Tuesday, April 19, 2016

Death with Dignity - Process Matters

DEATH WITH DIGNITY is a right, that should never have had to have been granted, but a right that is inherent in our humanness as determined by our ability to reason.  The Charter of Rights and Freedoms holds as equity millions of lives and more than 300 years of toil, it is a beautiful document, it should be respected.


The following is discourse on the functionality of Bill 14 legislation that would ensure people can exercise choice AND would ensure that DEATH WITH DIGNITY stays entirely in the hands of people. Our country is institutionalized and people tend to forget that Canada is in no way collective citizenry, but rather, a collection of individuals. Thankfully now, with the Charter of Rights and Freedoms, individuals have choice and the government is compelled to provide it absent any influence other than to administer “interface” between people.
   
The critical element in this legislation is that functionality builds a firewall between the state administering “treatment” and the choice to access DEATH WITH DIGNITY measures. The present DEATH WITH DIGNITY process as posited by Bill C 14 is dangerous in the extreme.


“PRIOR DIRECTIVES” are essential in administering DEATH WITH DIGNITY measures, while provisions are required for persons absent PRIOR DIRECTIVES; PRIOR DIRECTIVES need to be a part of the mix.  There are basically three management categories for people wanting DEATH WITH DIGNITY measures; PRIOR DIRECTIVE in place (no competency or competency in place), No PRIOR DIRECTIVE in place with competency and No PRIOR DIRECTIVE absent competency. 

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PRIOR DIRECTIVES need to be managed in a manner that informs medical personnel of DEATH WITH DIGNITY triggers and measures, in and for actuation, in a standardized way and the fact that there is Prior Directive in place (as opposed to the "document" itself) and must be registered centrally.  In this way, if an event that removes mental competency occurs there are means in place to have people’s wishes attended to and all relevant family and or designates informed.

The Registry would contain the fact there is a PRIOR DIRECTIVE in place and contacts provided by the patient at the time they registered.  This facilitates strict privacy requirements AND allows for circumstance where people arrive to care absent mental competency to be cared for as they've directed.  The registry would be managed by the respective jurisdiction or it could be nationwide and managed co-cooperatively if various jurisdictions if agreed.

People with PRIOR DIRECTIVES would have no requirement for court proceeding as the process precludes; an immediate assessment of choice, the application of institutional maleficence or other duress.

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In the event a person wants to access DEATH WITH DIGNITY measures absent a Prior Directive and they have mental competency, then all the processes laid out in the present iteration of the legislation must be actuated PLUS, an expedited court process. The aforementioned registry could also serve as a gazette to notify people of pending court processes and requirements to notify next of kin must be in place. A special process measured in hours would require that a court process be initiated, announced via the gazette, reasonable effort to notify next of kin is made, opportunity for intervenors is provisioned and finally the order is provided. This order process would be similar to the “bench order process”: very quickly executed, no hearing required, unless next of kin offered objection or someone applied for intervenor status.

In the event that an individual enters care absent mental competency and absent a PRIOR DIRECTIVE, then all medically necessary measures to sustain life must be undertaken.

It must be emphasized that under no circumstance can state representatives of any kind in any number authorize the ending of life. The provision for two doctors’ opinions absent judicial oversight is sheer folly and obscenely irresponsible from the perspective of vulnerable populations and the possibility of measures being misdirected in some way.

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People have the right to choose their own course in life and in managing life’s end, the state's only role here is to ensure that people’s wishes are attended to and facilitated, that interface between conflicted parties is managed and that the vulnerable are protected. Bill C 14 is failing on all counts. 
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