Medical Views

A Good (Assisted) Death in Canada

Canada legalised a limited form of assisted dying in 2016. A long article in the New York Times gives a detailed and inspiring account of John Shields who died by lethal injection in British Columbia. He suffered from an incurable condition, amyloidosis, which gave him increasing pain that he no longer wished to endure.

The article contains a video, (about two thirds of the way through), of a goodbye party which Mr Shields held for his friends and family. There is much laughter and emotion. Mr Shields seemed totally at ease with the fact that he would soon be dead.

Among many interesting aspects to the story is the fact that Mr Shields had been a Catholic priest at one stage in his life. Another is that in Canada, patients who are accepted for medical assistance to die have the choice between either taking a lethal medication themselves (assisted suicide), or for a doctor to give them a lethal injection, (euthanasia). Most patients prefer the latter. However, this puts additional responsibility on the doctor and some doctors find themselves unable to help their patients in this way. Dr Stefanie Green, who ended Mr Shields life by lethal injection, makes a significant contribution by explaining her reasoning, and why she doesn’t believe that offering lethal medication goes against medical training. The article quotes her saying “I think people go into medicine because they want to help people. … This is on the continuum of care of helping people.”

MDMD hopes that the example set by Mr Shields and Dr Green will inspire others to see how someone can have a dignified death in a safe and compassionate manner – what for them is a “good death“. Why should people in the UK be denied a death like this, if that is their wish, when the alternatives are, for them, far less acceptable?

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Euthanasia linked to Organ Donation

The Daily Mail 5/9/16 reports on a paper published in a medical journal which calls for allowing euthanasia to enable organ donation in the case ‘where it has been argued through the courts that a patient in a permanent vegetative state is going to have clinically assisted nutrition and hydration withdrawn, with the inevitable consequence of death, and causing dessication of the organs such that they are no longer able to be donated.’

This is actually a very narrow condition, however, it raises alarm bells for some people, perhaps because they fear that the principle might be easily extended. The involvement of a court decision is paramount. The court would have a much easier decision to make if the patient had previously completed both an organ donor card, and an Advance Decision – in particular one which requests assisted dying in hopeless circumstances such as this. MDMD strongly recommend everyone to complete an Advance Decision.

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Two BMJ Blog posts on assisted dying in Dementia and Psychiatric cases.

Richard Smith, former editor of the British Medical Journal (BMJ) writes a moving personal story of his mother who suffers from dementia, arguing the case for assisted suicide for early stage dementia patients – as he and his mother did 10 years before.

Colin Brewer, former psychiatrist and current associate coordinator of MDMD, follows this up with another BMJ blog expanding and clarifying the case for Medically Assisted Rational Suicide (MARS) for dementia cases. He expands the arguments to include severe incurable psychiatric cases. Among many important issues he raises, he usefully points out the illogical and cruel limitations of any “terminally ill” time constraint on permitting legal MARS.

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