Medical aid in dying

The legalization of physician aid in dying ("PAID") has been spreading across the United States and is currently legal in ten jurisdictions. Meant to respect autonomy at the end of life, PAID legislation is modeled after the Oregon Death with Dignity Act, which permits only terminally ill adults with contemporaneous decisional capacity to choose to hasten death with PAID. Right-to-die advocates and legal scholars have critiqued the strict eligibility requirements, which although meant to function as safeguards against mistakes and abuse, can be autonomy thwarting. Advocates and scholars have thus proposed using advance directives for PAID to expand access to this end-of-life option. Such a reform would permit terminally ill persons with moderate dementia or other types of decisional impairments to access PAID. To date, scholars have neglected another possibility for respecting autonomy at the end of life by expanding access to PAID for terminally ill persons with decisional impairments: supported decision-making. Supported decision-making legislation is also spreading across the United States as an alternative to guardianship and surrogate decision-making for persons with cognitive disabilities and is an option in nine jurisdictions. With this model of decision-making, a person with a cognitive disability receives decision-making assistance from supporters to facilitate the exercise of autonomy and retain legal capacity.
This Article is the first to address whether terminally ill persons with cognitive impairments should be able to access PAID through supported decision-making. If provided with decision-making support, terminally ill persons with cognitive impairments may be able to elect PAID intentionally, voluntarily, and with understanding; that is, despite their impairments, such persons may be capable of autonomous end-of-life decision-making. This Article thus argues that the principle of equality demands that the law not exclude terminally ill supported persons with decisional impairments from PAID. This Article also argues that supported decision-making is a superior means for terminally ill persons with decisional impairments to access this end-of-life option compared to advance directives, which have numerous and well-documented problems.
This Article also considers how PAID and supported decision-making laws interact in the one jurisdiction that currently has both laws, the District of Columbia, and concludes that it may be permissible for a terminally ill person with a decisional impairment, which would otherwise preclude them from accessing PAID, to elect this end-of-life option with assistance from a supporter. The Article ends with considerations for policymakers about building additional safeguards into these laws to ensure that persons with cognitive disabilities do not mistakenly, without understanding, or after the application of undue pressure hasten death through PAID.

This is a paper our research group published together with the Collège des Médecins du Québec (the provincial regulator). We are trying to understand what psychological suffering is exactly and how physicians can access it when they are asked to assess patients requesting medical aid in dying in Québec. An English version to follow...

Abstract Jewish law on the “end of life” teaches that nobody is expected to suffer and that for certain individuals, death might be better than life. However, these observations need to be illustrated on the backdrop of the prohibitions of direct killing, the public interest in the preservation of life and the integrity of medicine. Although Israeli law is a secular legal system, a hybrid of common law and con-tinental law, it has developed similar lines of reasoning to Jewish law on matters pertaining to the “end of life”. Israeli judicial processes address “end of life” issues by means of primary legislation, which is quite elaborate. Case law has also developed original and flexible interpretations to ceasing life support in order to benefit certain patients even though it may shorten their lives at times. Contemporary Israeli law contains elaborate structures of proxy and assisted decision making. While these are not formally connected to Jewish law, we argue that rabbinic law is influential in these contexts as well. The paper analyzes the development of Israeli law along these lines, demarcating three major tracks: Jewish Law, Case law and Primary Legislation.
Keywords End of life · Jewish law · Competence · Israeli law · Patient near death

This article intervenes in the debate, among US disability rights advocates, about physician-assisted suicide (PAS). Through an ethnographic study, I situate this debate in the context of the dominant form of end-of-life care in the US hospice. Based on this analysis, I argue that PAS should be an issue of secondary concern to disability rights advocates, and that their primary concern, at the end-of-life, should be the improvement of US hospice care. By thus "putting the 'right to die' in its place," they can achieve consensus among themselves and leverage this consensus to achieve the most substantial advancement of disability rights.

In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own.The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both dis- cursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.

In October of 2018, Norman Hardy became the first individual to be cryopreserved after successful recourse to California's then recently passed End of Life Options Act. This was a right not afforded to Thomas Donaldson, who in 1993 was legally denied the ability to end his own life before a tumor irreversibly destroyed his brain tissue. The cases of Norman Hardy and Thomas Donaldson reflect ethical and moral issues common to the practice of assisted dying, but unique to cryonics. In this essay, I explore the intersections between ideologies of immortality and assisted dying among two social movements with seemingly opposing epistemologies: cryonicists and medical aid in dying (MAiD) advocates. How is MAiD understood among cryonicists, and how has it been deployed by cryonicists in the United States? What are the historical and cultural circumstances that have made access to euthanasia a moral necessity for proponents of cryonics and MAiD? In this comparative essay, I examine the similarities between the biotechnological and future imaginaries of cryonics and MAiD. I aim to show that proponents of both practices are in search of a good death, and how both conceptualize dying as an ethical good. Cryonics members and terminal patients constitute unique biosocial worlds, which can intersect in unconventional ways. As temporalizing practices, both cryonics and MAiD reflect a will to master the time and manner of death.

Purpose:
(1) To provide an in-depth analysis of Parliament’s constitutional responsibilities under the Canadian Charter and the Supreme Court decision in Carter;
(2) To present a critical analysis of the proposed policy under which “persons whose sole underlying medical condition is a mental illness” would not be eligible to medical assistance in dying, but persons whose death is not reasonably foreseeable, and who are suffering from a mental illness and an additional underlying “grievous and irremediable medical condition” under section 241.2 of the Criminal Code would be eligible;
(3) To analyze whether the proposed bill could be unconstitutional and challenged on the basis that it affects the rights to life, liberty, security, and substantive equality of the more vulnerable, in particular women victims of sexual abuse and domestic violence.

On October 19, 2015, Justin Trudeau’s Liberals won a majority of seats in the 42nd Canadian General Election. Within one week, news media were reporting that the new government would consider asking the Supreme Court of Canada to extend the amount of time it gave Parliament to pass legislation regulating physician-assisted death. Eight months earlier, the Court had ruled unanimously in Carter v. Canada that the country’s criminal prohibition on assisted suicide violated an individual’s right to life, liberty, and security of the person under Canada’s federal bill of rights, the Charter of Rights and Freedoms. However, as a practical matter, the Court had suspended its declaration of invalidity for 12 months, giving Parliament one year to devise national regulations for medical aid in dying.

The haste with which Trudeau’s government decided to ask the Court for more time to act suggests, first, that the government felt it had to act and, second, that the government felt it needed the Court’s blessing to take more time. Neither of these assumptions was true. Instead, they represent implicit choices that tell an observer how advisors to the Trudeau government thought about the public problem it faced (physician-assisted death) and the solutions that were available to it. At the centre of that problem-solving process was the then-Minister of Justice, Jody Wilson-Raybould. Personal, institutional, cultural, and political factors influenced the Minister’s handling of the physician-assisted death file, which stifled Parliament’s ability to pass farther-reaching reform. This suggests that the task of advising is a highly dynamic, context-specific process that often requires advisors and their principals to make difficult choices among imperfect alternatives.

https://democracychronicles.org/life-choices "We are endlessly rethinking how to deal with the end of life. We begin the conversation with our loved ones and in our communities, showing it is not just a concern for healthcare professionals, the terminally ill or the elderly, but for everyone."

Many of us know, love, and have cared for someone that saw the end of their lives much too quickly. Almost everyone knows personally or knows of someone who went to the doctor for a routine medical exam and walked out several tests later with a condemning prognosis. In these instances, individuals may not be ready to die but the fact of the matter is that they are going to. In a lot of these cases the end of life can be drawn out, speaking relatively to the prognosis, and it can be painful, it can feel burdensome, and it can wipe any lasting dignity that a person may have had prior to the disease. Increasingly across the globe, medical aid-in-dying is becoming a legitimate and viable option for those individuals that wish to take back control from their ailments, even if it is just in the final act of dying on their own terms. This ethnology will take into consideration the anthropology of law, the cultural implications and morality concerns surrounding voluntary euthanasia and redefining a "good-death" in the United States and Japan.