Jonathan Breslin, PhD, is an Ethicist at the Southlake Regional Health Centre and Mackenzie Health in Ontario
Following the recent passage of Canadian legislation governing assistance in dying many might ask whether the law should be amended in the future to allow for request for medical assistance in dying in advance of becoming mentally incapable of doing so. This question is most relevant to people diagnosed with conditions like Alzheimer dementia (AD). The federal government made a commitment to study advance requests prior to passing Bill C-14. There are a host of problems with advance requests for medical assistance in dying that warrant deep and thorough reflection.
At first glance the idea of allowing advance requests for medical assistance in dying seems intuitive. ...continue reading →
When Canada’s Supreme Court struck down the law prohibiting the provision of assistance to someone committing suicide in February last year, I wrote a column welcoming this ruling. That led to an invitation to address the Annual Conference of the BC Palliative Care and Hospice Association in May 2015 on the topic of ‘healthy death’.
More recently, I have collaborated with Dr. Douglas McGregor, Medical Director of the Victoria Hospice, in conversations with hospice staff and volunteers from Victoria and across Vancouver Island. Our topic was physician-assisted death (PAD) and the dilemmas this poses for the people who work in hospice and palliative care.
I am very clear that a ‘healthy death’ is one that enables someone to have control over their way of death. ...continue reading →
This story is about my family’s experience with PAD (Physician Assisted Dying). Our hope is that it will be of some help to others following, or contemplating following, the same path.
In the fall of 2015 my brother, Curt, age 62, was diagnosed with incurable prostate cancer. He had been overseas for a number of years and by the time he came to us he was skin and bones, couldn’t walk, suffered from hallucinations and vision issues as well as bone and joint pain. The hospital doctors got him stabilized and resolved the hallucination and visions issues but held out no hope for curing the cancer. We were very lucky to secure him a bed at a hospice facility in a state in which PAD is legal. I cannot say enough about how wonderful and supportive they were to Curt and the rest of his family and we all feel a huge debt of gratitude for their efforts. I am not naming this facility or state because, although everything they did was perfectly legal and above board, the staff expressed a desire to fly under the radar regarding their participation in the process. This position reinforces the reality that PAD is still a very controversial endeavor ...continue reading →
In June 1993 I attended my first international research meeting. WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) was having its annual meeting in The Hague and I had gotten funding from my fellowship program to attend.
It was all very exciting for someone new to the research world to see the hustle and bustle, and feel the energy, that accompanies such a large meeting. Even Queen Beatrix attended.
Diagnosis of fetal alcohol spectrum disorder is essential to improve outcomes for affected individuals and families, and to inform pre-pregnancy counselling to prevent future cases. This guideline (open access) from the Canada Fetal Alcohol Spectrum Disorder Research Network provides evidence-based recommendations for best practices in the diagnosis of this condition.
In this podcast, two of the authors of the guideline explain what to look for in clinical practice. Dr. Valerie Temple is a clinical psychologist at Surrey Place Centre in Toronto, and Dr. Christine Loock is a developmental pediatrician at Children's and Women's Health Centre of British Columbia, with an academic appointment at UBC.
Dr. Rene Leiva is an Assistant Professor with the Department of Family Medicine of the University of Ottawa. Part of his work includes in-patient Palliative Care and Care of the Elderly at Bruyere Continuing Care in Ottawa, ON
I read with interest the CMAJ Editor in Chief’s latest editorial about protecting the right of physicians to conscientiously object to being party to physician hastened death. Principled medicine has dealt with suffering since Hippocratic tenets were first formulated about 2400 years ago. It is only in the last fifty years that causing death has been construed as ‘medical treatment’ for suffering, which I firmly believe to be erroneous. I’m disturbed to see that while Quebec is leading the country on euthanasia only a fraction of its population has access to palliative care. Palliative Care has been around for close to forty years, but Quebec's new law on ‘medical aid in dying’ expects to make that option available to 100 per cent of Quebecers in a matter of months. ...continue reading →
I found out my grandpa had a stroke on Thursday night. He was doing work in the backyard where he collapsed; my nanny found him 40 minutes later and called an ambulance. Too much time had passed. This was his second stroke, the first occurred 10 years ago just moments before he was due to depart on a cruise ship to Alaska. Emergency crews attended to him right away and his recovery was almost seamless.
This time it was different. My family told me to stay put in Ottawa for the night, but in the morning my brother called and told me I should come right away. It took about four and a half hours to reach the hospital in Mississauga where my grandpa, who I affectionately named Pa as a toddler, lay with tubes and patches attached to his body. When my mum told Pa that I had arrived, he opened his steel blue eyes for a moment with a look mixed with confusion and – I hoped – even acknowledgement. Then his eyes shut, and I never saw them again.
The recent Supreme Court of Canada ruling on assisted death has opened the door for legislation and sparked dialogue about what assisted dying should look like in this country. As we grapple with these difficult questions surrounding assisted death, it may be pertinent to consult those in our society with considerable experience: veterinarians are frequently asked to euthanize their patients. ...continue reading →
Today is a momentous day for physicians in Canada. No matter what your opinion about whether or not physician assisted dying is morally right, it will be a human right henceforth under certain circumstances.
Ewan C Goligher MD is an Intensivist at Toronto Western Hospital and a doctoral student in the Department of Physiology at the University of Toronto, Toronto, Ontario
Stephen W Hwang MD MPH is a General Internist at St. Michael’s Hospital and Professor of Medicine in the Department of Medicine at the University of Toronto, Toronto, Ontario.
The writing is on the wall. Physician-assisted death is very likely to soon be legal in Canada. Although legal decisions cannot put to rest ethical controversy, the winds of public opinion have shifted considerably, and policy changes will probably gain rapid and widespread acceptance in Canadian society. Requests for assisted death will become more frequent. Canadian physicians, of whom only a minority have indicated a willingness to provide or administer lethal doses of the drugs at their disposal, will therefore be faced with the serious personal ethical challenge of deciding whether to honour such requests and whether to refer patients to physicians willing to accommodate such requests. ...continue reading →