As­sisted dy­ing law must pro­tect the men­tally ill

De­fend moral rights of MDs too, write Ti­mothy Lau and Natasha Fer­nan­des.

Ottawa Citizen - - OPIN­ION - Ti­mothy Lau, M.D., F. R. C. P. (C)., M.Sc. is as­so­ciate pro­fes­sor, psy­chi­a­try res­i­dency train­ing di­rec­tor and clin­i­cal lead, Ge­ri­atric Psy­chi­a­try In­pa­tient Unit, at The Royal. Natasha Fer­nan­des, MSC., is an MD can­di­date 2016 and mem­ber of Cana­dian Physici

When the Supreme Court’s “Carter” rul­ing, strik­ing down Canada’s laws pro­hibit­ing as­sisted sui­cide, was re­leased in 2015, it was made clear that safe­guards could be in­sti­tuted to pro­tect the most vul­ner­a­ble. In­stead, re­cent rec­om­men­da­tions by Par­lia­ment’s Joint Spe­cial Com­mit­tee on Physi­cian As­sisted Dy­ing ex­tend eu­thana­sia and as­sisted sui­cide to those with a men­tal ill­ness and de­men­tia. We wait to see what the ac­tual leg­is­la­tion will con­tain.

As psy­chi­a­trists, we are con­cerned that at a time when we should be dis­cussing safe­guards to en­sure not one sin­gle Cana­dian is wrong­fully killed, the com­mit­tee fo­cused on how to max­i­mize ac­cess re­gard­less of com­pe­tency. It is cru­cial for public safety that those physi­cians and in­sti­tu­tions who can ap­pre­ci­ate the se­ri­ous flaws in such a plan should, at the very least, be pro­tected and not forced to re­fer.

We have lost sight of the ar­gu­ment that was re­spon­si­ble for strik­ing down our pre­vi­ous crim­i­nal laws. Sec­tions 241(B) and 14 of the Crim­i­nal Code were deemed un­con­sti­tu­tional for the sole rea­son that they placed lim­i­ta­tions on one’s right to life; in­so­far as the per­son had to pre­ma­turely take their own life while they were able be­cause no physi­cian could per­form that act at a later date when they were phys­i­cally in­ca­pable. This ar­gu­ment does not ap­ply to the psy­chi­atric pop­u­la­tion. In­di­vid­u­als with men­tal ill­ness are not phys­i­cally im­paired and they are not ter­mi­nally ill. In fact, physi­cianas­sisted dy­ing would ac­tu­ally in­trude on their right to life by end­ing their lives pre­ma­turely, pe­riod.

Fur­ther­more, pa­tients with de­pres­sion are in­her­ently in­ca­pable of mak­ing a com­pe­tent re­quest for eu­thana­sia. It is wrong to ig­nore the ef­fect de­pres­sion can have on a per­son’s cog­ni­tion.

We know de­pres­sion can dis­tort a pa­tient’s out­look on life. Sui­ci­dally de­pressed peo­ple are un­able to re­al­is­ti­cally eval­u­ate al­ter­na­tives to sui­cide and the con­se­quences of their ac­tions, and so lack a cen­tral pil­lar of men­tal com­pe­tency.

It is also im­por­tant to re­flect on the prac­ti­cal ques­tions that psy­chi­a­trists of­fer­ing as­sisted death will in­evitably face. It will be very likely that a psy­chi­a­trist will dis­suade one pa­tient from com­mit­ting sui­cide in the morn­ing, then see a pa­tient in the af­ter­noon whom they of­fer to as­sist in their death.

What makes the first pa­tient dif­fer­ent from the sec­ond? Is the sec­ond pa­tient harder to treat? Liv­ing a life less wor­thy? What mea­sur­ing stick do we use to eval­u­ate a “rea­son­able” re­quest?

What if the leg­is­la­tion fails to in­sist on ob­tain­ing in­for­ma­tion from friends and fam­ily? It is hard to know what is go­ing on at home.

Most con­cern­ing: Would it not make some­one with de­pres­sion even fur­ther de­pressed if their physi­cian agreed that they should die? Would eu­thana­sia gen­er­ate its own de­mand?

Lastly, us­ing ad­vanced di­rec­tives to eu­th­a­nize those with de­men­tia would be ir­re­spon­si­ble. It is in­con­ceiv­able to think of end­ing a per­son’s life at a time when they are in­com­pe­tent to make that re­quest.

We have no way of know­ing if that in­di­vid­ual has changed their mind and prefers life to death de­spite their de­men­tia. No one, ver­bal or non­ver­bal, should lose the right to change their mind.

This is all to say that physi­cians’ con­science rights not only should be, but must be, pro­tected.

The Cana­dian Med­i­cal As­so­ci­a­tion pres­i­dent has re­as­sured the com­mit­tee that pro­tect­ing con­science rights will in no way im­pact ac­cess.

It seems clear, then, that a cen­tral­ized reg­istry or des­ig­nated in­sti­tu­tions where Cana­di­ans can go to seek as­sis­tance must be sup­ported.

Any­thing less would make Canada the first coun­try to force physi­cians to re­fer pa­tients for physi­cian-as­sisted dy­ing — and be­come a hu­man rights vi­o­la­tor in the process.


Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.