Overview of Medical Aid in Dying

00:01 Another issue that we need to consider in end-of-life care is medical aid in dying.

00:07 It's a controversial topic.

00:09 And I'm going to walk you through some of the things that have been considered when we have places where this is an option for people.

00:19 So medical aid in dying, otherwise known as physician assisted death or medically assisted dying.

00:26 So it's an umbrella term encompassing both euthanasia and assisted suicide, in which the physician or other clinician in some jurisdictions, assists and brings about the death of a patient.

00:39 So euthanasia is when a person, it's generally going to be a physician administers medication, such as a sedative and neuromuscular relaxant, or performs a procedure to intentionally end a patient's life.

00:53 And they're going to be a few different forms of euthanasia.

00:55 So, there's first of all, voluntary euthanasia.

00:58 So, this is bringing about the death of a person by their informed choice, they are requesting this other physician and the physician is acting based on that request.

01:09 There could be non-voluntary euthanasia.

01:11 So this is bringing about the death of a person incapable of making an informed choice.

01:17 So whether it's a child, whether it's a patient that lacks competence to make their own decisions, so it's non-voluntary in that way, and the position is bringing about their death.

01:28 There can also be involuntary euthanasia.

01:31 So this is bringing about the death of a competent person who opposes being killed.

01:37 So they don't want it but the physician is acting to end their life.

01:43 There's also physician assisted suicide.

01:46 So, based on where you are, for instance, in the United States might be called physician aid in dying.

01:52 Some of the states in the United States call it death with dignity.

01:57 Some people like to object to the term that it's physician assisted suicide.

02:02 Usually, they would say that, well, suicide is only for instances where a person ends their life as a result of mental illness, if they've got major depression, for instance.

02:11 If you actually look at the root of the word suicide, it is self killing.

02:16 So homicide is killing another person, suicide is killing oneself.

02:21 And in physician assisted suicide, it is the person that is voluntarily doing the action to bring about their death.

02:28 It's just with the assistance of the physician.

02:31 So what happens here is the physician provides the medical means, it may be a prescription for a lethal dose of medication or medications, and then the patient will take those medications to cause their own death.

02:44 And that death will obviously occur earlier than would have occurred, had they just gone through, you know, or whatever their disease processes.

02:54 And the caveat with physician assisted suicide is that this is only going to be limited to patients who are physically able to self administer medications.

03:05 So patients that don't have the ability to take in medications orally, or to give it to themselves would not have this as an option.

03:13 I think it's important for people to recognize the distinction between voluntary active euthanasia and physician assisted suicide.

03:20 So with physician assisted suicide, it's the self action by the patient.

03:25 So, they are the ones that are voluntarily choosing the path to end their life.

03:29 So there's that additional step or safeguard, once removed from the physician, the physician preside provides the prescription, but it's the patient that is actually taking the medication.

03:39 Whereas with euthanasia, the physician is the one that's directly acting to end the patient's life.

03:45 The concerns when people say that there is this distinction as well, the downside of saying that is that patients who are competent, but otherwise incapable of self administering medications are not able to avail themselves of medical aid and dying.

03:59 The upside is that allowing, you know for this to be this demarcation, make sure that you limit abuses by physicians might otherwise pursue involuntary euthanasia, you're really making sure that this is a voluntary decision by the patient, and not something that the physician is entertaining themselves.

04:17 Some people have framed medical aid in dying in the context of the right to die.

04:22 So again, a controversial topic as to whether a person has a right to die.

04:26 Some people say, you certainly have a right to life, but two people also have a right to die.

04:31 So this is an opinion that human beings should have the right to decide, how long they live, and when they can choose to end their own life.

04:41 The question is going to be, if we legalize this right to die, is this going to be done with or without the assistance of a medical provider? So, when this has been brought up in countries or like in the United States and various states where this has been debated, it's what whether or not a medical provider is going to be also available for the assistance in dying.

05:06 It may be that even if it's not legally mandated or legally permitted, that it still happens covertly.

05:14 So people may decide to choose this option, even if it's not legal.

05:19 And there's also a question of whether society can place limits on who can exert this right.

05:26 So for instance, in the United States, it's only available for those people that are determined to have a terminal illness.

05:32 So they've got a limited life expectancy, a limited prognosis, and then choosing this right to die.

05:41 In other places, there might be a wider range of individuals who have this ability to choose medical assistance and die.

05:51 But again, society can help determine whether that's appropriate or not appropriate.

05:58 There can be various reasons why a person might choose to hasten their death, you know, to die earlier than they would naturally.

06:06 So anytime a person is suffering, there's a natural reaction in which they really, you know, see no way out, they may have this desire for hasten death and want to accelerate their dying process.

06:18 It's really different, you know, a person that's terminally ill may except that they're going to die one day, so they envision their impending death.

06:25 And there's a certain amount of acceptance to that.

06:28 Or they might actually wish that they could die naturally, and just hope that it would be sooner.

06:34 This desire for hasten death is different from that, it's that I want to take the active means of ending my life sooner than would happen naturally.

06:44 And why would people choose this? So what are the factors that lead to a wish for hasten death? Well, one, there could be physical symptoms.

06:51 So the person has pain, shortness of breath, nausea, other really difficult symptoms to manage, they're either having them now or they anticipate they're going to get them as their disease progresses, so they wish to hasten their death to avoid these burdensome symptoms.

07:13 There might be psychological anguish that leads a person to this.

07:16 So if they have depression, if they feel hopeless, if they are fearing the dying process, and what that's going to be like, and whether they could actually handle it, they might say, well, I'm going to choose the time of my death.

07:27 So I don't have to go through all of that.

07:31 There may be existential suffering, so a person has lost meaning in life, or they've lost a sense of control, or they anticipate that they're going to lose their control over their own destiny.

07:42 They fear a loss of function, or they feel that they've lost their autonomy, and maybe, you know, control and autonomy, and functionality, were so important in their life, that envisioning a life where those things aren't present, leads to this existential suffering, and then a desire for hasten death.

08:03 There may be patients that are, you know, led to the desire for hasten death because of social distress.

08:08 So they're no longer able to enjoy the activities that once you know really gave them meaning and made them feel connected to other people.

08:17 They may feel isolated.

08:20 They may worry that, you know, as they get sicker or dying, that they're going to be a burden to their loved ones.

08:26 And they want to try to prevent the burden on their loved ones, so they'll, they'll desire this hasten death.

08:32 There may be financial worries of you know, if this disease process continues, that might be financially, you know, untenable for myself or for my family, and that leads them to this desire for hasten death.