Thursday, May 30, 2024

Bad care brings euthanasia and euthanasia brings bad care.

Gordon Friesen
Gordon Friesen
President, Euthanasia Prevention Coalition

In January, 2024, Normand Meunier visited the emergenc
y department of a major regional hospital in the Province of Quebec, the jurisdiction with the highest euthanasia rate in the world.

Meunier was complaining of a potentially life-threatening respiratory infection which was successfully treated during his stay. And yet, before he was even formally admitted to hospital, this patient spent 95 hours on a stretcher in the emergency corridor, resulting in a severe pressure sore which ultimately decided him to end his own life through consent to Medical Assistance in Dying.

Article: Québec quadriplegic man "chooses" euthanasia after suffering horrific negligent care. (Link)

Normand Meunier
Quite naturally, these circumstances raised great excitement among the public, who universally condemned this demonstration of dysfunctional care. Our own friends and allies quickly pointed out, also, that these shortfalls in public healthcare actively push vulnerable people like Mr. Meunier towards euthanasia --an allegation which was explicitly levelled by Meunier, himself, in the course of pre-MAID interviews.

One point

With the reader's permission, I would like to add a MAID related reflection to this analysis: concerning the active feedback loop now created between poor care and euthanasia. For this relation does not proceed in one direction only.

Yes. It is true that poor care will inevitably drive increased demand for MAID. However, it is equally true that the availability of MAID (to clean up embarrassing inadequacies in public policy) will also tend to reduce good-faith efforts to resolve these problems --and ultimately to encourage a sort of passive fatalism in the face of sustained degradation in our medical system.

For in the end (according to this new death-medicine paradigm) whatever other treatments might be lacking, at least we have one sure-fire remedy to settle any serious medical challenge, which is Medical homicide, aka Euthanasia, aka MAID.

Unhelpful and clumsy attempts to avoid meaningful criticism

Faced with the evidence that something had gone terribly wrong for Normand Meunier, public figures and bureaucrats --from the Provincial Premier on down-- were quick to denounce this episode with sincere and righteous outrage, vowing that it must never be repeated.

(Which, if we read between the lines, is simply to say that Normand Meunier's case was officially minimized, as a tragic one-off, from which specific lessons might be gleaned, but no more.)

To promote this reassuring perception, much was made of the special circumstances encountered. 

1) Meunier was a quadriplegic (a generally mysterious and little understood condition) 

2) The specific issue was pressure sores (which ordinary people know little or nothing about) 

3) The reason these sores became a problem was attributed to a simple tech problem, in the lack of a pressure-alternating mechanical air mattress.

Together these factors have been used to tacitly imply that under "normal" circumstances emergency rooms work just fine (or at the very least, that for "normal" folk, the pressure sores of quadriplegics are no more a threat than unicorns on another planet).

Unfortunately, however, these assumptions are quite false. For in truth: all of the Very Special Factors cited above are no more than proverbial "red herrings".

Nothing but business as usual

To begin with, there is nothing "special" about bedsores (aka decubitus ulcers) and these sores are not an exclusivity of quadriplegics. For although the typical citizen is largely ignorant of their fatal significance, pressure sores are everywhere seen among sedentary patients. In fact, no less than 30% of patients in Canadian long term hospital facilities have pressure sores which are qualified as "difficult" and require constant attention.

It should thus be perfectly obvious that patients are constantly turning up in ER, both at risk of ulcers and with active sores; and that nothing, therefore, could be more typical (however gruesome that reality might be) than the specific problem presented by Mr. Meunier.

But just as importantly, regarding the famous missing therapeutic mattress itself: there is no need, whatsoever, for such a mattress in the normal treatment of patients at risk of ulcers; nor do any large percentage of such patients have the benefit of this technology; nor would Normand Meunier have had any need of one, had he been treated according to basic accepted rules of the Medical Art.

For this is truly nursing 101. Pressure ulcers are caused by unrelieved pressure (invariably present whenever someone is laid in a bed or seated in a chair). And pressure is most effectively relieved by regular repositioning (ie. "turning") of the patient. It would be extremely curious, moreover, if these facts were unknown to those who had responsibility for Mr. Meunier's care --considering that (unlike typical civilians) ALL nursing staff EVERYWHERE know what pressure sores are --and how to prevent them-- and that patients are (in theory) being "turned" every two hours in ALL hospitals throughout the civilized world.

According to standard nursing procedure, therefore, Normand Meunier should simply have been "turned" (47 different times) during his stint in Emergency. And yet, he was NOT turned. On the contrary, he was apparently left to stew in his own juice.

It is this fact which demands an explanation: not an isolated incident caused by one or two incompetent individuals in an extraordinary situation; but a seemingly incomprehensible continuum of neglect suffered by a perfectly ordinary patient --in perfectly ordinary circumstances-- which was played out over a period of four full days, during which Mr. Meunier was surrounded by first-world doctors and nurses, methodically rotating through twelve consecutive shifts, where notes and recommendations, concerning every single patient, were dutifully exchanged at the beginning and end of every one.

Clearly, that explanation will not be easy.

No sense in demonizing the staff of one particular hospital

It would be absurd to represent Emergency Room conditions in St-Jerome, QC, as uniquely inadequate, or the medical professionals of that city as uniquely incompetent.

The sad fact is that Emergency culture has become the reflection of a public health policy which has ultimately created centers of catastrophic triage --all over the Province and possibly Canada, functioning with a work-flow appropriate for battlefields or civil disasters, but NOT for normal circumstances in peacetime society. Doctors and nurses are thus constantly occupied, running back and forth from one pressing task to the next, resetting priorities as they go, and only with the greatest difficulty completing sufficient tasks to allow a descent to the mundane level of basic nursing.

It is, perhaps, a model well adapted to the reception of accident victims, or gunshot wounds. However, warning alarms are unavoidable when we consider that the ER also provides the routine interface between more or less stable patients in very fragile condition --such as those arriving from nursing homes or rehabilitation-- and simple admission to acute care hospitals.

Like Mr. Meunier, such patients typically need a continuity of care, with admittedly complex issues, and will routinely suffer serious harm in the extended limbo of Emergency triage. For quite clearly: it is not just any patient who can survive the consequences of being placed at the back of the priority queue, for multiple days, in an ER corridor.

I myself once spent a mere 23 hours, as a figuratively "ambulatory" patient in Emergency, during which time I managed my own pressure issues by periodically transferring out of my wheelchair to rest, on the floor of my van in the hospital parking lot. Much like Normand Meunier, I was fortunate enough to receive full satisfaction for the complaint I presented. However, my normal hypothermia, compounded by rests in the cold van, plus the exceptional neglect of proper bladder voiding, and (above all) pushing myself well beyond my own limits of endurance, resulted in the conversion of certain chronic renal problems into something much more menacing, with which I then had to deal, just as Meunier did with his new sores.

My point is this: Urban Emergency rooms in Canada are gruelling environments for both professionals and patients. Not in extraordinary circumstances with Very Special patients, but as a perfectly ordinary routine.

Making it all go away: no patient, no problem!

Huge efforts have been provided in attempting to solve the problems described. But we must remember that those efforts are provided only in response to the frequent, obvious, and largely gratuitous (but statistically inevitable) suffering and mortality presently observed. For without that constant pressure, there is no urgency to sustain change.

It is easy therefore to understand the decision of Normand Meunier, to consent to a death which, as he says himself, he never wanted, and should never have been forced to confront. It was also a most regrettable decision from a scientific perspective, in that he was still objectively floundering at the peak of an inevitable --but statistically temporary-- period of rehabilitative distress (only 2 years post-trauma) and thus should not ethically have been authorized (let alone encouraged) to die from MAID.

Certainly, also, it is a most praiseworthy reflex of the general public to decry such tragic events. But it still remains for us to learn the extent to which deaths of people like Normand Meunier (and even the effect of lesser fears, such as my own of returning to the ER...) will themselves provide a mortal safety-valve, removing just enough pressure from our medical policy-makers, to ensure that no proper changes will be made.

In a word: Bad care produces more euthanasia. And more euthanasia enables more bad care. 

Link to more articles by Gordon Friesen (Link).


gadfly said...

The lesson 'caregivers' and administrators have learned here is: wait long enough and a problem will solve itself. A few problems will solve themselves in this context, actually. Yes, cynicism. But I've been through the emergency room wringer a few times myself.

gordon friesen said...

gadfly, Thank you for the benefit of your experience. What I can't personally get past is how ordinary all of this has become. The novelty of MAID garnered interest for this one instance, but as MAID itself becomes ordinary, things will deteriorate even more.