Palliative Care & Oncology
The role of psychiatric consultants in managing patients who want to die was once clear but is now considerably more complicated and likely to become even more complex in the future. U.S. Supreme Court rulings have affirmed a variety of death-hastening medical practices: withholding and withdrawal of life-support, VSED and palliative sedation, while leaving it to individual states whether to legalize physician-assisted dying/suicide. The last is legal throughout Canada, as is clinician-administered medical assistance in dying (voluntary euthanasia). However, there currently is no societal consensus throughout North America, and skeptics regularly invoke the ‘slippery-slope’ argument that the criteria for these practices will likely change with negative consequences resulting.
Moderated by Dr. Riyaz, this session is sponsored by the Bioethics SIG. Each presentation has been selected to stimulate discussion about consultation-liaison’s future role in death-accelerating practices.
-- Dr. Stewart will introduce the topic and review some themes from her first “100 Medical Assistance in Dying Psychiatric Assessments,” contrasting the Canadian and American approaches. (15 minutes)
--Dr. Mazur will report how assisted dying is being provided in Europe to patients suffering from major psychiatric disorders and discuss “The Use of Psychiatric Advance Directives in Death-hastening Decisions.” (15 minutes)
--Dr. Cohen will discuss “Should Assisted Dying Laws Include Patients with Neurodegenerative Disorders,” which would entail dropping the requirement that people be terminally ill and leading to greater reliance on advance directives. (15 minutes)
--Dr. Bostwick will describe “Coda,” a new, in-between life stage created by assistive technologies in which traditional ethical constructs no longer apply. Supplanting natural death, patient and team must decide when to start and stop technological support, a decision sometimes confused with committing suicide or murder. (15 minutes)
The talks will be followed by a panel discussion and Q & A Session moderated by Dr. Riyaz. (30 minutes)