Physician Assisted Death - Alberta Survey

Physician Assisted Death is finally going to be recognized by Canadian, provincial, and territorial law, thanks to the ruling of our Supreme Court of Canada.

The government of Alberta has quietly issued a survey for public consultation and fortunately, because I listen to CBC radio, I heard about it this morning for the first time - Survey closes at 11:59 pm March 31st so get your answers in before they close it.

I'm going to run through the questions on this sometimes reasonable, sometimes ridiculous, survey:

1.  The Supreme Court decision requires that any eligible patient must be competent.  This means that the person has to understand what they are asking for when they request the help of a doctor to die.  But there are differing opinions about whether the person must remain mentally competent throughout the process.

Which is closest to your opinion?

• The person must be mentally competent at the time they make the request, and the doctor may fulfill the request only if the person remains competent to the end.
• The person must be mentally competent at the time they make the request, and the doctor may fulfill the request even if the person loses competence before the end.
• The person must be mentally competent at the time they make the request, but may lose competence even before they reach the point of intolerable suffering, and the doctor may fulfill the request once the person has reached that point.
• Don't know/no opinion

This is a good question to start with and it acknowledges that patients with Alzheimer's and other conditions can lose their mental faculties due to their illness.  When fully able to live a full life, these people might decide that, as their condition worsens and they are no longer able to recognize their loved ones, or they understand that they may become violent when they never would have before they got sick, that there may be a stopping point they want to set up.

Don't know and no opinion should be separate answers, though.

2.  Some countries and states that already provide physician-assisted death require there to be a period of reflection for a person who requests it - meaning a person is required to make a request for the procedure and a later second request confirming their intentions.

Which is closest to your opinion?

• There should be a defined minimum period of time between when a patient makes an initial request and a second request confirming their intentions before it is fulfilled.
• There should be a period of reflection between when a patient makes an initial request and a second request confirming their intentions, but it should vary according to individual circumstances, based on the doctor's opinion.
• There should be a defined minimum period of reflection for patients with non-terminal, slowly progressing conditions; but for those with terminal or rapidly progressing conditions, the period of reflection should vary according to the patient's circumstances, based on the doctor's opinion.
• There should be no period of reflection required.  A person should be able to have a request fulfilled immediately.
• Don't know/No opinion

This question makes paternalistic assumptions. People will not decide to end their lives lightly and they understand without being constrained by those opposed to the Supreme Court ruling. More needs to be done for ANYONE who is leading a "life" of suffering that does not actually allow them to live.

3.  If there were to be a defined minimum period of reflection, what would the appropriate timeframe between the first and second request be?

• Less than 7 days
• 14 days
• 30 days
• 60 days
• More than 90 days
• Don't know/No opinion

The people who insist on a long minimum period of reflection should also get that time: 30-60 days in a hotel with minimal comforts including institutional-grade food but great access to the internet for research and video calls with family and friends - but no published date of when they will be released, in order to give them a TINY perspective on what these patients and their families are going through.

4.  The Supreme Court ruling applies to competent adults.  Some believe people under age 18 should be eligible if they are mature enough to decide.  In other words, age shouldn't matter; it's a question of competence and maturity.  Which is closest to your opinion?

• A person must be at least 18 years old to be eligible
• A person can be younger than 18 to be eligible, so long as they are mature and competent enough to understand the nature of the request and its consequences.
• Don't know/No opinion

Illness and pain don't check for ID before invading someone's life and some children can be convicted of crimes as adults, so this decision has already been partially made.  If a young person is suffering from a condition, affliction, or limitation that stops them from enjoying life, they should be able to express their wishes.  If they and a trusted person chosen by them have been through the depressing and painful precess like the adults meant for this legislation, then they should absolutely be applicable.

5.  Doctors who do not wish to provide physician-assisted dying for religious or moral reasons will not be required to participate.  If a patient of theirs makes a request of them, what should they be required to do?

• Refer the patient to a physician who does provide the service
• Refer the patient to a resource that will provide accurate information about all available medical options
• Should not be required to provide a referral of any kind
• Don't know/No option

I understand that this can be a tough topic for doctors because they have worked their whole lives to limit the suffering of their fellow human beings.  They research, sweat, worry, and strain against the fact that we are mortal and they don't want to give up on any fight.  I believe they should have all the resources we can give them so their efforts are as successful as possible.

Unfortunately, even their best efforts are sometimes unsuccessful and the patient suffers from complications and suffering due to both their illness and the treatments prescribed.  Pharmaceuticals are helpful but often have incredibly difficult and often painful side effects that can sometimes be possibly worse than the original problem.  Patients need to have access to every help medical people can provide, but then they need to be given the control our mortality takes from them.

Doctors are here to give us their best way to keep us the healthiest they can. Once they have had every opportunity to fix the medical condition and the patient decides that they are no longer able to live an actual, functional life without unbearable suffering they should be free to decide their time of death. A doctor's personal beliefs on politics and religion should NOT ENTER THIS DISCUSSION.

Religion has interfered with treatment and caused too much loss to our medical system in the past and we can't keep falling into this trap.

6.  The College of Physicians and Surgeons of Alberta has recommended several safeguards to help protect potentially vulnerable people, such as the elderly or disabled.  These include the following:
- The patient must be made aware of all medical options
- Two doctors must agree the person meets the criteria set out by the Supreme Court
- If there is any question about the person's mental state, there person must be referred to a psychiatrist or psychologist
- Two people must witness the person's request; and at least one of these witnesses must not be a relative or heir, or the owner, operator or employee of a health facility where the patient is receiving treatment, or the physician
- The person must be advised at each step that they may change their mind, including just before the procedure is administered

Which is closest to your opinion?

• These safeguards are sufficient to ensure the person understands and is acting without any pressure or outside influence
• More needs to be done to ensure the person understands and is acting without any pressure or outside influence
• These safeguards are too onerous in that they require too much of a person who wishes to end their life
• Don't know/No opinion

The elderly and disabled absolutely need to be protected, but we need to address senior abuse and other harmful practices in our society that are not talked about.  Retirement homes and Extendicare centres that don't take care of hygiene issues of those under their control; funding cuts to education and organizations that hire valuable, skilled, and caring nursing and nursing students; family members who assume responsibility for people in a weakened state for their own benefit; and the very idea that anyone who has had a mental health issue must be directed, restricted, and preached to.  We need to increase discussion about these issues and fight against the impertinence behind these "safeguards".

7.  If you believe more needs to be done to ensure the person understands without any pressure or outside influence, what do you suggest?

Thankfully, there is a spot at the end of the survey for further comments but while your filling it out, you don't know that - and the wording of this question is very limiting

8.  The drugs used in physician-assisted death:

• Should be administered only by a physician
• Should be administered only by the patient themselves with a prescription from a physician
• Either, depending on what the patient and physician agree to
• Don't know/No opinion

You can't assume that the patient will be physically capable of administering any drugs - many in this situation lose motor skills.

9.  If a patient is allowed to administer the drugs themselves, should a physician or other healthcare professional be required to be present, in case there are complications?

• A physician should be required to be present
• A physician OR another healthcare professional should be present
• There should be no requirement for a physician or other healthcare professional to be present, unless the patient requests it

There should also be a certification service and additional funding available for hospice services including the respectful end of a life - there is no need to reinvent the wheel here, just more opportunity to give comfort to people seeking an assisted death.

10.  Which of the following locations should a patient's request be allowed to be fulfilled?

• In a hospital
• In an assisted living or long-term care facility
• In a hospice
• In a private residence
• Don't know/No opinion

Patient's choice.

11.  Should hospitals, other healthcare facilities, long-term care and assisted living homes be allowed to deny access by patients to physician-assisted death?

Which of the following is closest to your opinion?

• These facilities should be required to provide physician-assisted death on site, but only if they are publicly funded.
• These facilities should be required to provide physician-assisted death on site, even if they are not public funded.
• These facilities should not be required to provide physician-assisted death on site, even if they are publicly funded
• Don't know/No opinion

Funding is a red herring - The Supreme Court has spoken and the law does not rely on who is funding these services.

12.  Please share any additional comments you have in the space below or attach to your submission

The online form limits this space to 1500 characters and doesn't have a character counter to let you know how many you have left

13.  Are you answering this survey

• As an individual
• Representing an organization.  Specify__________
• Both

Alberta survey on Physician Assisted Death

Please go to the link and fill out the survey.  Now that you know what you will be asked and where you have an option to give them further information, I hope this debate will help people in need.