homes and, especially as a nurse, I am always saddened by how few of the other residents had any visitors, even family members. I have even heard relatives say they would just prefer to remember their relative “the way they were”.

This is not only tragic for the family member’s or friend’s psychological well-being but also potentially for their safety. Nursing home residents without visitors are at greater risk of neglect or even abuse. With sometimes inadequate staffing and/or high nurse and aide turnover, it is important that people in a nursing home have someone who knows them to look out for them.

Here are 3 tips that can help safeguard a friend or relative:

  • Get to know the staff and tell them about your friend or relative, especially likes or dislikes. Visit at different times or days in order to know the staff and when it is most convenient to talk with them. 
  • Notice “red flags” like poor personal hygiene, unexplained injuries, weight loss, emotional changes, environmental hazards etc. and know who to contact if you see a problem.
  • Especially if you are have health care power of attorney for your relative or friend, ask about care conferences so that you can attend them. Such conferences usually cover how the resident is doing in terms of activity, possible pain, eating, mobility, etc. It is also crucial to know what medications have been ordered and given, especially the PRN (as needed) ones. For example, you may notice a change such as sleepiness or fatigue that can be helped with a medication change.

By 2020, it is projected that the global population of human beings who are 65 and older will surpass those under 5 for the first time in human history. At the same time, families have fewer children, older adults are more likely to have never married or to be divorced and adult children often live far from their parents. This makes it harder for many older people who prefer to live independently in their own homes indefinitely without help.

According to the CDC, 1.4 million people are nursing home residents in the US and, as I wrote in last week’s blog “‘Rational’ Suicide and the ‘Elderly'”, those residents really
benefit from visitors as do all of us who volunteer to help the elderly!

AMA grapples with assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The Worchester Telegram published an excellent article on July 22, 2018 by Dr Thomas E. Sullivan concerning the American Medical Association (AMA) assisted suicide debate. 

Dr Sullivan is the Past President of the Massachusetts Medical Society, the past chair of the New England delegation to the AMA and he is currently an American Medical Association delegate.

Sullivan begins his article by expressing his surprise that the AMA House of Delegates sent recommendations from the AMA Council on Ethical and Judicial Affairs (CEJA) back for clarification. Sullivan explains:
It was felt that the body of the report was not accurately and clearly reflected in the conclusion and recommendation that there should be no change in the policy opposing physician assisted suicide. AMA Delegates said that the ethical guidance was confusing, especially for those physicians practicing in the small number of states that have legalized assisted suicide.
Sullivan encourages people to read the CEJA Report (Link) which represented a two-year extensive re-examination of this complex dilemma. Sullivan states that CEJA did a superb job of addressing all the issues in their report to the AMA House of Delegates. Their treatment of the issue is as delicate as it is nuanced. Sullivan then address some of the issues contested by AMA delegates:
They first address language, affirming that “the term ‘physician assisted suicide’ describes the practice with the greatest precision,” and therefore reject using the euphemistic alternative language of proponents, such as “death with dignity” or “medical aid in dying,” because it “could be used to describe either euthanasia or palliative/hospice care at the end of life, and this degree of ambiguity is unacceptable for providing ethical guidance.”
... CEJA draws attention to the unintended consequences of physicians assisting patient suicides and a public policy that removes all liability for doctors. They pose the question: can the safeguards in assisted suicide laws actually protect patients and sustain the integrity of medicine? With all of the documented cases of mistakes, abuse, and coercion and the obvious paucity of data and reporting involved, it is clear that the answer is a resounding NO! CEJA concludes that “oversight of practice may not be adequate,” and that safeguards in the six states that have legalized the practice ought to be improved, which I believe indicates that they are hollow and circumventable.
Sullivan adds his own opinion to the assisted suicide debate:
No matter what you “fix” in these deeply flawed laws, however, I still find there are inherent issues consequent to subverting the physician’s role as healer, not the least of which is that people of economic disadvantage can and will be denied coverage for expensive care for which they cannot pay out of pocket yet offered coverage for suicide instead. Suicide is not medical care.
Building upon the report, I can add my personal experience of 44 years in direct patient care as a cardiologist, primarily in the Boston area. I was also the medical director of a long-term care facility in Ipswich where death was an ever-present, common occurrence among our frail, elderly residents.
But there are growing numbers of patients in mundane, non-personal environments where life has lost its meaning in the individual’s mind. I must acknowledge that our system does not do enough currently for those who have “given up on life” and need the compassionate, palliative and hospice care alongside professional, psychological and psychiatric support that should be available to everyone when appropriate. This must not be conflated with the doctor assisted suicide perversion of “end of life care.”

I’ve practiced medicine with compassionate care and dignity for all patients remaining at the forefront of my mind for my entire four-decade career. I will not submit to those who want to distort the English language and the “sacred” relationship we physicians have with patients by substituting assisted suicide for compassion, palliation, and support when it is needed most.
Sullivan strongly supports for the CEJA assisted suicide report:
The defense and support for recommendations from the recent CEJA report to maintain the AMA’s current policy and the AMA’s longstanding position opposing physician assisted suicide is critical in shaping both legal and ethical guidance worldwide.
...Our next formal meeting is in November in Washington, D.C. For now, the AMA still remains formally opposed to physician-assisted suicide without any vote to overturn the policy. And I trust that delving further into the issue, both CEJA and average citizens alike will continue to see the inherent dangers of any change to our patients and the very practice of medicine.
The Euthanasia Prevention Coalition recognizes that the assisted suicide lobby is working to have their supporters become delegates at the AMA annual convention. It is the responsibility of our supporters to also work to become AMA convention delegates.