Assisted dying is one thing, but governments must ensure palliative care is available to all who need it

The Conversation, 24 October 2017
Author: Stephen Duckett
“Assisted dying moved one step closer to reality in Victoria last week with the authorising bill passing the lower house with a comfortable 47-37 majority. Throughout the debate, many MPs spoke of terrible personal experiences of the deaths of family members. Such harrowing stories were also present in submissions to the parliamentary inquiry into end-of-life choices, that recommended an assisted dying regime leading to the bill.”
Find article here.

Oregon’s Death With Dignity Act: 20 Years of Experience to Inform the Debate

Ann Intern Med. 2017;167(8):579-583.
Authors: Katrina Hedberg, Craig New
“Twenty years ago, Oregon voters approved the Death With Dignity Act, making Oregon the first state in the United States to allow physicians to prescribe medications to be self-administered by terminally ill patients to hasten their death. This report summarizes the experience in Oregon, including the numbers and types of participating patients and providers. These data should inform the ongoing policy debate as additional jurisdictions consider such legislation.”
Find article here.

 

Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper

Ann Intern Med. 2017;167(8):576-578.
Authors: Lois Snyder Sulmasy, Paul S. Mueller; for the Ethics, Professionalism and Human Rights Committee of the American College of Physicians
“Calls to legalize physician-assisted suicide have increased and public interest in the subject has grown in recent years despite ethical prohibitions. Many people have concerns about how they will die and the emphasis by medicine and society on intervention and cure has sometimes come at the expense of good end-of-life care. Some have advocated strongly, on the basis of autonomy, that physician-assisted suicide should be a legal option at the end of life. As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end. However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling.”
Find position paper here.

Family in dispute over care of woman with brain damage

The Guardian, 17 October 2017
Author: Josh Halliday
“A family is in dispute over the ongoing care of a woman with brain damage who had suggested she would want to die in such circumstances, a court has heard. The woman, identified as Mrs P, is said to be in a “minimally conscious state” on an acute hospital ward following a fall last year. A Court of Protection judge is being asked to consider whether she should continue to receive clinically assisted nutrition and hydration.”
Find article here.

Dutch geriatrician faces charges over euthanasia case

BMJ 2017; 359: j4639
Author: Tony Sheldon
“A specialist in elderly care medicine could face prosecution under the Netherlands’ euthanasia laws after ending the life of a 74 year old nursing home patient with advanced dementia. The woman was considered no longer competent to consent but had previously signed a living will requesting euthanasia. Yet Dutch public prosecutors have launched a criminal investigation, claiming a “serious suspicion” that a criminal offence had been committed. This is the Netherlands’ first such investigation under the reporting arrangements established in the 2002 euthanasia law.”
Find article here.

Aid-in-dying laws and the physician’s duty to inform

Journal of Medical Ethics 2017; 43: 666-669.
Author: Mara Buchbinder
“On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it.”
Find article here.

Is there a place for CPR and sustained physiological support in brain-dead non-donors?

Journal of Medical Ethics 2017; 43: 679-683.
Author: Stephen D Brown
“The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor’s requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.”
Find article here.

Children can decide their medical treatments under Victoria’s unique advance directive laws

The Conversation, 4 October 2017
Author: Carolyn Johnston
“Writing an advance care directive is part of the planning process, but a directive means the person’s preferences are bound to be followed by law. All states and territories have varying laws enabling adults to make advance care plans or directives. In Victoria, new legislation will come into effect in March 2018, creating clear obligations for health practitioners to respect advance directives.”
Find article here.