November 30, 2011

Trial: Days 9 and 10 from the BC Supreme Court

Here are the updates from the trial, days 9 and 10, as reported by the Farewell Foundation for the Right to die.

Day 9: Thursday, November 24,  2011  Dr. Herbert Hendin (Expert for Canada)

Thursday’s session opened at 06:30 a.m. for a video conference with Dr. Hendin, a witness from New York.  Dr. Hendin is a psychiatrist with Suicide Prevention International and author of the 1997 book, Seduced by Death: Doctor’s, Patients, and the Dutch Cure.  

Dr.  Hendin is one of the first Americans to critique euthanasia in the Netherlands.  Age 85, Hendin told the court that he continues daily clinical practice from 07:00 to 10:00 am, and again from 4:00 to 7:00 pm.  Between those hours he works on projects with Suicide Prevention International.

Under cross-examination, Dr. Hendin faced problems similar to those that confronted Dr.  Jose Pereira earlier in the week.  When counsel for the plaintiffs asked Dr. Hendin to confirm references that were cited in his affidavit for Canada, Hendin declared that he could not actually affirm that the references supported his propositions.  He told the Court that he never actually read some of the articles, it was a mistake, and he did not have the chance to check his own references.

Dr. Hendin was shown a passage from Professor John Griffiths’ book Euthanasia and Law in the Netherlands: “Hendin has, of all foreign critics, probably devoted the most effort to collecting information on the Dutch situation.  Unfortunately, his research methods are quite inadequate to support the conclusions he draws… The ‘findings’ which supposedly support his conclusions are so filled with mistakes of law, of fact, and of interpretation, mostly tendentious, that it is hard to be charitable and regard them as merely negligent.”

“What do you say to that?” asked counsel for the plaintiffs. Dr. Hendin gave a long and discursive answer that he taught research methods in university and that he had done research with many people and organisations.  “I don’t give (Griffiths) two cents,” he said.

It was expected that Dr. Hendin’s testimony would last a minimum of 4 hours, but it terminated after only 2.5 hours.  His very long and rambling answers appeared to bewilder the court when a yes or no response was all that was requested.   A number of times counsel apologized for interrupting Dr. Hendin in order to redirect him to the question.  Justice Smith intervened a couple of times to ask Dr. Hendin to please answer the question directly.

The final question of the day came from Justice Smith.  She asked why Dr. Hendin thought Dutch doctors feel they need not abide by the law.  In response Dr. Hendin said that physicians in the Netherlands don’t get punished when they break the law, the Dutch guidelines don’t help, and as a result doctors are getting away with murder.

Day 10: Friday, November 25,  2011  Dr. Harvey Chochinov (Expert for Canada)

Dr. Chochinov is a professor of psychiatry at University of Manitoba and a director of  palliative care research at CancerCare Manitoba.   Dr. Chochinov spoke confidently and with authority about his research into dignity.  He noted that dignity is frequently invoked in the right to die debate but there is very little research about what dignity is and how it relates to notions of autonomy and self-determination.  Since the mid 1990’s Chochinov has carried out a number of studies that he says help to show that dignity is measurable.

Patients with a fractured sense of dignity are said to report less satisfaction with their quality of life.  Dr. Chochinov and his team have developed a psychometric instrument called a Patient Dignity Inventory (PDI) which is used to measure dignity related distress in palliative care patients.   He has also developed something called “Dignity Therapy” which has been used to enhance sense of dignity in patients as well as the way that families perceive a patients’ dignity.

Dignity Therapy asks patients to discuss what matters most to them, or what they believe they would most want to be remembered about them.  Sessions are recorded, transcribed, and turned into a final document that can be bequeathed to someone special.  More than 90 percent of patients in several countries report high levels of satisfaction with Dignity Therapy, saying that it helps with depression, their will to live, suicidal thoughts, and sense of meaning.

An issue identified by Chochinov’s research is that patient dignity is enhanced when the patient has involvement in treatment and health care decisions.  Dr. Chochinov said that he was talking about patient involvement in multiple areas where a patient can exercise control, but only in areas that are legal, not aiding suicide or euthanasia.

The recent Royal Society of Canada (RSC) Expert Report on End of Life Decision Making (see http://farewellfoundation.ca/wordpress/?p=312) received strong criticism from Dr. Chochinov.   Chochinov, who is a Fellow of the Royal Society, said it was a very curious report, and he wondered how the group of experts was able, in a very short time, to accomplish a conclusion that was at odds with the US Supreme Court, the Supreme Court of Canada, and the Senate of Canada.  He pointed out that members of the RSC expert panel were vocal supporters of assisted death.

In particular, Dr. Chochinov characterised as “ill-conceived and harmful” the Expert Panel’s recommendation on terminal sedation: “The federal government should revise the Criminal Code to make it clear that terminal sedation in circumstances where it is not required to alleviate physical suffering should be considered euthanasia and be subject to the same procedural conditions and requirements as other forms of euthanasia.”

When asked why he felt the Panel’s recommendation was harmful, Chochinov said that it amounted to taking a step backwards, that terminal sedation should not be subject to a legal regime.  He argued that terminal sedation is a modality of care that is working well and that doctors should not be put in the position of redefining it as a form of euthanasia.

Cheryl (3 years ago)
If we stop calling it assisted suicide and name it something like......terminal assisted euthanasia.

Ony a doctor could determine when it is required.

Why do we do this humane act to animals and not to people?

If we can avoid an animals suffering, we do.

Death is a natural part of life. When one is terminal as determined by a doctor, then with all our compassion and technology, why must the patient suffer til passing?

Please for the sake of people like Ms. Taylor and many more like her, change the laws!

G. Waters(3 years ago)
In response to Dr. Chochinov - "that terminal sedation is a modality of care that is working well" - I beg to differ. I also believe that no one would willingly choose this treatment, and have seen it fail horribly. I watched a loved one suffocate unto death (lung cancer) because the nurses in the hospital were "too busy" to maintain the proper and effective level of sedation required. Although the doctor offered me and my family a verbal apology after the fact, it does not undo the deed. Doctors have become desensitized to the agonies of death. As Canadians, and for all humankind, we deserve the right to choose.
G. Waters

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