00:01
So the attitudes about medical
aid in dying are buried.
00:05
This is a controversial
topic, it's unsettled.
00:09
Really something
that each clinician
is going to have to
decide for themselves,
whether this is appropriate.
00:15
There are professional societies
that have various
standpoints about this.
00:19
Some are neutral, some are against
it, some are in favor of it.
00:23
So that professional level,
you really need to consider
what are the implications
of considering
medical aid and dying.
00:31
It's probably clear that,
at least in several countries,
that public attitudes
towards legalization
of medical aid and dying
appear to be shifting in
favor of its permissibility.
00:43
At least for those patients
who wish to use it.
00:45
So giving this as an
option for certain people.
00:49
And it's been around
now for a few decades,
in certain countries.
00:53
There are about a
dozen countries now
where medical aid and
dying is available.
00:57
And when you
actually look at it,
it's sort of rarely used
less than 5% of deaths
in those countries
are the result of
medical aid and dying.
01:08
So let's walk through
the arguments for
and the arguments against
medical aid and dying
so you can again, make up your
own mind about these issues.
01:17
So some of the main arguments
for medical aid and dying
are, first of all, it
promotes patient autonomy.
01:22
So this idea that the patient
should be able to choose
their own treatments or
choose to refuse treatments
or choose to end their life,
this is a manifestation of their
autonomous decision making,
and medical aid
and dying is just
one other demonstration
of their autonomy.
01:38
There could be an argument
that it preserves
patient defined dignity.
01:42
So again, people
might think that
being functional and in
control and independent
is a manifestation
of their dignity.
01:51
And if they are bed
bound or incontinent,
that is some way you
know, undignified,
so how they define
their dignity,
if they don't want to
be in that condition,
that state of being,
they may choose medical
aid and dying to
they may preserve what they
view as a dignified life.
02:10
It's a means of having that
person address their suffering.
02:13
So if they really have
intractable suffering,
or envision that they're
going to be suffering more
in the future,
with their terminal illness,
this option of medically denying
is a way to address the suffering.
02:26
When it's the involvement
of a physician or clinician,
the other argument for
medical aid in dying is that
having the physician
be available for these,
these means of assistance
is a way to uphold
non-abandonment.
02:41
So if you're supposed to
be there for your patient,
being there through the end,
whatever decisions they make,
if it's for assistance in dying,
that's part of the role of the
physician in that circumstance.
02:54
So those are arguments for
medical assistance in dying.
03:01
Their arguments against
medical aid and dying,
the first would be
well, some people would say
that killing another person
or assistance in the killing
of another person is wrong.
03:12
So that is intrinsically against
the role of the physician
who is supposed to preserve
life or promote healing.
03:18
So there's the wrongness of
killing or assistance in killing.
03:23
Is it really true to
the role of healers.
03:26
So if healer is supposed
to make a person whole,
so even when they're suffering,
there is still the opportunity
to make them whole,
despite their natural
progression of their illness.
03:38
Is this assistance actually
counter to that role?
There may be concerns
that this undermines
trust in the physician,
especially those looking,
you know, from the public into
this involvement by physicians,
how do we know that we
can trust the physician
is not going to go to
involuntary euthanasia?
How do we know that in that
one on one relationship
with a patient that the
physician was in some way,
unduly influencing the patient
to choose this option
and medical aid in dying?
How do we know that it
was truly voluntary?
Another concern is well,
we really haven't
done an adequate job
of providing palliative
care resources.
04:23
The state of the
world might be that,
you know, we need more
palliative care clinicians,
we need all clinicians
to be better trained
in primary palliative care.
04:31
We haven't achieved that yet.
04:33
So when patients are faced
with intractable symptoms,
these other means of suffering,
and we haven't provided them
adequate palliative care,
they might see
medical aid and dying
as the option to consider
because we haven't
done a good enough job
of relieving their symptoms
or their suffering.
04:55
There's also concerns well,
you know, maybe
there are patients
where they're desiring
this hasten death
because they have inadequately
treated mental illness.
05:03
So similar to the
physical symptoms
or the existential suffering,
that might exist for
certain patients.
05:09
There might be mental illness that
if it were adequately treated,
that desire for hasten
death might go away.
05:15
And there have been
studies to show
that if you give adequate
psychiatric support,
things where you're
really trying to help them
work through their
existential suffering,
help them with their
mental illness,
that desire for hasten
death may go away.
05:32
Other arguments against the use
of medical aid in dying are,
well, there's a risk of abuse
without regulatory oversight.
05:40
So you need to
have some means of
a legal system,
regulatory system
to oversee this,
so that, there aren't abuses
and how it's being implemented.
05:54
There may be times
and it's perhaps rare,
but it can happen,
so if a patient
that decides on physician
assisted suicide,
if they take that dose
of lethal medication,
maybe they can't
swallow it completely.
06:08
Maybe they get
nauseous as a result.
06:11
Maybe that actually leads
to other complications.
06:13
That enhances their distress,
they're having more suffering,
because their action to end their
life actually wasn't successful.
06:25
A big concern,
especially from people
with disability is,
this is a concern that
vulnerable patients
might be pressured into
ending their lives.
06:37
And there might be, you know,
feelings of indifference towards
people that are vulnerable
or prejudiced towards
people that need assistance
in terms of their daily care.
06:47
You know, they're bathing,
they're dressing,
they're being bed bound.
06:52
There might be patients
that feel compelled
to consider medical
aid and dying
because of psychological
or financial pressure.
06:58
So for any of those
reasons, they would say,
well, that's taking advantage
of their vulnerability
and pushing them
into this decision,
whereas if we had
actually not been
indifferent to their suffering,
have not been prejudiced against
people with disabilities,
had made sure that there aren't
these financial pressures,
maybe they wouldn't
desire the hasten death.
07:20
And then lastly,
there's this concern
that it might lead you
down a slippery slope.
07:24
So if you make it permissible
for terminally ill patients,
what's to say that you
couldn't make it available
for other patients with
other kinds of suffering?
Maybe they're, they're
not near the end-of-life,
but they just can't envision,
you know, years or decades
of living with their
current condition.
07:40
And there have been movements
in certain countries
to permit medical aid and dying
for things like
intractable depression.
07:49
Is that something that we
really should be considering?
Again, a controversial
debatable topic
about who should be able to
pursue medical aid and dying.