Tuesday, May 17, 2016

How to improve assisted dying legislation with one simple rule

I've been reading about the various flaws in the current assisted dying legislation, and my shower gave me an idea of a simple way to improve it, or any other assisted dying legislation really.

I propose that, in addition to whatever categories of patients legislators deem acceptable candidates for assisted dying, any patient who has tried everything and still wants to die is permitted access to assisted death.

I don't think this is anywhere near a whole solution, but I do think it's a (relatively) easy rule that is unobjectionable to as many people as possible and achieves a number of things:

1. It catches the patients that legislators didn't think of. People generally want to impose restrictions on access to physician-assisted dying because they have various "What if?" scenarios in mind that they want to prevent, and they try to write restrictions that address those scenarios.  But, apart from people who don't want anyone to die at all ever, I doubt any of the scenarios people are thinking of preventing include cases where absolutely everything has been tried and the patient still can't bear to go on living.

2. It could create an additional path to help patients access treatments they haven't been offered yet. Sometimes you hear about situations where doctors simply rule out the possibility of certain potential treatments on grounds that the patient might not agree with (e.g. to protect the patient's fertility). But if applying for physician-assisted dying triggers a review of what has been tried so far and a protocol for trying everything else, when they say "We can't offer you death without first trying to remove your ovaries to see if it helps," you can say "Great, let's do that!"

3. It provides hope for all patients.  Even if you don't qualify for assisted dying right this second, you can get there just by following the standard protocol of trying, ruling out and refining treatments.  It will take time and difficulty, but you can get there. Every unsuccessful treatment you attempt is a step towards being put out of your misery.

4. It provides a built-in waiting period. Many people who are opposed to death at will cite first-hand or third-hand experiences of wanting to die but then, after some time passes, not wanting to die any more. Their concern that the desire to die might go away with time would be addressed by all the time it takes to proceed through all the treatments, which makes them less likely to oppose this rule.

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At this point, you're probably wondering about the definition of "everything". Does that mean you have to try every single medication in existence, or just a representative sample? Do you have to try alternative medicine? What if it's unproven? Do you have to participate in clinical trials?

And what if you can't afford the prescriptions or alternative medicine treatment? What if you can't get into the clinical trials?

First of all, I think the Try Everything rule could be implemented immediately before these points are addressed, with the understanding that we will take the time to examine the nuances and refine the definition of "everything".  This will provide immediate  access for a (admittedly very small) number of people who may have otherwise slipped through the cracks but whose death by choice is as unobjectionable as possible, because they already have tried everything and have documented evidence of this.

Then, the process of working on refining the definition of "everything" could leverage the Anti-Death No Matter What lobby to improve access to medical care in general. Currently, they seem to be limited to saying "No death! Death is Bad!"  But this would give them positive things to lobby for that would serve as obstacles to death, but also help everyone in the meantime.  For example, it's not reasonable to expect people to try every prescription medication if the cost is prohibitive. So now the anti-death lobby is incentivized to lobby for pharmacare.  It's not reasonable to demand that people try alternative medicine that's unproven and not covered by OHIP, so now the anti-death lobby is incentivized to lobby for alternative medicine to undergo clinical testing, and for treatments that turn out to be proven by clinical testing to get covered by OHIP.

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Of course, this comes nowhere near addressing all the problems with assisted dying legislation.  Notably, it does nothing about the lack of ability to provide an advance directive. But, nevertheless, expanding assisted death availability to include patients who have tried everything would fill in some gaps while being consistent with the spirit and intent of the legislation.

3 comments:

laura k said...

It's so simple and elegant, it's a wonder it wasn't included.

I have not been paying attention to the details of this debate at all. I didn't know there was no advance directive. Is that not legally recognized in Canada? Or is it that assisted suicide can't be included in an advance directive?

impudent strumpet said...

Advance directives definitely exist, but the current state of the legislation is that you can't set out an advance directive for circumstances under which you want medically-assisted dying.

For example, I can make an advance directive saying I do not under any circumstances want a feeding tube, and I'm pretty sure I could be permitted to starve to death accordingly if my advance directive is sufficiently clear on the question. But I can't make an advance directive saying that I want to be euthanized if I should ever permanently lose the ability to eat.

laura k said...

Ah right. Thanks for the clarification. I remember that from the US too.