Take The Quiz
1. True or False. If you decide not to accept a course of treatment recommended by a doctor, the doctor has the right to end their relationship with you and you will need to look elsewhere for medical care.
You have the right to change doctors or to a second opinion. You can decline a course of treatment proposed by a doctor (such as chemotherapy, or amputation) and still expect to be given comfort care and pain control.
If your doctor feels that he or she cannot provide you with acceptable care, the onus is on them to find another doctor who will provide it to you.
2. A hospital has the right to ignore an Advance Medical Directive or the instructions of a Substitute Decision Maker if measures are required to save a patient's life.
C. Yes, unless the patient is in palliative care and has signed a Do Not Resuscitate order.
B. No. Hospitals are required to recognize Advance Medical Directives and the guidance of Substitute Decision Makers.
A case that illustrates this is that of Malette v. Schulman in Ontario in 1992. Malette was involved in a serious car accident, her husband was killed and she had critical injuries. She was taken to the hospital for emergency surgery.
On inspecting her wallet, a nurse pulled out a card that identified Malette as a Jehovah's witness and indicated that she did not want blood transfusions. The card was signed but not dated. The Dr. decided that since the card was not dated, and since the surgery was life-saving, the operation should continue.
Malette's daughter then arrived and indicated that her mother would not want a blood transfusion under any circumstances. As the transfusion was critical to the success of the operation, the doctor ignored the daughter's request.
The surgery was successful and Malette recovered. She then went on to sue the hospital for battery and was successful. The hospital appealed to the Ontario Court of Appeal but the decision was upheld.
3. True or False. A hospital or medical facility cannot allow a patient to stop eating and drinking because under the Canadian Charter of Rights every Canadian is entitled to the basic necessities of life which include the right to food and drink.
False. While it is true that Canadians have the rights to basic necessities, we also have the right to stop or refuse treatment. A voluntary decision to stop eating and drinking is considered a decision to stop treatment and must be respected by hospitals and other medical facilities.
4. True or False. Patients must sometimes experience uncontrolled pain at end of life, even if they are asking for further pain medication, if they are at risk for addiction or if an increase in their medication would likely lead to death through respiratory failure.
False. Sadly some patients do experience uncontrolled pain at end of life because of a lack of medication. Some medical professionals mistakenly think that they should not increase medication, either because the patient is at risk of becoming addicted, or because respiratory failure might result.
Evidence clearly shows that where medication is being used for pain control, addiction does not arise.
Patients have the right to sufficient pain control and comfort care. If a patient's needs for pain control put the patient at risk, as long as the patient understands the risk, they have the right to sufficient pain control. If the patient is not competent to make this decision, their Substitute Decision Maker in consultation with their Advance Care Directive can make it on their behalf.
5. True or False. I have an Advance Care Directive.
The correct answer should be true. If you have an Advance Care Directive, do you review it annually?
6. True or False. I have named a Substitute Decision Maker and have discussed my beliefs, values and wishes with them.
The correct answer should of course be true. No partial marks for appointing the decision maker and not having the discussion. It is the discussion of beliefs, values and wishes that is the key to planning for end of life decision making.
7. When was suicide legalized in Canada?
D. Suicide is not legal in Canada
In 1972, suicide was removed from the Criminal Code. It remains illegal under section 241 to counsel, aid or abet someone to suicide.
8. True or False. There are seven jurisdictions in the world where appropriately-regulated, medically-assisted dying is legal.
True. Medically assisted dying is currently legal in the US states of Washington, Oregon and Vermont and in Belgium, Luxembourg, The Netherlands and Switzerland.
It has been decriminalized (but not legalized) in Montana through a successful court challenge. Attempts to pass a law either legalizing it or re-criminalizing it have both been unsuccessful.
Quebec have draft legislation, Bill 52, which if passed will legalize assisted dying in that province. A recent BC Supreme Court Decision (with Gloria Taylor and Lee Carter) ruled that the current prohibition in Canada is unconstitutional. That decision is being challenged. The outcome of the eventual Supreme Court of Canada Appeal will determine whether assisted dying is legalized for all Canadians.
9. True or False. One of the biggest problems with choice in dying is that it erodes the trust between a patient and his or her Doctor.
False. The Netherlands was the first country in Europe to have legalized aid in dying. In a survey of European countries, Dutch residents recorded the highest level of trust in their doctors.
What the research is now showing is that in jurisdictions where aid in dying is legal, physicians are much more comfortable having discussions with their patients about their end of life choices and this is leading to higher levels of trust and satisfaction.
In addition, in a completely unanticipated benefit, the quality of palliative care has improved significantly since choice in dying legislation was introduced in both The Netherlands and Oregon.
10. True or False. Sue Rodriguez lost her appeal for medically assisted dying to the Supreme Court of Canada because they ruled she should not have the right to die.
False. The ruling stated that while the judges actually supported her right to die, they did not want to change the laws as they were concerned that such a change would put the vulnerable members of society at risk.
Since that time, intense study has been made of assisted dying laws passed in Oregon and The Netherlands and the studies show that weak and vulnerable members of society are not at risk where appropriate protocols are in place.
The Supreme Court of Montana recently ruled that individuals should have the right to die and referenced these studies as the reason for its decision that vulnerable members of society would not be at risk.
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1 - 4 Yikes! You need to get learning now to make sure your end of life choices will be respected.
5 - 7 Good work. You have more to learn, but you are on your way.
8 - 9 Excellent. You have a bit of learning to do, but you're off to a first-rate start.
10 Gold star! Congratulations, you really know your stuff.