Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

Lori Seller, Marie Eve-Bouthillier, Veronique Fraser

Journal of Medical Ethics

Abstract

Background Medical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.

Methods A retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.

Results Of 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.

Interpretation We highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

Seller L, Bouthillier M, Fraser V. Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations. J Med Ethics. 2019;45:106-111 .

Drawing the line on physician-assisted death

Lynn A. Jansen, Steven Wall, Franklin G. Miller

Abstract

Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.


Jansen LA, Wall S, Miller FG. Drawing the line on physician-assisted death. J Med Ethics. 2019;45:190-197.

3 ethical reasons for vaccinating your children

The Conversation

Joel Michael Reynolds

Across the country, billboards are popping up suggesting that vaccines can kill children, when the science behind vaccination is crystal clear – vaccinations are extremely safe.

Researchers who study the beliefs of anti-vaxxers have found many different reasons, not just religious or political, as to why some parents refuse to get their children vaccinated.

As a bioethicist who investigates how societal values impact medicine, I consider such decisions to be downright indefensible. And here are three reasons why. . . [Full text]

HSE to help women find doctors who provide abortion services

Irish Examiner

Elaine Loughlin

A new HSE helpline will provide women seeking terminations with the names of doctors in their locality who provide abortion services.

The helpline which is being set up in tandem with the rollout of abortion services after the passing of the historic referendum to repeal the eighth amendment, will provide advice on options and support to women. . . [Full text]

Canadian doctors grapple with how to approach assisted dying for young patients

Toronto’s Sick Kids hospital drafting policy on requests for assisted dying from those over 18

CBC Radio

Duncan McCue

Three years after Canada’s top court decriminalized doctor-assisted suicide, the federal government is about to wade into an emerging controversy: How to respond to requests from children for medical assistance in dying, or MAID.

Canada’s largest children’s hospital has already gotten a taste of this thorny issue.

“We had discussed that there may be a time in the future that MAID would be available for patients under the age of 18, or a group called ‘mature minors,'” said Dr. Adam Rapoport, director of the Pediatric Advanced Care team at Toronto’s Hospital for Sick Children.

“We, as an organization, like to be ready for things that might be coming down the pike.” . . .[Full text]

Mom to the internet: Anybody want to trade my girl embryo for a boy?

New York Post

Jane Ridley

Lisa, a mom desperate to give her son a little brother, is looking to trade embryos with another mom. Doing so, she’s wading into legal territory colored in shades of gray, experts say.

Just this week, Lisa’s son spotted a pair of young brothers on the street near their home in Bushwick. He turned to his mom with pleading eyes.

“When am I going to get a brother?” asked Daniel. . . [Full text]

GPs critical of timing of ICGP meeting on provision of abortion services

Raidió Teilifís Éireann

Ailbhe Conneely

GPs who organised a petition calling on the Irish College of General Practitioners to hold an Extraordinary General Meeting on the provision of abortion services in Ireland, have described the decision to hold it in four weeks time as “wholly unacceptable”.

The 2 December EGM was announced in a statement by the ICGP board this evening, after it received a petition from hundreds of General Practitioners, who are concerned about the introduction of GP-led abortion services here. . . . [Full text]


ACLU objects to Hawaii retirement home assisted suicide ban

Times Daily

Audrey McAvoy, Associated Press

HONOLULU (AP) — The American Civil Liberties Union demanded Thursday that a Hawaii retirement home stop discriminating against non-Catholic residents and allow them to take advantage of the state’s new medically assisted suicide law if they wish.

The ACLU of Hawaii sent a letter to the executive director of the Kahala Nui home after receiving an anonymous tip that the home had notified residents they would not be permitted to exercise the provisions of the law, which takes effect in January. . . [Full text]

Completion of Medical Certificates of Death after an Assisted Death: An Environmental Scan of Practices

Janine Brown, Lilian Thorpe, Donna Goodridge

Abstract

Policies and practices have been developed to operationalize assisted dying processes in Canada. This project utilized an environmental scan to determine the spectrum of assisted death reporting practices and medical certificate of death (MCD) completion procedures both nationally and internationally. Findings suggest medically assisted dying (MAiD) is represented on the MCD inconsistently nationally and internationally. Related factors include the specifics of local assisted death legislation and variations in death-reporting legislation, variation in terminology surrounding assisted death and designated oversight agency for assisted dying reporting.


Brown J, Thorpe L, Goodridge D. Completion of Medical Certificates of Death after an Assisted Death: An Environmental Scan of Practices. Healthc Policy. 2018 Nov;14(2):59-67. doi: 10.12927/hcpol.2018.25685.

Peadar Tóibín suspended from Sinn Féin for six months for voting against abortion legislation

thejournal.ie

Christina Finn

SINN FÉIN’S PEADAR Tóibín has been suspended from the party for six months.

Disciplinary proceedings had been initiated against the Meath TD, who broke ranks with his party’s policy by voting against the abortion legislation in the Dáil last month.

As indicated by Sinn Féin party leader Mary Lou McDonald in April, Tóibín would face suspension from the party for doing so. . . [Full text]