pad presentation
TRANSCRIPT
Physician Assisted Death
Defining pad and what it means
The SCC decision establishes physician-assisted death (PAD) as a Charter right for
“a competent adult person who (1) clearly consents to the termination of life; and
(2) has a grievous and irremediable medical condition (including an illness, disease
or disability) that causes suffering that is intolerable to the individual.” The
decision focuses on “physician-assisted” death.
This implies that only a patient who is capable of making a decision may have this
right.
Who is excluded: (1) Minors (2) Mentally incapacitated or ill patients
Examples of case in which pad may apply
A patient with carcinoma with mets to the bones and many other organs, in excruciating
pain which is out of control even with extremely high doses of opioids.
euthanasia, where a physician directly administers a lethal dose of medication (or
equivalent) in accordance with the wishes of the patient.
KEY: The patient is competent and is not coerced into making the decision to end suffering
a patient with ALS who is provided with a lethal dose of medication for self-
administration)
Legality of PAD and regulatory safe guards
The SCC decision establishes physician-assisted death (PAD) as a Charter right for “a competent
adult person who
(1) clearly consents to the termination of life; and
(2) has a grievous and irremediable medical condition (including an illness, disease or disability)
that causes suffering that is
intolerable to the individual.” The decision focuses on “physician-assisted” death.
Patient requesting and consenting to PAD should be assessed by two different physicians and on
two different occasions with at least two weeks time interval in between the two occasions.
Confidentiality is to be maintained throughout such a treatment.
Ethical issues that may arise
How about an individual who wants to commit suicide at home?
As far as the law is concerned, PAD does not affect such an individual. There is no indication that the
management of patients who are suicidal will change. There are many times during which suicidal attempts
are a result of momentary perceived threats to the patients. Once those are dealt with the patient may get
back to normalcy.
In the case of PAD,
This is a case where a patient wants to end suffering not with cruel means, but rather end suffering with
dignity. Such a case has to have been verified with 2 physicians, one of the two with no connections with the
patient and on two separate occasions. This is to ensure that the request is not arising out of a momentary
decision but rather a carefully and persistent request to end suffering.
Proponents continued…
I do not believe in PAD. It is against both my moral and religious values.
Physicians whose moral and religious values make them
uncomfortable to render this service or treatment to their patients,
are free to opt out, but they are required to find a physician who
will be able to provide such a services. Similarly other health care
providers including nurses with similar positions can opt out of this
service.
Can the hospital/clinic say no to Pad?
CRITERIA FOR PAD – PATIENT’S SIDE
There are 6 criteria which must be fully met (ALL of them);
(1) The patient must be an adult
(2) Must be capable of giving consent to PAD
(3) There should be no coercion or undue influence
(4) Patient’s decision must be informed
(5) Patient must have a grievous and irremediable medical condition
(6) The grievous and irremediable condition must cause enduring suffering
that is intolerable.
PAD SEQUENCE – Physician (primary)
First step is a written request from a patient to his or her physician for
PAD
The Physician then follows this up with a dialogue with the patient on the
diagnosis, prognosis and treatment options.
The physician has to give or provide the patient with a copy and the
contact information to the College of Physician in the jurisdictions about
PAD.
Assessment of the patient in person to ensure that the patient meets
the 6 criteria
PAD SEQUENCE (Secondary Physician)
Patient meets all the 6 criteria , then the primary MD arranges for a 2nd MD to assess the patient.
Inform the patient whether or not he or she is able to provide the service.
If unable, refer the patient to a 2nd MD known to be willing to assist patient with PAD
The 1st MD review all documentation provided by the 2nd MD and advises the patient of her right to reverse his or her decision at any time in the time line.
Then arrangements to provide PAD whether with oral medications or injectables is discussed with the patient.
References
Standards of Practice: PAD (2016), College of Physicians & Surgeons of
Nova Scotia. Halifax, NS: Retrieved from www.cpsns.ca
Johnston, W. (2015). Euthanasia in Canada? The coming World of Assisted
dying. Retrieved from https://www.youtube.com/watch?v=SCKVqbO4n2U
Tyson, R. (2016). Physician Assisted Dying in Canada: The Legion of Reason.
Retrieved from https://www.youtube.com/watch?v=GmAMqnKLKMM