PHYSICIAN ASSISTED SUICIDE ST MARY’S CATHEDRAL ROUND TABLE DISCUSSION 18 APRIL 2016 BY DR KHAYA NZIMANDE “A COMPASSIONATE CLINICIAN IS HIMSELF A PILL”
DEFINITIONS 1. 1. EUTHAN HANASIA ASIA : KILLING ON REQUEST. DOCT CTOR R INTENTIO TENTIONAL NALLY Y KILLI LLING NG A PERSON BY THE ADMINISTRATION OF DRUGS AT THAT AT PERSONS RSONS VOLUNTA LUNTARY RY AND COMPETENT PETENT REQUEST. UEST. 2. 2. PALLIA IATI TIVE E SEDAT DATIO ION: N: USE OF SEDATIVE MEDICATION TO RELI LIEV EVE E INTOL OLERAB ERABLE E SUFFERING FFERING IN PALLIATIVE CARE. 3. 3. ASSISTAN SISTANCE CE IN SUICIDE ICIDE: KNOWI WINGL NGLY AND INTENTI ENTIONAL NALLY Y PROVIDING A PERSON WITH THE KNOWLEDG WLEDGE /MEANS (OR BOTH) REQUIRED TO COMMIT SUICIDE, INCLU NCLUDING DING COUNS UNSEL ELLING ING ABOUT OUT LE LETHAL HAL DOSES S OF DRUGS, GS, PRESC ESCRIBIN RIBING G SUCH UCH LE LETHA HAL DOSES ES OR SUPPLYING PPLYING THE DRUG. G.
DEFINITIONS 4. 4. PHYSICI CIAN AN ASSIST STED ED SUICIDE DE: A DOCTOR INTENTIONALLY HELPING ING A PERSON TO COMMI MIT SUICIDE. BY PR PROVIDING OVIDING DRUGS UGS FOR R SELF-ADMINI DMINISTR STRATION TION, AT THAT PERSON’S VOLUNTARY AND COMPETENT REQUEST. 5. 5. ETHIC ICS: S: BRANCH OF PHILOSOPHY THAT INVOLVES SYSTEMATISING, DEFENDING AND RECOMMENDING CONCEPTS OF RIGHT AND WRONG CONDUCT. 6. 6. BIOET ETHI HICS CS (MEDICAL ETHICS) IS THE STUDY AND EMPLOYMENT OF MORAL RAL VALUE LUES S IN MEDICAL ICAL SCIENCE. CE.THIS INVOLVES CLINICAL CARE & CLINICAL RESEARCH.
DEFINITIONS 7. 7. PALLIA IATI TIVE E CARE ARE: WHO DEFINES IT AS: AN APPROACH PROACH THAT T IMPROVES ROVES THE QUALITY ALITY OF LI LIFE E OF OF PATIENTS TIENTS AND ND THEIR IR FAMI MILIES ES FACING PROBLEMS ASSOCIATED WITH LIFE-THREATENING ILLNESS, THROUGH OUGH THE PREV EVENTI ENTION N & RELIEF IEF OF SUFFER FFERING, ING, THE EARLY IDENTIFICATION AND IMPECCABLE ASSES SESSMENT SMENT AND TREATMENT ATMENT OF PAIN, AND OTHER PROBLEMS PHYSICAL, PSYCHOSOCIAL AND SPIRITUAL.
REAS ASONS ONS GIVEN EN BY PAT ATIE IENTS NTS WHE HEN N AS ASKI KING NG FOR PHY FO HYSICIA ICIAN N AS ASSISTE TED D SUICIDE CIDE THE FOLLOWING REASONS WERE LISTED, BY PATIENTS, AS THE COMMONEST: • LOSS OF AUTONOMY • LOSS OF DIGNITY • FEAR OF NOT KNOWING THE SEVERITY OF PAIN • BEING A BURDEN TO THE FAMILY AND RELATIVES • LOSS OF INDEPENDENCE, INCLUDING FFINANCIAL
PATIENTS’ REASONS CONTINUED... • UNBEARABLE/POORLY CONTROLLED PAIN & OTHER SYMPTOMS • DEPRESSION (MAJOR OR DEPRESSED AFFECT) • ESTRANGED RELATIONSHIPS &/UNRESOLVED FAMILY MATTERS • UNBEARABLE SUFFERING
BACK TO THE DEFINITION OF PALLIATIVE CARE... • PALLIA IATI TIVE E CARE ARE: WORLD HEALTH ORGANISATION DEFINES IT AS: AN APPROACH PROACH THAT T IMPROVES ROVES THE QUALITY ALITY OF LI LIFE FE OF OF PATIENTS TIENTS AND ND THEIR IR FAMI MILIES IES FACING PROBLEMS ASSOCIATED WITH LIFE-THREATENING ILLNESS, THROUG OUGH H THE PREVENTI EVENTION N & RELIEF IEF OF SUFFE FFERING RING, , THE EARLY IDENTIFICATION AND IMPECCABLE ASSESSM SESSMENT ENT AND TREATMENT TMENT OF PAIN, AND OTHER PROBLEMS PHYSICAL, PSYCHOSOCIAL AND SPIRITUAL.
APPLYING THE PRINCIPLES OF PALLIATIVE CARE TO COUNTER THE ARGUMENT FOR PHYSICIAN ASSISTED SUICIDE(PAS) • REASONS GIVEN BY PATIENTS WHO WOULD CONSIDER PAS: • LOSS OF AUTONOMY • LOSS OF DIGNITY • FEAR OF NOT KNOWING THE SEVERITY OF PAIN • BEING A BURDEN TO THE FAMILY AND RELATIVES • LOSS OF INDEPENDENCE, INCLUDING FFINANCIAL
CLOSING REMARKS • CONSIDER THE REASONS GIVEN BY PATIENTS WHO WOULD CONSIDER PA’S • CONSIDER WHAT PALLIATIVE CARE OFFERS TO PATIENTS AND FAMILY • CONSIDER WHICH, IF ANY, OF THE RESULTS ARE NOT ADDRESSED BY SOME ASPECT OF PALLIATIVE CARE • EARLIEST REFERRAL, BY THE TREATING CLINICIAN, TO PALLIATIVE CARE TEAM/CENTRE • OFFER PALLIATIVE CARE TO PATIENTS, AS AN ALTERNATIVE, TO PHYSICIAN ASSISTED SUICIDE.
END-OF-LIFE CARE DOCTOR & CARE TEAM’S PRIMARY RESPONSIBILITIES: • ASSIST THE PATIENT IN MAINTAINING AN OPTIMAL QUALITY ALITY OF LIFE; • CON ONTRO TROLLING ING PAIN& OTHER DISTRE STRESS SSING ING SYMP MPTOMS TOMS; • ADDRESS RESSING NG PSYCHOLOGICAL & SPIRIT IRITUAL AL NEEDS; AND • ENAB ABLE THE PATIENT TO DIE WITH DIGNI NITY & IN COMFORT FORT. • THE HEALTH ALTH CARE RE PROFESS FESSIONAL NAL IS TO TRY, AS FAR AS POSSIBLE, TO OFFER CARE THAT WILL EASE THE DYING, BUT NOT DELI LIBERAT ERATEL ELY Y BRING ABOUT DEATH.
POINTS TO NOTE NONE NONE OF THE FOLLOWING SHOULD BE SEEN AS EUTH THANAS ANASIA IA : • WITH THHO HOLDING DING FUTI TILE E TREATMENT; • WITHDRAW THDRAWAL AL OF OF FUTI UTILE LE TREATMENT; THE ABOVE IS A SOUND ND CLI LINIC NICAL L DECI CISION SION WHEN REACHED IN D/W THE PT (IF COMPETENT ); THE FAMILY & THE CARE TEAM. • PALLIA IATI TIVE E SEDAT DATIO ION N
ETHICAL DECISION MAKING IN END-OF-LIFE CARE ONE MUST CONSIDER SIDER: • EACH CH PT INDIVIDU DIVIDUALL ALLY & DEVELOP A CARE PLAN RELEVANT TO THE INDIVIDUAL • THE STAGE AGE OF THE ILLNESS • THE PATIENT’S PREFERENCES & THE FAMILY’S WISHES • THE AIM OF PALLIATIVE TREATMENT IS TO OBTAIN SYMPTO PTOM CONTRO TROL & A HIGH QUALITY ALITY OF LIFE, EVEN IF LIFE EXPECTANCY MAY BE RELATIVELY SHORT AND THE PATIENT’S HEALTH MAYBE POOR.. AN N AFFIRM FIRMATI ATION N OF OF LI LIFE E EVEN IN N THE FAC ACE E OF IMPEND ENDING ING DEATH TH.
REFERENCES 1. LEGAL ASPECTS OF PALLIATIVE CARE, HPCA. 2012. LIZ GWYTHERIN ET AL 2. EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE: URGENT QUESTIONS, MELESE TUMATO SHULA 2 NOVEMBER 2015,CATHCA (CATHOLIC HEALTHCARE ASSOCIATION) 3. GWYTHER L. WITHHOLDING AND WITHDRAWING TREATMENT: PRACTICAL APPLICATIONS OF ETHICAL PRINCIPLES IN END-OF-LIFE CARE. SOUTH AFRICAN JOURNAL OF BIOETHICS AND LAW. JUNE 2008 1 (1) 24-26 4. MATERSTVEDT L. J., CLARK D., ELLERSHAW J., FØRDE R., BOECK GRAVGAARD A-M., 5. MÜLLER-BUSCH H C., PORTA I SALES J., RAPIN C-H. EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE: A VIEW FROM AN EAPC ETHICS TASK FORCE. PALLIATIVE MEDICINE 2003; 17: 97-101 6. SISSEL J., JACOB H., STEIN K. 2005, ATTITUDES TOWARDS, AND WISHES FOR, EUTHANASIA IN ADVANCED CANCER PATIENT AT A PALLIATIVE MEDICINE UNIT, PALLIATIVE MEDICINE, VOL. 19, PP. 454 - 460
THANK YOU FOR YOUR ATTENTION “A COMPASSIONATE CLINICIAN IS HIMSELF A PILL”
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