Euthanasia Archives - Page 2 of 13 - Protection of Conscience Project Library

The “Normalization” of Euthanasia in Canada: the Cautionary Tale Continues

Leonie Herx, Margaret Cottle, John Scott

Extract
This paper will balance recent portrayals in the popular and medical media that imply only a positive impact as a result of the introduction of euthanasia into Canada’s health system [3–4]. Evidence will be presented to demonstrate that there are significant negative and dangerous consequences of this radical shift for medicine, and particularly for palliative medicine. These include the widening and loosening of already ambiguous eligibility criteria, the lack of adequate and appropriate safeguards, the erosion of conscience protection for health care professionals, and the failure of adequate over- sight, review and prosecution for non-compliance with the legislation. Indeed, what we have seen over the past four years is that “the slope has in fact proved every bit as slippery as the critics had warned” . . . Euthanasia is not the panacea that proponents promise. Its legalization and subsequent rapid normalization have had serious negative effects on Canadian medicine and on Canadian society as a whole. We urge the WMA and our colleagues around the world to look beyond the simplistic media reports and to monitor developments in Canada carefully and wisely before making any changes in their own country’s legal frame- work for medical practice.

Herx L, Cottle M, Scott J. The “Normalization” of Euthanasia in Canada: the Cautionary Tale Continues. World Medical Journal020. 2020;66(2):28-37.

(Correspondence) Organ Donation after Medical Assistance in Dying — Canada’s First Cases

Ian M. Ball, Andrew Healey, Sean Keenan, Fran Priestap, John Basmaji, ,Kimia Honarmand, ,Jeanna Parsons Leigh, ,Sam Shemie, ,Prosanto Chaudhury,,Jeffrey M Singh, Jeffrey Zaltzman,Stephen Beed, Matthew Weiss

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
The provision of organ donation after medically assisted euthanasia involves unusual challenges, including first-person direct consent, navigation of a new legislative landscape, and incorporation of the legislated requirements of euthanasia into the donation process. Ethical issues involving the well-being of health care workers and conscientious objection have also been raised.

Medical assistance in dying followed by organ donation is new to North America. It is evolving, and if offered to potential donors it provides them with the opportunity to fulfill their dying wishes. Secondarily, this process may make more organs available to patients on transplant waiting lists. There is substantial room for enhanced education of both the public and health care workers and for the evolution of clinical practice. National level, prospective data will be necessary to assess this evolving area of care.

Ball IM, Healey A, Keenan S, Priestap F, Basmaji J, Honarmand K et al. Organ Donation after Medical Assistance in Dying — Canada’s First Cases. N Engl J Med. 2020;382(6):576-577.

Conscientious objection and moral distress: a relational ethics case study of MAiD in Canada

Mary Kathleen Deutscher Heilman, Tracy J. Trothen

Abstract
Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged.

Heilman MKD, Trothen TJ. Conscientious objection and moral distress: a relational ethics case study of MAiD in Canada. J Med Ethics. 2020;46(2):123-127. doi:10.1136/medethics-2019-105855

The Independence of Judicial Conscience

Barry W. Bussey

Extract
. . . Competence and character are no longer the sole criteria for evaluating a judicial nominee; candidates face a climate which demands they have the “correct” moral opinions on fundamental human rights issues. Those issues include abortion, marriage, and the euphemistically-termed Medical Assistance in Dying (MAiD). . . to disregard the judicial conscience is to compromise the dignity of the judge, the worth of her convictions, the fullness of her humanity. Even more, it undermines the very essence of what distinguishes a democratic society characterized by diversity, inclusion, and freedom.

Bussey BW. The Independence of Judicial Conscience. J Christian Legal Thought. 2019; 9(2): 34-37.

Débats entourant l’objection de conscience : le cas du don d’organes après l’aide médicale à mourir au Québec

Julie Allard, Marie-Chantal Fortin

Résumé
Depuis décembre 2015, l’aide médicale à mourir, une pratique au centre de nombreux débats éthiques, est légalisée dans la province du Québec, au Canada. Ce nouveau type de décès a créé un tout nouveau contexte pour le don d’organes, soit le don d’organes après l’aide médicale à mourir. Le prélèvement des organes s’effectue alors suivant le protocole habituel du don d’organes après décès cardiocirculatoire contrôlé (catégorie Maastricht III), un protocole qui suscitait déjà de nombreux questionnements médico-éthiques. En outre, l’amalgame des deux pratiques soulève de nouveaux enjeux éthiques qui peuvent se traduire par des objections de conscience chez les médecins directement impliqués dans l’aide médicale à mourir et/ou le don d’organes. Or, une telle objection de conscience peut-elle être acceptable ? Nous tenterons de répondre à cette question en trois temps : d’abord, par un bref historique de l’objection de conscience ; ensuite, par une revue des débats actuels sur ce sujet ; enfin, par l’examen, à l’aide de critères recensés dans la littérature, de cas où les médecins refuseraient de participer au don d’organes après l’aide médicale à mourir.

Summary

Medical assistance in dying, a much debated practice in ethical literature, is practiced since 2015 in the province of Québec, Canada. Its practice has opened the door to organ donation after medical assistance in dying. This type of donation is possible through donation after controlled cardiocirculatory death (Maastricht III category), a procedure that also raises many ethical questions. Combining these two practices raises new ethical issues and could therefore generate conscientious objections from physicians directly involved in medical assistance in dying and/or organ donation. Would conscientious objection be acceptable in this context? To answer this question, we present a brief history of conscientious objection, an overview of the actual debates on conscientious objection and we will examine the case of the physician who would object to participate in organ donation after medical assistance in dying using existing criteria.

Allard J, Forin M.-C. Débats entourant l’objection de conscience : le cas du don d’organes après l’aide médicale à mourir au Québec. Éthique & Santé; 2019 Sep; 16(3): 125-132

Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners

Marike E De Boer, Marja FIA Depla, Marjolein Den Breeje,Pauline Slottje, Bregje D Onwuteaka-Philipsen, Cees MPM Hertogh

Abstract
The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide (EAS). This study aimed to explore the content of this pressure as experienced by general practitioners (GP). We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: (1) emotional blackmail, (2) control and direction by others, (3) doubts about fulfilling the criteria, (4) counterpressure by patient’s relatives, (5) time pressure around referred patients and (6) organisational pressure. We conclude that the pressure can be attributable to the patient-physician relationship and/or the relationship between the physician and the patient’s relative(s), the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account.

Boer MED, Depla MF, Breejen MD, Slottje P, Onwuteaka-Philipsen BD, Hertogh CM. Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners. J Med Ethics. 2019;45(7):425-429.

Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium

Nicholas Gilbo, Ina Jochmans, Daniel Jacobs-Tulleneers-Thevissen, Albert Wolthuis, Mauricio Sainz-Barriga, Jacques Pirenne, Diethard Monbaliu

Journal of the American Medical Association

Extract
Transplantation of organs donated after euthanasia may help alleviate the critical organ shortage.¹ However, aside from preliminary data on lung transplantation,² data on graft and patient survival following transplantation of organs donated after euthanasia are unavailable. Because donation after euthanasia entails a period of detrimental warm ischemia that hampers graft survival, similar to donation after circulatory death,³ results after transplantation of this type of graft need to be carefully evaluated.

Gilbo N, Jochmans I, Jacobs-Tulleneers-Thevissen D, Wolthuis A, Sainz-Barriga M, Pirenne J, Monbaliu D. Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium. JAMA. 2019;322(1):78-80. doi:10.1001/jama.2019.6553

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

James Downar, Sam D. Shemie, Clay Gillrie, Marie-Chantal Fortin, Amber Appleby, Daniel Z. Buchman, Christen Shoesmith, Aviva Goldberg, Vanessa Gruben, Jehan Lalani, Dirk Ysebaert, Lindsay Wilson and Michael D. Sharpe

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Key Points

First-person consent for organ donation after medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) should be an option in jurisdictions that allow MAiD or WLSM and donation after circulatory determination of death.
The most important ethical concern — that the decision for MAiD or WLSM is being driven by a desire to donate organs — should be managed by ensuring that any discussion about organ donation takes place only after the decision for MAiD or WLSM is made.
If indications for MAiD change, this guidance for policies and the practice of organ donation after MAiD should be reviewed to ensure that the changes have not created new ethical or practical concerns. . .

Downar J, Shemie SD, Gillrie C, Fortin M-C, Amber Appleby A, Buchman DZ, Shoesmith C, Goldberg A, Gruben V, Lalani J, Ysebaert D, Wilson L, Sharpe MD. Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019 Jun 3;191(22):E604-E613. doi: 10.1503/cmaj.181648.

(Editorial) A right to be unconscious

Julian Savulescu, Janet Radcliffe-Richards

Extract
[Referring to Sinmyee et al] This seems to us to be an important, landmark paper. This is because the issues it addresses are important in their own right: how to ensure death without suffering in jurisdictions where assisted dying (including assisted suicide or euthanasia) is allowed, and also, because the technicalities are the same, in cases of capital punishment by lethal injection. Moreover, the paper shows the potential for the use of anaesthesia in contexts beyond surgery. Anaesthesia in its ordinary uses is intended to facilitate surgery designed to restore a patient to improved health and functioning. In assisted dying, however, there is no question of restoring health. The proposition is to use anaesthesia primarily to prevent suffering in a patient who is about to die and, in this sense, places anaesthesia on a new footing as a primary medical intervention, serving a purpose in its own right. . .

Savulescu J, Radcliffe-Richards J. A right to be unconscious. Anaesthesia. 2019 May; 74(5): 557-559

Victoria’s voluntary assisted dying law: clinical implementation as the next challenge

Ben P. White, Lindy Willmott, Eliana Close

Extract
The Voluntary Assisted Dying Act 2017 (Vic) (VAD Act) will become operational on 19 June, 2019. . . . While some have written on the scope of, and reaction to, the VAD legislation, there has been very little commentary on its implementation. Yet, important choices must be made about translating these laws into clinical practice. These choices have major implications for doctors and other health professionals (including those who choose not to facilitate VAD), patients, hospitals and other health providers. This article considers some key challenges in implementing Victoria’s VAD legislation.

White BP, Willmott L, Close E. Victoria’s voluntary assisted dying law: clinical implementation as the next challenge. Med J Australia. 2019 Mar;210(5):207-209.e1