Panel Presentation SK Hospice Palliative Care Association (SHPCA) - - PowerPoint PPT Presentation

Panel Presentation SK Hospice Palliative Care Association (SHPCA)

May 11, 2016

Nuelle Novik SPHERU, Faculty of Social Work, University of Regina

Presentation Overview

Physician-Assisted Dying – International

Perspective

A Social Work Perspective An Aging Population Implementation – Issues to Consider

International Perspective

• As of April 2016 , human euthanasia is

legal in the Netherlands, Belgium, Ireland, Colombia and Luxembourg.

• Assisted suicide is legal in Switzerland,

Germany, Japan, Albania, and in the US states of Washington, Oregon, Vermont, New Mexico, Montana and California (effective June 2016).

United States

• Physician-assisted suicide is legal in five

U.S. states.

• It is an option given to individuals by

state law in Oregon, Vermont, Washington and California.

United States

• It is an option given to individuals in

Montana via court decision.

• Individuals must have a terminal illness

as well as a prognosis of six months or less to live.

• Physicians cannot be prosecuted for

prescribing medications to hasten death.

US Statistics

Oregon

Since its enactment, there has been a steady

increase in both prescription recipients and the number of deaths.

Since 1997, prescriptions have been written

for 1,327 people and 859 patients have died from ingesting the drugs that were legally prescribed to them under the law.

US Statistics

Washington –

Since 2009 prescriptions have been written

for 549 people and there have been 525 reported deaths. Vermont –

Since May 2013, physician reporting forms

have been completed for two people, according to the Department of Health.

Europe

The Netherlands: Legislation legalizing

assisted suicide and euthanasia was introduced in 2002, but the country's courts have permitted these actions since 1984.

Belgium: It legalized euthanasia and

physician-assisted suicide in 2002 and, in February 2014, removed the age limit of 18, allowing assisted suicide for children as long as they are terminally ill, suffering unbearably and conscious of their decision, and have the consent of their parents and doctors.

Europe

Switzerland: Assisted suicide has been

allowed since 1942, but euthanasia is forbidden, with patients having to administer the lethal medication themselves.

Luxembourg: This country of about 600,000

people passed a law legalizing euthanasia and assisted suicide in 2009 with conditions similar to those in the Netherlands.

A Social Work Perspective

 The CASW Code of Ethics highlights the

importance of self-determination, capacity to consent, and informed consent.

 Protections must be in place to prevent a

person from selecting physician-assisted death as a result of a lack of appropriate, sufficient, accessible, or timely palliative care.

CASW supports a palliative first approach to the entire physician- assisted death dialogue – this approach supports a robust model of palliative care that is accessible to all Canadians.

Access to Services

A Social Work Perspective

 The assessment process to determine

eligibility for physician-assisted death must be rigorous and comprehensive at the policy level, and highly individualized at the level of the individual person – capacity of the individual is an integral component.

 A social work perspective considers a client

holistically: as an individual and as part of a family, a community, and a system.

A Social Work Perspective

 CASW notes that the role of the social

worker extends beyond the client, to include psychosocial support to the families, caregivers, and other professionals involved in the assessment and treatment of the client.

An Aging Population

Canadian Demographics

• Between 1982 and 2012 Canada’s population
• f seniors over the age of 65 has increased

from 9.7% to 14.9% of the total population (Statistics Canada, 2015).

• Contributing to this increase is also the fact

that seniors are also living longer than they ever have before.

Canadian Demographics

• By 2036, seniors will reach approximately

25% of the total population.

Aging in Saskatchewan

Saskatchewan: 14% seniors in 2012 – will

increase to 23% by 2036.

Many rural communities have a higher

proportion of seniors than the provincial average.

Rural Aging

Compared to urban seniors, rural seniors

• ften have isolating conditions,

socioeconomic disadvantage, less education, transportation and access issues, and shortage of health services.

An Aging Population

In Canada, most cancer diagnoses happen

after age 50, and most Alzheimer’s patients are diagnosed after 65.

The risk for dementia doubles every five

years after age 65.

As the baby boomers (30 per cent of the

population) watch their parents die, they are also feeling the affects of their declining health and facing their own end of life.

Dementia in Canada

 In 2011, 747,000 Canadians were living with

Alzheimer’s disease and other dementias - that's 14.9 per cent of Canadians 65 and

• lder.

By 2031, if nothing changes in Canada, this

figure will increase to 1.4 million.

By 2038, 28,000 Saskatchewan residents will

be living with dementia, accounting for 2.3% of the population.

Cost of Aging in Canada

Keeping a chronically ill patient in a hospital

bed costs $1,000 a day, compared to $130 in a home, or $55 with home care.

If nothing changes, seniors will account for

almost 60 per cent of health-care costs in Canada in 2030,

Today, the combined direct (medical) and

indirect (lost earnings) costs of dementia total $33 billion per year - if nothing changes, this number will climb to $293 billion a year by 2040.

Income Issues to Consider in Implementation

Issues to Consider

Protection for all health care practitioners Professional self-care The proposed legislation does not include

specific discussion related to older adults, the disabled, and the mentally ill

Role of Advance Care Directives Established links between palliative care

and physician-assisted suicide

Contact Information

Nuelle Novik Phone: (306)585-4573 email: nuelle.novik@uregina.ca

References

 Alzheimer Society of Canada. (2010). Rising tide: The impact

• f dementia on Canadian society. Toronto, ON.

 Canada. Parliament. Special Joint Committee on Physician-

Assisted Dying. Medical assistance in dying: A patient centred approach: First Report. Ottawa, ON: House of Commons, 42nd Parliament, 2016. (1st Reading, April 14, 2016.

 Canadian Association of Social Workers (CASW). (2016). Physician

assisted death: Discussion paper. Retrieved from: http://www.casw-acts.ca/en/physician-assisted-death-casw- discussion-paper

 Canadian Association of Social Workers (CASW). (2005). Code of

• ethics. Ottawa, ON: Author.

 Canadian Association of Social Workers (CASW). (2005).

Guidelines for ethical practice. Ottawa, ON: Author.

References

 CBC (October, 2014). Assisted Suicide: Where do Canada, other

countries stand? Retrieved from: http://www.cbc.ca/news/canada/assisted-suicide-where-do- canada-other-countries-stand-1.2795041

 CNN (April, 2016). Physician-Assisted Suicide: Fast Facts.

Retrieved from: http://www.cnn.com/2014/11/26/us/physician- assisted-suicide-fast-facts/

 Himchak, M.V. (2011). A social justice value approach regarding

physician-assisted suicide and euthanasia among the elderly. Journal of Social Work Values and Ethics, 8(1).

 Jeffery, B., Bacsu, J., Abonyi, S., Novik, N., Martz, D.,

Johnson, S., & Oosman, S. (2013). Rural healthy aging

• interventions. Saskatoon, SK: SPHERU.

References

 National Seniors Council. (2014). Report on the Social Isolation of

• Seniors. Government of Canada. Retrieved from:

www.seniorscouncil.gc.ca/eng/research_publications/social_isolat ion

 Provincial-Territorial Expert Advisory Group on Physician-

Assisted Dying. (2015). Final Report. Retrieved from: http://www.saskatchewan.ca/government/government- structure/ministries/health/other-reports/other-ministry-plans- and-reports

 Statistics Canada. (2015). Canada’s population estimates: Age

and sex, July 1, 2015. Retrieved from http://www.statcan.gc.ca/daily- quotidien/150929/dq150929b-eng.pdf