Who chooses medically supported death?

When should people legal medical aid to obtain dying? It is an important question that often causes strong emotions and violent arguments.

A growing number of countries in the USA and countries around the world has started to legalize or expand medical help in dying, also known as a maid. Maid is defined as a medical provider to prescribe medication to a patient so that he can end his own life (sometimes it is confused with euthanasia, but the two differ; euthanasia usually includes a doctor who acts actively and less is often practiced). Servant programs have strict criteria for the authorization, in which people usually diagnose a serious illness in which a forecast of less than six months is forecast. A common scenario could affect someone with cancer in the late stage.

But there are Maid critics who are concerned about the relaxation of these criteria and the associated dangers. In countries such as the Netherlands, for example, people searched and received based on maid or euthanasia Mental suffering alone. In other cases, people have received maids for conditions that cause painful suffering, but are not regarded as an terminal Myalgic encephalomyelitis/chronic fatigue syndrome.

Critics have argued that these cases, as these programs have expanded, have increasingly normalized these cases. Some people will continue to argue that medical providers in maid-maiden countries are also unknowingly incentive to drive it to people who are disabled, poor and/or vulnerableInstead of only offering people who benefit the most, such as the terminally ill, the option. Proponents, on the other hand, often argue that excessively strict guidelines from many people who reasonably deserve the opportunity to choose such a way (including those with disabilities) And who would otherwise suffer unnecessarily.

The fears of a slippery slope effect had a concrete influence. Last year, the Canadian government postponed its planned expansion of maids that would have made it possible for people with only mental illness to apply to previous delays by 2027. Officials in the explanation of the move Quoted More time to ensure that the country’s health system can appropriately evaluate these complex cases.

Last December researchers in the USA, Canada and Europe published A study in Jama constraint medicine Dedicated to understanding the positive and potential negative of the maids. Analyzing of records from 20 different jurisdiction, in which the maids are practiced, tried to answer a simple question: Exactly who chooses and may choose maids?

Gizmodo turned to one of the authors of this study, James Downar, the head of the Palliative care department at the Department of Medicine at the University of Ottawa. We talked to Downar about the results of the study, its greater effects and the future of Maid.

The following conversation was easily worked on for grammar and clarity.

Ed Face, Gizmodo: What tried to research your studies?

James Downar: Now that Maid is legal in more than two dozen jurisdiction, we have a lot of data about the people who receive maids all over the world. Opponents of the maids have taken care of that the potential of maids is driven by external factors such as compulsion, poor availability of services and structural susceptibility. However, every jurisdiction that has published data about maid recipients has shown that the vast majority were people with cancer or amyotrophic lateral sclerosis (also known as; also known as a motoneuronous disease), even if these conditions only make up a minority of all deaths.

In this study, we wanted to examine the proportion of people with different types of diseases (e.g. cancer, heart disease, as) as) who receive a maid at the end of life instead of dying naturally. We found that people with (17%) received the most likely maid, followed by cancer (3-4%), and then other diseases (e.g. heart disease) received far less a maid (<1%). The absolute numbers and percentages varyed across the jurisdiction, but the relative rates of people who received maids were remarkable in all jurisdiction. The relative differences between the diseases were far greater than the relative differences between the jurisdiction or the differences associated with a socio -demographic factor (which was examined in other studies).

Gizmodo: There was a heated debate about whether in certain parts of the world, including Canada, the maids laws cause a slippery slope in which people who may still benefit from medical interventions are increasingly encouraged to die. Do the total data show signs of this?

Downar: Our research suggests that the underlying disease or disease factors are by far the most important factors to determine whether someone is given a maid. This indicates that there is a kind of suffering or situation that are promoted to other diseases for diseases such as and cancer, which are promoted to requests for maids, especially for this type of suffering or situation. As and cancer, in addition to your trajectory, there are little together as illnesses – you tend to have a high degree of basic line function, but then a relatively fast, progressive and accelerating loss of function in the past few weeks or in short months of life. Other diseases (heart disease and frailty) develop more slowly and are generally only diagnosed after a slow drop in function has already come.

This is important because people with cancer and lung or heart disease overall have a similar symptom and quality of life if they approach the end of life, but people with cancer generally have lower support needs and much better access to services than people with heart and People lung disease. So if high support needs or poor service access would go to maids, we would see that people with lung and heart diseases become far more maids than people with cancer – the opposite of what we actually see. If social attitudes are as possible, we would see much higher rates for lung and heart diseases, since these diseases would cause disabilities longer and to a greater extent than cancer.

I have seen absolutely no indication that people do without beneficial treatments in favor of Maid. Most people who receive maids have already followed palliative providers for some time before they request and maintain maids, and have been in the past few weeks and months of life. There are certainly cases in which people deny treatments that can extend life because the treatments have side effects that the person does not want to endure, or the life level of the lifespan is small enough that the patient is not willing to get the side effects too Standing or having to come to the hospital to get them. This is actually a frequent scenario for people, followed by palliative care providers, and is a decision that many people have made who do not ask for maids.

To be clear, there are two different decisions: (1) A decision about whether you want to continue the treatment or not; And (2) A decision about whether you want to allow natural death or receive maids. It is never a decision to pursue maid instead of a lifelike treatment.

I am also very skeptical that people are “encouraged to die at all”. I am aware of an assertion in the media that this happened, but the transcript from this interaction (the patient recorded it) clearly shown that the person held the person from ending their own lives. Data from Canada also show a low decline in the aggressiveness of the treatment of diseases such as cancer at the end of life, measured by new chemotherapy in the last month of life or in the last few weeks of life. This is a metric that we have tried for years in every country in the world – it is considered a marker for poor care. Palliative Care providers want to go down all over the world, and we would interpret this as a positive result.

Gizmodo: Are there any things that could be improved in current maid systems? Do we need more protective measures to prevent problems with abuse or exploitation either now or possibly in the future?

Downar: I believe that Canada’s protective measures are appropriate and that according to all the data we have function very well. The people who access Maid are disproportionately privileged by any structural measure (wealthy, educated, white/majority culture) with incredibly high use and access to palliative and disability support. Compliance reports show that significant procedural violations or admission concerns are very rare (eight out of 23,000 cases in Ontario, in which each individual case is checked by the forensic doctor). The challenge in every system is to reconcile the security with access, and in many jurisdiction there is an almost universal complaint that people have enormous difficulties to access Maid. This should not be seen as a sign of success.

Gizmodo: Where do you go maid from here? And how do we ensure the best quality of care for people who can be at the end of their lives?

Downar: In Canada there are ongoing discussions about admission criteria, as in many countries. I think every change in the law has to be taken into account due to the data, practice and values ​​of this jurisdiction. There are no “correct” laws for every jurisdiction. The main focus should identify and support the discovery of better treatments for the type of suffering, regardless of the maid laws, is modest. It’s not just about improving existing approaches.