# What to wear to medically assisted death?



## Winhes2 (Jun 29, 2011)

Yes. Anyway. Any suggestions?


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## Winhes2 (Jun 29, 2011)

I'll suggest something on the nicer half of whatever the person is used to seeing you in.


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## drlivingston (Jun 21, 2012)

@eagle2250 Would this be more appropriate for the Interchange? It could go south in a hurry.


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## derum (Dec 29, 2008)

Awful situation, and no-one should judge the patient for his/her choice.
Perhaps wear something that the patient is familiar with seeing you in. You can dress somberly for the funeral.
But really, there is no right or wrong way to dress for this situation.


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## Dhaller (Jan 20, 2008)

I assume the room will be uncomfortably warm (to make it comfortable for the patient), so I'd dress accordingly, or at least in layers. Keep it comfortable and casual - you don't want your leather-bottom dress shoes clacking across the tiled or cement floor (I'm assuming an institutional setting) when you move around.

I'd bring a book, and maybe some cards and board games, either for the family or (who knows?) maybe even for the patients; I know I wouldn't mind heading out on a winning poker hand or chess game.

DH


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## vpkozel (May 2, 2014)

Are you a attendee or the ...um.... guest of honor?


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## Mr. B. Scott Robinson (Jan 16, 2017)

I am thinking about starting a thread "What to wear to a state execution?" referencing classical works depicting sartorial choices worn at Golgotha and in classic film. 

I am rather broad minded, but I find this particular thread absurd and disturbing on several levels.

Cheers,

BSR


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## eagle2250 (Mar 24, 2006)

Mr. B. Scott Robinson said:


> I am thinking about starting a thread "What to wear to a state execution?" referencing classical works depicting sartorial choices worn at Golgotha and in classic film.
> 
> I am rather broad minded, but I find this particular thread absurd and disturbing on several levels.
> 
> ...


My sentiments, exactly!


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## Brio1 (May 13, 2010)

Why not arrive naked ?


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## drlivingston (Jun 21, 2012)

Brio1 said:


> Why not arrive naked ?


At some point, we all did.


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## Winhes2 (Jun 29, 2011)

It hadn't occurred to me that this thread would cause controversy. In my jurisdiction the law now allows this after the person, while competent, goes through a couple of panel interviews. Consequently, the question comes up in practice. Because it was the first time we've been involved in such a situation, my wife and her sister were uncertain. I posted thinking others here may have already had experience with the situation. In the particular case people dressed as suggested above, "on the nicer half of whatever the person is used to seeing you in" or casually because they were family members. Hopefully, this is informative when someone else on the board has to experience this situation.


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## Dhaller (Jan 20, 2008)

I think assisted suicide is still rare enough that even a large sampling of people is unlikely to produce anyone who's experienced it as an attendee.

As for "controversy", any time you have something new, and especially something new which only a minority experiences, there is a certain species of person who will reflexively dislike it. They are best ignored in this case.

DH


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## SG_67 (Mar 22, 2014)

Dhaller said:


> I think assisted suicide is still rare enough that even a large sampling of people is unlikely to produce anyone who's experienced it as an attendee.
> 
> As for "controversy", any time you have something new, and especially something new which only a minority experiences, there is a certain species of person who will reflexively dislike it. They are best ignored in this case.
> 
> DH


People have been committing suicide for as long as humans have been alive.

To assist with a suicide is murder, which too, we have been very good at since we first walked upright.

There's really nothing new about it. Sanitizing it with a new name does not make it new.


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## Troones (Mar 7, 2018)

To the OP:

I'm sorry you are going through a difficult time, and no need for specifics. But a few thoughts:

1. It really did appear you were trolling by asking such a question. A lot of us thought that what you might wear would/should be the last thing on your mind.

2. You and I are living in Canada. A country with socialized health insurance. Legal assisted suicide is a *VERY* dangerous thing in a country with socialized health insurance.

3. I experienced your pain but in reverse. I very much wanted my dad to LIVE, however I was out-voted in my family and he was allowed to perish "naturally." This was just before assisted suicide became legal. Had it been afterward, It's quite likely that his doctors would have floated the idea of speeding up the process.


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## Dhaller (Jan 20, 2008)

SG_67 said:


> People have been committing suicide for as long as humans have been alive.
> 
> To assist with a suicide is murder, which too, we have been very good at since we first walked upright.
> 
> There's really nothing new about it. Sanitizing it with a new name does not make it new.


I see no argument in which assisting suicide is murder.

If it were so, the Seventh Circle of Hell would be full of everyone who ever lit someone's cigarette for them.

DH


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## SG_67 (Mar 22, 2014)

Dhaller said:


> I see no argument in which assisting suicide is murder.
> 
> If it were so, the Seventh Circle of Hell would be full of everyone who ever lit someone's cigarette for them.
> 
> DH


I believe your analogy is at best flawed.

To kill someone, even if he asks for your help in doing it, is still killing someone.

By the way, why is a physician required for this murder?


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## derum (Dec 29, 2008)

In the States where it is legal, physicians assist those terminally ill, who have 6 months or less to live, to die, if that is their stated wish. I would like this option. Those who fight for a loved one to keep living despite that loved ones wish to die, because of unimaginable pain and suffering, are doing it for selfish reasons. 
In States where it is not legal, and you assist in suicide it is manslaughter, if you commit euthanasia, it is classed as murder.


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## SG_67 (Mar 22, 2014)

Why a physician? Why not put a gun to the head of the terminally ill? A physician heals. He does not kill. 

Why not smother or choke to death the terminally ill?


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## derum (Dec 29, 2008)

A physician has access to prescription drugs, and the administering thereof. A layman could balls it up.


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## SG_67 (Mar 22, 2014)

Lots of lay people in Chicago do a fine job of killing their fellow human beings on a weekly basis. As far as I know, none of them are physicians. 

Why doesn’t the person wishing to die buy a gun and do it himself? Or ask a friend to?

Should assisting in suicide now become a core function of a physician? Can a physician conscientiously object? What if a terminally ill person came into the ED seeking to be assisted with his suicicde. Should the emergency physician do it? If not, is he causing unnecessary pain and suffering in the same way as if he had committed malpractice?

Physicians are trained to heal, not kill. Make the drugs accessible to anyone. For that matter, a hefty plastic bag and roll of duck tape should do the trick. As should a push off of a high cliff.


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## derum (Dec 29, 2008)

A lot of the lay people in Chicago, i'm guessing, didn't actually ask to be offed.......
Physicians aren't forced to do it.
It's not an emergency situation, it's well planned.
But i suspect you know this already


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## Pentheos (Jun 30, 2008)

SG_67 said:


> Physicians are trained to heal, not kill. Make the drugs accessible to anyone. For that matter, a hefty plastic bag and roll of duck tape should do the trick. As should a push off of a high cliff.


Exactly correct. If you really want to go, it is quite easy to end life.


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## Dhaller (Jan 20, 2008)

Pentheos said:


> Exactly correct. If you really want to go, it is quite easy to end life.


Not if you're paralyzed, or otherwise deprived of physical agency.

If someone's life is an inescapable nightmare of breathless agony from which there is no plausible cure or relief, I would argue that assisted suicide is "healing".

If you prefer lingering for months as a piece of convulsing meat at end-of-life, fine, but some of us would prefer more dignified exits.

DH


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## Winhes2 (Jun 29, 2011)

Now I understand why the moderators moved my original question to the interchange.

Rather than raise some additional points inspired by the very considered opinions of contributors above, let's just conclude that the sartorial question was answered early in the discussion.

This is the interchange where, I'll assume, the opportunity exists for people to learn by having opinions, other than their own, shared. However, it is also possible that on a topic like this, where minds are unlikely to change, the likelihood of harm to the board from conflict is greater than the likelihood of good to members from transformation. So, let's consider the original sartorial question answered.


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## Mr. B. Scott Robinson (Jan 16, 2017)

"I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course."

Oaths are such antiquated baubles.....

Cheers, 

BSR


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## SG_67 (Mar 22, 2014)

Dhaller said:


> Not if you're paralyzed, or otherwise deprived of physical agency.
> 
> If someone's life is an inescapable nightmare of breathless agony from which there is no plausible cure or relief, I would argue that assisted suicide is "healing".
> 
> ...


There's a difference between sustaining life with heroic measures and an affirmative act which takes life.

By the way, no one is saying a person cannot choose suicide. My argument is that, as a physician, you don't get to ask or require of me assistance in doing so.


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## derum (Dec 29, 2008)

SG will probably be familiar with this:

"I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."


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## SG_67 (Mar 22, 2014)

derum said:


> SG will probably be familiar with this:
> 
> "I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."


Ah yes! The "modern" version. I wonder if Hippocrates approved. When the rules don't suit you anymore, just change the rules.

The oath is symbolic. The law is not. And even if the law allowed it, I don't agree with it, would not do it and would enjoin my fellow physicians to remember that we are acting as highly educated and well paid killers.


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## Mr. B. Scott Robinson (Jan 16, 2017)

SG_67 said:


> Ah yes! The "modern" version. I wonder if Hippocrates approved. When the rules don't suit you anymore, just change the rules.
> 
> The oath is symbolic. The law is not. And even if the law allowed it, I don't agree with it, would not do it and would enjoin my fellow physicians to remember that we are acting as highly educated and well paid killers.


...and well insured.

I fully agree with your views on this. We forget that death is a part of living and something that we must all face with as much courage and dignity as we can muster.

"This too shall pass...."

Cheers,

BSR


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## eagle2250 (Mar 24, 2006)

There is a big difference between granting a patient's request to withhold medications/treatment and just keep them comfortable, as they die with dignity and administering a substance that will contribute to the untimely death of a patient. The first can be provided by completing and filing a living will and the second is murder. It is not my intent to judge anyone's conflicting choice, but suicide, assisted or otherwise, is an act I would not voluntarily choose to witness, even if the law does allow it to occur. To each his/her own, I guess?


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## derum (Dec 29, 2008)

Interesting article on the concept of death with dignity from the BMJ Journal of medical ethics:

https://jme.bmj.com/content/28/4/255


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## SG_67 (Mar 22, 2014)

I have no problem comforting a dying patient with pain meds or other means of alleviating the suffering associated with death. Anything beyond that is outside the scope of medicine. To kill is not a science. 

If the patient opts for suicide, that’s his decision. I won’t be party to it nor do I want to live in a society where I’m obligated to offer such assistance.


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## Dhaller (Jan 20, 2008)

A lot of talk about "dying with dignity" here... I have to assume many here haven't actually been present at too many deaths. There's not a lot of "dignified" in a patient whose brain has been half-consumed by a cancerous tumor, as they rage and hurl vile obscenities at caregivers, the actual "them" which once inhabited their body long since departed.

Sure, there are the lucky ones, but the very medical science which allows people who *should be dead* to linger on has mostly deprived us of the "passed peacefully in the night" which might, yes, be called a dignified exit.

My own mother was lucky. She was undergoing pointless yet aggressive treatment for stage 4 esophageal cancer - she would never again be able to actually eat again (all feeding was through a surgically-installed port), and she'd begun the slide into dementia. This, a retired history professor who read a book a day, just lay in pain on a sofa (she enjoyed home care, at least) watching arguing heads on Fox news, too weak and unfocused to pick up a book or paper. One night she got up to go to the bathroom, suddenly said "ohh!" and fell over, and was dead by the time she got to the hospital: aortic aneurysm. Not exactly *dignified*, but timely. Also, in my opinion, lucky - an unexpected savior jumping from behind a curtain to ferry her to a better place.

I remember the last time my daughter saw her - my daughter was 18 months old - she cried. My mother had wasted into an emaciated crone; to my daughter, a witch. Even then, I dreaded the ordeal I knew she would go through (esophageal cancer is one of the less "pleasant" ones, if one is arranging them on a scale), and my father as well.

Wanting someone to linger on in a state of agony, despair, and dementia is nothing less than utterly selfish; you're sacrificing their dignity for your own sense of moral absolution. "I'm such a dutiful son" and so forth. If an informed-yet-doomed person wants to check out while they can still make the decision, more power to them.

DH


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## SG_67 (Mar 22, 2014)

I don't think anyone is suggesting that the patient does not possess the agency to do so provided _compos mentis. 
_
I am simply arguing that it is not the role of the physician in these cases.


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## Dhaller (Jan 20, 2008)

SG_67 said:


> I am simply arguing that it is not the role of the physician in these cases.


I imagine at some point a non-physician specialty will evolve under the rubric of palliative care (itself fairly new). Something akin to a midwife, only stationed at the exit from life rather than the beginning.

As for earlier, pithy suggestions that one should just eat a bullet or take a ten-story dive, again - I assume these are people who have not observed the scene of a suicide.

My cousin had the consideration to conduct his shotgun suicide in a bathtub - curtains drawn - but that in no way tempered the discovery of the scene by his sister (who was, I think, 8? 9?... he was 18.)

The dignity of an assisted suicide is as much for the family as for the imminently-deceased (as is, truth be told, relief at the passage - in modern America, a prolonged, complex death is both emotionally and financially ruinous.)

DH


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## Howard (Dec 7, 2004)

I don't think you should be wearing anything at all, one should be naked.


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## SG_67 (Mar 22, 2014)

Dhaller said:


> I imagine at some point a non-physician specialty will evolve under the rubric of palliative care (itself fairly new). Something akin to a midwife, only stationed at the exit from life rather than the beginning.
> 
> As for earlier, pithy suggestions that one should just eat a bullet or take a ten-story dive, again - I assume these are people who have not observed the scene of a suicide.
> 
> ...


It wasn't meant as either pithy or off hand. A person has a right to kill himself. Let him do it in a manner of his choosing. But to ask that the lethal dose be delivered by a physician is a bridge too far.


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## Dhaller (Jan 20, 2008)

SG_67 said:


> It wasn't meant as either pithy or off hand. A person has a right to kill himself. Let him do it in a manner of his choosing. But to ask that the lethal dose be delivered by a physician is a bridge too far.


Possibly you are confusing medically-assisted suicide with euthanasia.

The physician *prescribes* the lethal drug; he does not administer it. It *must* be self-administered (or that is my understanding). Well, depending on the state (or nation). Switzerland may have an essentially "euthanasia" process. I *believe* in the USA the drug has to be self-administered (correct me if I'm wrong... I know that's the case in Oregon, at least.)

That said, in the case of someone physically unable to self-administer (someone in late stage Werdnig-Hoffmann disease, say), I do feel they should be able to "actuate" the process by proxy. Perhaps a robotic delivery system might work.

DH


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## drlivingston (Jun 21, 2012)

SG_67 said:


> I have no problem comforting a dying patient with pain meds or other means of alleviating the suffering associated with death. Anything beyond that is outside the scope of medicine. To kill is not a science.


What you are describing here is called palliative care. It's a common practice for those who are terminally ill.


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## SG_67 (Mar 22, 2014)

Dhaller said:


> Possibly you are confusing medically-assisted suicide with euthanasia.
> 
> The physician *prescribes* the lethal drug; he does not administer it. It *must* be self-administered (or that is my understanding). Well, depending on the state (or nation). Switzerland may have an essentially "euthanasia" process. I *believe* in the USA the drug has to be self-administered (correct me if I'm wrong... I know that's the case in Oregon, at least.)
> 
> ...


What ever the means or the methods, there's no need for a physician to be involved. This is not doctors work. Anymore than an electricians or a plumbers.

There are plenty of ways to take ones own life.

To use the knowledge and power of medicine to end a life is simply murder. Efficient though it may be, then it'a efficient murder.


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## SG_67 (Mar 22, 2014)

Dhaller said:


> ..... *in modern America, a prolonged, complex death is both emotionally and financially ruinous.)*
> 
> DH


This is an aspect of the entire argument that has not been fully examined. When there is a financial stake in the overall outcome.

Under government subsidized healthcare, as is the case with Medicare and Medicaid, does the financial stakeholder get to determine the rules? Some bureaucratic actuary crunches the numbers at CMS in DC and discovers that X billions of dollars a year can be saved if we ended the life of the terminally ill by such and such amount of time. Then lawmakers can pass a law to enable just that.

What if the insurance company in a state that allows for assisted suicide decides that the cost of ongoing care is too high as the patient is terminal. They won't pay for any more treatment past a certain date, but will pay for the cost of an assisted suicide.

What about the family members to stand to inherit the estate? What is their stake in the patient ending his life earlier and preserving for them a greater inheritance than would otherwise be available. What about pressure that has been borne down on the patient.

For the state to sanction in anyway a method or a particular profession to aid or assist in anyway the ending of a life opens a Pandora's box of unintended consequences that will ultimately engage the courts.

This is a decision best left to the individual but should not involve anyone else. There are any number of ways that the terminally ill can end their life. Those who "assist" are no better than murderers.


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## Troones (Mar 7, 2018)

SG_67 said:


> Under government subsidized healthcare, as is the case with Medicare and Medicaid, does the financial stakeholder get to determine the rules?


This is the point I was making in my reply to the OP about legal assisted suicide being dangerous in countries with socialized health insurance (ei. Canada) where the OP and I reside.

In my country, the government takes damn near half your pay check which in many cases actually drops people (the working poor) below the poverty line. You are not a customer of the health care system as there is no choice in the matter. As soon as you actually need to use the health care system however, you are by the very nature of the system, a_ burden_ on it.

As of 2016, we have legal physician assisted suicide. I won't go into the politics of it as I don't want to bore you, but the writing is on the wall.

In time, and my guess is sooner rather than later, pressure will be put on the terminally ill to free up hospital beds by taking the "dignified" way out.


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## derum (Dec 29, 2008)

Passive or active euthenasia is legal in most European countries: Those with socialized medicine have not sanctioned wholesale euthenasia to save money.
Doctors have a choice. Some agree to be part of the process, some do not. 
We all face death, and some will have to face the choices discussed here as a patient. 
To quote Ovid: "When I shall die, let it be doing that I had designed".


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## SG_67 (Mar 22, 2014)

derum said:


> Passive or active euthenasia is legal in most European countries: Those with socialized medicine have not sanctioned wholesale euthenasia to save money.
> Doctors have a choice. Some agree to be part of the process, some do not.
> We all face death, and some will have to face the choices discussed here as a patient.
> To quote Ovid: "When I shall die, let it be doing that I had designed".


They may not sanction it but I can see where certain end of life care decisions will be weighed against the cost of such care and certain decisions will be made in favor of the cost saving.


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## jackmccullough (May 10, 2006)

First off, my condolences to the OP. I assume that you were close to the person or you wouldn't have been invited, and it can't have been easy.

I understand there is a considerable range of opinion on this topic. Based on experience and observation I can easily imagine circumstances worse than death, so I don't begrudge anyone the choice.

I also don't begrudge any individual doctor the choice not to participate, but I don't think reference to a text from the fourth or fifth century BCE necessarily answers the question.

It's not a perfect book, but you might want to read _Still Alice_ and consider what your choice might be.


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## SG_67 (Mar 22, 2014)

It’s an oath physicians still take. I suppose it should mean something. Anyone can kill. One need not spend 10 years learning how to do so.


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## McKay (Jun 13, 2005)

Troones said:


> As of 2016, we have legal physician assisted suicide. I won't go into the politics of it as I don't want to bore you, but the writing is on the wall.
> 
> In time, and my guess is sooner rather than later, pressure will be put on the terminally ill to free up hospital beds by taking the "dignified" way out.


You're making a fallacious slippery slope argument. We've had medically assisted dying for more than two years in Canada and this supposed pressure has not materialized.

Moreover, your use of the term "socialized medicine" suggests a misunderstanding of the economics of health care in Canada. Your argument implies a greater degree of central control over patient treatment than exists. Most physicians in Canada are small businesses that bill an insurance provider on a fee-for-service basis. It's of little consequence for the present argument that the insurance provider is a public entity rather than a for-profit corporation. (It's of much consequence in other policy areas, of course.) Finding a physician who is incentivized by our partially publicly-funded health care system to pressure a patient to request medical assistance in dying would be a significant challenge. Finding one who would do it, even in the presence of an incentive, would be even harder.

It's important to understand that the legislation that allows medically assisted dying in Canada is a very narrow carve-out of the Criminal Code. In general, it remains a serious offence to assist in a suicide, but an exception has been made for very limited circumstances with ample safeguards in place. (Details can be found here, if anyone's interested.) A physician or nurse practitioner* who steps one foot outside of the very narrow path will be very likely to be charged with some form of homicide.

Finally, it's also important to understand that no objecting practitioner is required to participate in medical assistance in dying in any Canadian jurisdiction.

Sue Rodriguez, who sought a medically-assisted death several years before it became legal in Canada, framed the argument in favour of allowing patients this option very well: "If I cannot give consent to my own death, whose body is this? Who owns my life?"

*Nurse practitioners in Canada are close to family physicians in their scope of practice.


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## Troones (Mar 7, 2018)

McKay said:


> You're making a fallacious slippery slope argument. We've had medically assisted dying for more than two years in Canada and this supposed pressure has not materialized.


Yeah, a whole two years. And don't be so sure that this pressure hasn't materialized. If there's one thing I learned while navigating this nifty health care system of ours, is that a lot goes on behind the curtains, and if you're not directly involved, you never see it.



McKay said:


> Moreover, your use of the term "socialized medicine" suggests a misunderstanding of the economics of health care in Canada.


I did NOT use the term "socialized medicine." I used the term *"socialized health insurance."* I deliberately used this term to illustrate that I DO understand the economics of health care in Canada. I've been in and out of hospitals since childhood, I have a chronic condition that requires use of medication, and I lost two parents within the last 10 years who, in a better system, would likely still be alive. There are not many that have a better understanding than I do.
The government provides health insurance that we pay for through our taxes. There is no opt-out clause. You get a paycheck, you pay the government for health insurance (a big chunk at that.) I'd love to know where this supposed "misunderstanding" is that I supposedly have on the subject. Please enlighten me.
In a free system, like in the U.S., I would be permitted to seek out my own insurer, I could weigh the benefits that each presented me and pick the option that is right for me. Or, if I was wealthy enough I could forego insurance and pay for my health care services as needed. In other words, I would be the boss. *I* would decide how much of my income is devoted to it, and *I *am a far better judge of what is right for me, than the government ever will be. Our government believes in choice, but only certain choices, and only for certain people. If we love choice so much, why are most of mine denied me?



McKay said:


> Finding a physician who is incentivized by our partially publicly-funded health care system to pressure a patient to request medical assistance in dying would be a significant challenge.


My family and I sat in a small room with my in-shock father as my mother lay comatose in a hospital bed, and listened to the "doctor" tell him all about how the best option would be to let her go. This was in 2009, several years before legal assisted dying came to pass. That doctor did not seem too "incentivized" to try to save her life.



McKay said:


> Finally, it's also important to understand that no objecting practitioner is required to participate in medical assistance in dying in any Canadian jurisdiction.


Not yet. But as you pointed out, its only been two years. The government set up a system whereby suicidal patients can locate on-side physicians, and bypass those with moral objections. That's the first step.



McKay said:


> "If I cannot give consent to my own death, whose body is this? Who owns my life?


The point has been made several times in this thread. We own our own lives. The health care system (fragile as it is) belongs to all of us.


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