GESTIÓN EN SALUD PÚBLICA: It’s about autonomy, not pain

viernes, 18 de marzo de 2016

It’s about autonomy, not pain

Careful! is MercatorNet's blog about end-of-life issues. We respect the dignity of each person from the beginning of life to its natural end. Leave your comments at the foot of our articles. The more the better! Write to us at editor@mercatornet.com.

FRIDAY, 18 MARCH 2016

It’s about autonomy, not pain

BY CRISTINA ALARCON

1 |

A Canadian euthanasia trail-blazer has openly admitted that pain is not behind most requests for death.

The Supreme Court of Canada struck down the ban on doctor-assisted death last year and has given the federal government until June to come up with a new law.

Until then, a patient can present a pharmacist with a court order and a prescription for a lethal dose. However, as there is currently no requirement to verify that the physician has done a proper assessment, it is strongly advisable that pharmacists obtain legal advice.

Whatever happened to wellness and harm reduction?

To prevent death from overdose, we carefully restrict doses of opiates and benzos for drug addicts. Why, then, would we help the suicidal to take a lethal dose? The shift from harm reduction and suicide prevention to state-sponsored death is worrisome, to say the least.

How did we get from kill the pain to kill the patient?

The answer lies with Dr. Ellen Wiebe. Medical director of the Willow Women’s abortion clinic in Vancouver, she is the first doctor to publicly help an adult Canadian outside of Quebec to end her life.

In a recent Webinar sponsored by the British Columbia Pharmacy Association for Canadian pharmacists, Wiebe candidly admitted that euthanasia is not about the pain.

“Oh, you know,” she said, “We are pretty good at controlling pain at the end of life, and so I think that if for some reason one was not able to, you have to ask a patient if they want palliative sedation … It is unusual that we can’t get the pain under control …”

But palliative sedation is not the same as killing. One jacks up the pain medication to make the patient comfortable; the other uses a lethal dose to end it all.

Logically, better palliative care ought to make assisted suicide obsolete. Not so, said Wiebe.

About 90 per cent of the people who get an assisted death in other jurisdictions, she admitted, are not doing it for reasons that palliative-care physicians can help with. They are not doing it because of pain, they are not doing it because of vomiting, they are doing it because of loss of autonomy.

And that, said Wiebe, is the major reason that people choose to have an assisted death.

But wait a minute! How can we ensure that a patient’s life is not snuffed out too early? One of my elderly patients recently spent six months in palliative care but her condition improved and she was sent home. Another has been “palliative” for years. Another seemed to be at death’s door due to dehydration and over-medication but a brief hospital stay returned her to a vigorous, fulfilled and normal life.

Yet Wiebe does not seem to think that a mistaken prognosis is problematic. It’s all about autonomy, she insists. And that, I say, is why the legalization of doctor-hastened death is dangerous for vulnerable Canadians.

“Can anybody give you autonomy”, chimed Wiebe, “when you’ve lost your ability to use your limbs, when you’ve lost your ability to speak, when you can’t feed yourself anymore? No, no one can give you autonomy. They can maybe help you cope with your loss of autonomy, that’s something palliative care physicians do a good job of, but they can’t give you autonomy.”

But is it not possible that pure autonomy is an illusion? From the elderly patient who walks into my pharmacy, to the young man with multiple sclerosis who drives in on his scooter, to sick children held in their mothers’ arms, we all have limitations. And if the sick have lost some autonomy, rarely are the healthy self-sufficient.

My life would fall to pieces without electric power, meaning no computer or iPhone. What would I do without my car? My life would certainly be drab without my family and friends. My work life would be a mess without my colleagues.

A court order does not oblige any health care professional, pharmacists included, to participate in assisted suicide. It merely frees them from criminal prosecution. It will not, however, free them from grappling with their conscience and from the after-effects of having hastened someone’s death.

And so, Dr. Wiebe, the moment a patient invests you with the power to take his life, free of prosecution, the moment the IV drugs are pumped into his veins, at that moment that man, that woman or that child loses all autonomy, he may gasp — he may have a change of heart — but it will be too late.

So how did we ever shift from kill the pain to kill the patient? The answer is an illusion.

Cristina Alarcon is a pharmacist in West Vancouver who holds a master’s degree in bioethics. This article was first published in The Province newspaper.

- See more at: http://www.mercatornet.com/careful/view/its-about-autonomy-not-pain/17782#sthash.DiiI76Ip.dpuf

There is important news from the United States today. Sheila Liaugminas reports that, “finally”, the United States Congress and the State Department have acknowledged that the violence directed against Christians, Yazidis and other religious minorities by ISIS is genocide.

On Monday, the House of Representatives passed a resolution of Congressman Jeff Fortenberry (R-NE) to that effect unanimously. It took Secretary of State John Kerry until the March 17 deadline set by Congress last year to follow suit. His staff were still reviewing the evidence. Don’t they read the newspaper?

Sheila, who has been interviewing people all week about this concludes:

Congressman Fortenberry told me what he’s been saying to everyone listening lately, that this is a threat to civilization itself. As of today, the U.S. has risen to join a growing international coalition of voices and forces that can, finally, do something to stop the spread of that threat, reverse it, and protect innocent people and the existence of whole populations. What can be done is newly on the table. What will be done comes next.

Still in the Middle East, Marcus Roberts concludes his informative highlights from a Pew survey of Israel’s religiously divided society (Jews and Arabs both seem to worry about economic issues as much as about violence); and Christopher Szabo reports the (rather positive) comments of former Israeli prime minister Shimon Peres on peace in the region.

There’s lots more good reading in the other articles too. Enjoy your weekend!