Panel Presentation SK Hospice Palliative Care Association (SHPCA) May 11, 2016 Nuelle Novik SPHERU, Faculty of Social Work, University of Regina
Presentation Overview Physician-Assisted Dying – International Perspective A Social Work Perspective An Aging Population Implementation – Issues to Consider
International Perspective As of April 2016 , human euthanasia is • legal in the Netherlands , Belgium , Ireland, Colombia and Luxembourg . Assisted suicide is legal in Switzerland , • Germany, Japan, Albania, and in the US states of Washington, Oregon, Vermont, New Mexico, Montana and California (effective June 2016).
United States • Physician-assisted suicide is legal in five U.S. states. • It is an option given to individuals by state law in Oregon , Vermont , Washington and California .
United States • It is an option given to individuals in Montana via court decision. • Individuals must have a terminal illness as well as a prognosis of six months or less to live. • Physicians cannot be prosecuted for prescribing medications to hasten death.
US Statistics Oregon Since its enactment, there has been a steady increase in both prescription recipients and the number of deaths. Since 1997, prescriptions have been written for 1,327 people and 859 patients have died from ingesting the drugs that were legally prescribed to them under the law.
US Statistics Washington – Since 2009 prescriptions have been written for 549 people and there have been 525 reported deaths. Vermont – Since May 2013, physician reporting forms have been completed for two people, according to the Department of Health.
Europe The Netherlands : Legislation legalizing assisted suicide and euthanasia was introduced in 2002, but the country's courts have permitted these actions since 1984. Belgium: It legalized euthanasia and physician-assisted suicide in 2002 and, in February 2014, removed the age limit of 18, allowing assisted suicide for children as long as they are terminally ill, suffering unbearably and conscious of their decision, and have the consent of their parents and doctors.
Europe Switzerland: Assisted suicide has been allowed since 1942, but euthanasia is forbidden, with patients having to administer the lethal medication themselves. Luxembourg: This country of about 600,000 people passed a law legalizing euthanasia and assisted suicide in 2009 with conditions similar to those in the Netherlands.
A Social Work Perspective The CASW Code of Ethics highlights the importance of self-determination, capacity to consent, and informed consent. Protections must be in place to prevent a person from selecting physician-assisted death as a result of a lack of appropriate, sufficient, accessible, or timely palliative care.
Access to Services CASW supports a palliative first approach to the entire physician- assisted death dialogue – this approach supports a robust model of palliative care that is accessible to all Canadians.
A Social Work Perspective The assessment process to determine eligibility for physician-assisted death must be rigorous and comprehensive at the policy level, and highly individualized at the level of the individual person – capacity of the individual is an integral component. A social work perspective considers a client holistically: as an individual and as part of a family, a community, and a system.
A Social Work Perspective CASW notes that the role of the social worker extends beyond the client, to include psychosocial support to the families, caregivers, and other professionals involved in the assessment and treatment of the client.
An Aging Population
Canadian Demographics • Between 1982 and 2012 Canada’s population of seniors over the age of 65 has increased from 9.7% to 14.9% of the total population (Statistics Canada, 2015). • Contributing to this increase is also the fact that seniors are also living longer than they ever have before.
Canadian Demographics By 2036, seniors will reach approximately • 25% of the total population.
Aging in Saskatchewan Saskatchewan: 14% seniors in 2012 – will increase to 23% by 2036. Many rural communities have a higher proportion of seniors than the provincial average.
Rural Aging Compared to urban seniors, rural seniors often have isolating conditions, socioeconomic disadvantage, less education, transportation and access issues, and shortage of health services.
An Aging Population In Canada, most cancer diagnoses happen after age 50, and most Alzheimer’s patients are diagnosed after 65. The risk for dementia doubles every five years after age 65. As the baby boomers (30 per cent of the population) watch their parents die, they are also feeling the affects of their declining health and facing their own end of life.
Dementia in Canada In 2011, 747,000 Canadians were living with Alzheimer’s disease and other dementias - that's 14.9 per cent of Canadians 65 and older. By 2031, if nothing changes in Canada, this figure will increase to 1.4 million. By 2038, 28,000 Saskatchewan residents will be living with dementia, accounting for 2.3% of the population.
Cost of Aging in Canada Keeping a chronically ill patient in a hospital bed costs $1,000 a day, compared to $130 in a home, or $55 with home care. If nothing changes, seniors will account for almost 60 per cent of health-care costs in Canada in 2030, Today, the combined direct (medical) and indirect (lost earnings) costs of dementia total $33 billion per year - if nothing changes, this number will climb to $293 billion a year by 2040.
Income Issues to Consider in Implementation
Issues to Consider Protection for all health care practitioners Professional self-care The proposed legislation does not include specific discussion related to older adults, the disabled, and the mentally ill Role of Advance Care Directives Established links between palliative care and physician-assisted suicide
Contact Information Nuelle Novik Phone: (306)585-4573 email: nuelle.novik@uregina.ca
References Alzheimer Society of Canada. (2010). Rising tide: The impact of dementia on Canadian society. Toronto, ON. Canada. Parliament. Special Joint Committee on Physician- Assisted Dying. Medical assistance in dying: A patient centred approach: First Report. Ottawa, ON: House of Commons, 42 nd Parliament, 2016. (1 st Reading, April 14, 2016. Canadian Association of Social Workers (CASW). (2016). Physician assisted death: Discussion paper. Retrieved from: http://www.casw-acts.ca/en/physician-assisted-death-casw- discussion-paper Canadian Association of Social Workers (CASW). (2005). Code of ethics . Ottawa, ON: Author. Canadian Association of Social Workers (CASW). (2005). Guidelines for ethical practice. Ottawa, ON: Author.
References CBC (October, 2014). Assisted Suicide: Where do Canada, other countries stand? Retrieved from: http://www.cbc.ca/news/canada/assisted-suicide-where-do- canada-other-countries-stand-1.2795041 CNN (April, 2016). Physician-Assisted Suicide: Fast Facts. Retrieved from: http://www.cnn.com/2014/11/26/us/physician- assisted-suicide-fast-facts/ Himchak, M.V. (2011). A social justice value approach regarding physician-assisted suicide and euthanasia among the elderly. Journal of Social Work Values and Ethics, 8(1). Jeffery, B., Bacsu, J ., Abonyi, S., Novik, N., Martz, D., Johnson, S., & Oosman, S. (2013). Rural healthy aging interventions. Saskatoon, SK: SPHERU.
References National Seniors Council. (2014). Report on the Social Isolation of Seniors . Government of Canada. Retrieved from: www.seniorscouncil.gc.ca/eng/research_publications/social_isolat ion Provincial-Territorial Expert Advisory Group on Physician- Assisted Dying. (2015). Final Report. Retrieved from: http://www.saskatchewan.ca/government/government- structure/ministries/health/other-reports/other-ministry-plans- and-reports Statistics Canada. (2015). Canada’s population estimates: Age and sex, July 1, 2015. Retrieved from http://www.statcan.gc.ca/daily- quotidien/150929/dq150929b-eng.pdf
Recommend
More recommend
