Part of a Whole

My name is Nicolas Steenhout.
I speak, train, and consult about inclusion, accessibility and disability.

Involuntary Euthanasia by Proxy

A recent article in the New Zealand press talks about how a doctor placed a “Do Not Resuscitate” order in a patient’s file, against the patient’s wish. The patient’s son noticed the order in his mother’s file and countermended it. This kind of things concerns me a great deal when thinking of the issues of legalising physician assisted suicide.

Story Overview

We have here a case of:

  1. A woman who, "despite" a relatively low quality of life, is lucid enough to decide she does want to live,
  2. a son who supports that decision,
  3. a doctor who overrides that without talking with the people directly concerned.

This is what we know from the articles (see Hospital accused of acting like God and Do-not-resuscitate order shocks family for more):

  • A Do-Not-Resuscitate (DNR) order was placed in an 85 year old woman’s file at a NZ hospital.
  • The woman’s son has enduring power of attorney.
  • The woman’s quality of life isn’t very good, but she is lucid, doesn’t have dementia.
  • When the topic has been discussed with her, she’s always refused a DNR, as recently as a few weeks previously.
  • DNR form was placed in the woman’s file, with an illegible doctor’s signature.
  • There was a circle indicating on the form that this had been discussed with the patient and her family.
  • The woman was unable to have that discussion, and the son is adamant nobody talked to him.
  • The son "said he turned his mother’s oxygen back on himself, insisted that the morphine be cut back and that she be given fluids. The next day, she was sitting up in an armchair and was talkative."1
  • A formal complaint was lodged with the hospital, who is investigating.

Euthanasia

That story scares me, especially when I think about the legalisation of physician assisted suicide. Euthanasia.

One of the things proponents of legalised physician assisted suicide always bring up is "informed consent". A patient could not have access to euthanasia without having all the information about their options. They also say that there would be safeguards in place to make sure that only the "right" people could be euthanised.

But who informs the patient, and their family? In most cases, it would be doctors or medical personel. I’ve already provided a bewildering number of statistics and studies clearly showing that doctors have a negative bias.

Who decides who the "right" people are that should be left to die? The very same doctors who have that negative bias.

Enters this particular story where the patient had been clearly opposed to dying, where the son was clearly wanting to have her mother given proper treatment, where proper treatment had the mother talkative and lucid and able to sit up, and where a doctor had decided that this woman should die.

Because signing that Do-Not-Resuscitate was saying, quite literally, "let her die". Against the wishes of both the patient and the family.

What If?

How often does this kind of thing happen in New Zealand hospitals? Too often, I suspect. How many people have already been left to die, against the family’s wishes, because they didn’t have a power of attorney and some doctor decided the patient wasn’t worth saving?

This is involuntary euthanasia by proxy. It is not exactly administering the "killing blow", but it is just as bad.

What happens if physician assisted "suicide" is legal? How many people will a doctor like this "help to die". It’s illegal to do so now, not to mention unethical to go against the family’s informed wishes. Yet it happens.

I hope you’ll understand why I’m really concerned about legalising physician assisted "suicide". I hesitate to use the term "open season" on people with disabilities and on the elderly, because many would perceive that as being too radical – hence dismissed out of hand. But really – think about it. How easy is it for doctors to decide a person’s quality of life is not going to be good enough, sign a Do Not Resuscitate order, without talking it over with the family, and the person dies?

I’m afraid. Very afraid. And so should you.

6 thoughts on “Involuntary Euthanasia by Proxy

  1. Perhaps there’s a procedural change that could be made, that would make it impossible to place a DNR without the person legally able to make such a decision agreeing?

    I don’t know much about how hospitals and this process in particular currently works, but I wager that a smart person could figure out a way to subvert the doctors.

    That way, we could have the benefits, such as they are, of euthanasia, without this issue. Which I agree is a tremendously serious problem. We’re talking about people and their lives after all.

  2. That is a shocking story and I am sure it happens in silence in every hospital in the world.

    In Qu├ębec, a special commission on dying with dignity (http://www.assnat.qc.ca/fr/travaux-parlementaires/commissions/csmd-39-1/index.html) has been holding consultations on the subject of doctor assisted suicide. And with a name like that, I guess you could assume which way this whole process is leaning.

    I worry too about the abuse. But I am also a bit torn on the subject. I think that as for me personally, I would want to be able to decide when I go if I came to be so sick and in pain. Or have someone close to me who knows my wishes and that I can trust to respect them.

    But, you never know. One thing I do know, that I am absolutely sure of, is that I do not want some hotshot 28 year old doctor with a gazillion patients and about 3 and a half minutes to devote to each of his or her patients to decide or to even influence that decision one way or another.

    Thanks for this post, it is an important subject and more people need to think about it instead of just letting the “experts” decide a societal value as crucial as this.

  3. @Nigel, you wrote “Perhaps there’s a procedural change that could be made, that would make it impossible to place a DNR without the person legally able to make such a decision agreeing?”

    There are already policies and procedures in place that are supposed to make that impossible. But everything is possible… Obviously.

    @catroy, yes, it is a tricky issue. And I understand where you come from on not wanting to linger. Have you read my other post: Opposing the legalisation of physician assisted suicide? It explains where I stand on the issue.

    And I just love, love LOVE this:

    One thing I do know, that I am absolutely sure of, is that I do not want some hotshot 28 year old doctor with a gazillion patients and about 3 and a half minutes to devote to each of his or her patients to decide or to even influence that decision one way or another.

  4. Heh, we all know that what a process is “supposed” to do has very little bearing on what it “actually” does :)

    Maybe in 40 years, when the health sector has caught up to the latest technological breakthroughs from 2010, there will be a solution that actually does make it impossible for a doctor to set the DNR state of a patient.

  5. I think that its dangerous to be mixing DNR and Euthanasia together in this context. To use this event as a reason not to legalise euthinasia is to also provide an arguement against DNR orders.

    DNR orders are provided as a means for patients to provide guidance to medical partitioners and are a legal right in NZ where people have the right to provide advance directive and to withhold services.

    When a doctor takes it upon his or her self to apply such a right I would argue it is both morally wrong and legally criminal. The doctor should suffer the consequences. But the fact that it could happen should not be a reason to remove what I consider a very basic civil right.

    My mother who passed away in 2006 had a DNR order, my family was aware of it and accepted both her wishes and the actions of a nurse present at the time of her death which was peaceful and in the comfort of her own home. I would like to think I would have the right to make this choice when my time comes.

    On the matter of euthanasia (which I admit I support) I would expect there to be rigorous legal and procedural mechanisms in place prior to any changes to the current laws.

    I have watched a person go through the latter stages of terminal cancer. As a result I could not be the one who would tell a person facing that fate they they may not die in comfort and must do so only after an exhaustive and agonising last few months.

    Both DNR’s and Euthanasia are about an individual’s right to choose and in my opinion should be legally supported. That said medical practitioners acting outside the law and wishes of the individual should face the same fate as any other criminal.

    ps. Sorry about he long reply Nic.:)

  6. @Shayne, I don’t have a problem with DNR’s, I think it’s *totally* up to the patient (or their family) as long as they have informed choice. This situation was a problem because the patient’s wishes were not respected.

    The reason I associated this case with the case against legalising physician assisted suicide is because the actions of this particular doctor were obviously demonstrating how they are poor judges of quality of life and of patient’s autonomous choices. And these two issues are mission critical in the decision to euthanise. If doctors are showing themselves unable to respect DNR wishes, I don’t have any confidence in them being able to help a family through a difficult choice regarding end of life decisions such as euthanasia.

    As I’ve stated before, I don’t have anything against people wishing to end their lives, but I do have an issue with legalising physician assisted suicide because of the risk to people that are not in terminal phases of painful illnesses.

    No problem on the long reply – it’s all good :)

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