Meeting Minutes - Don Johns: Dying with Dignity - June 4th. 2020
This virtual Zoom meeting opened at 10:01 am. Juliann Sale welcomed everybody and also welcomed Don Johns, today’s presenter. He announced that we are going to start holding regular virtual membership meetings every two weeks from now on. We will be using a phone tree to contact members who are unable to connect virtually in order to keep them informed. He also announced that the Board has prepared a survey to be sent by email to members to determine their level of participation in Club activities. Julian invited members to ask male friends and neighbours to join us for our virtual meetings with the intent of growing our membership. If someone is interested we can assist the person to join us.
The Annual General Meeting will be held as a virtual meeting on June 25th and the AGM Report can now be found on the Club website which contains the nomination report. Julian explained the Constitutional requirement of providing eight weeks’ notice regarding the announcement of the slate of nominations. The Board is asking that in view of the issues around the pandemic this year that it be allowed to set that requirement aside and has put forth the slate in the AGM report that is now on the website. Any new nominations will be accepted up until June 21st. On June 22nd an email will be sent to all members providing an opportunity to vote on the nominations and the results will be announced at the AGM. Bob Reeve, chair of the House Committee is stepping down from this position but will remain on the Committee. Thanks to Bob for his dedicated service in this director position and for his service on the committee. Bob Berry has allowed his name to stand for the position of director. The other changes on the slate are Vice-President Frank Webster becoming president as per the Constitution. Julian Sale is nominated for the position of Vice-President. The remaining directors are continuing in their current term.
Bob Paul introduced Don Johns, to speak on Dying with Dignity.
Bob has known Don Johns for most of their lives. As kids they grew-up in the same neighbourhood and have been in contact ever since. They have both retired to the Village-on-the-Arboretum and are neighbours again.
Don has been quite involved with Dying with Dignity and he has worked as a support volunteer, and as a speaker for medical assistance for dying. Don brings a passion for this kind of support work even though he had difficulty in finding support in the rest of the church in which he was the minister. The Canadian government put out a survey a few months ago soliciting Canadian’s opinion about dying with dignity and they had over 300,000 responses to the survey and polls show that Canadians support the concept of dying with dignity. So, Don is going to bring us up to date on this issue.
Don Johns Don began by giving a brief comment on medical issues in general over the last number of years. He then wanted to talk about what’s available to us at this time so that we can look forward to a gentle death. Then he wants to talk about current legislation in the process of looking at this issue of assistance in dying in Canada.
There are two reasons why this issue of medical dying has come to the fore in the last forty years. The first is the significant progress made in medical science and this means that we live longer. Until recently we died of acute disease. We have heart attack, pneumonia, difficult child birth ….. all of this would kill in a few days. Today we die of what is called chronic illnesses which is a slow process. So, we die of heart disease, liver disease, diabetes, Alzheimer’s, old age. And this can be a long process.
Most of us when asked what is a good death, we would say reaching a mature age, enjoying a night-cap, going to bed, having a deep sleep and never waking up…. a good death. Today the chances of a good death are almost unattainable. According to statistics 50% of us will die in hospitals. Twenty-five percent will die in nursing homes, often intubated, often nauseous, often incontinent. This is not a good death or a gentle death.
The second reason why the topic is so current is that medical ethics and patient rights lag far behind the institutional values of medical science. What is usually laid on us are the institutional values of medical science.
Don related a story of a medical doctor who had worked in a hospital emergency department who witnessed elderly patients whose quality of life was nil being wheeled in for surgeries that were not going to be of benefit to the patient who was too far gone to know what was being done to them. The cynical view from the doctors was that the surgeries were medical practice for new doctors.
Next Don spoke about what is now available to us. The first thing that was lacking in the above scenario was lack of pre-planning. We know that we live in a death-denying culture. There are few people willing to deal with questions about their death and even fewer who are equipped to talk about it. The second thing that was missing was an apparent lack of involvement of family members who might have changed the course of treatment. We call them substitute decision-makers.
Dying with Dignity is a charitable organization that is the leading defender in Canada for a good end of life. DWD believes it is the right of every person to have a peaceful death and a gentle death. To that end it advocates that each of us designate a person to have the power of personal care. This person speaks for us when we can no longer do so. It is a legal document. And many of us will have incorporated it with our will. The caveat at this point is to say that a will is tucked away in a safe place somewhere. And at the time that it is really needed when we’re being picked up by the EMO or we’re being admitted to the emergency department it’s nowhere to be found. The greatest concern that doctors have occurs when someone arrives at an emergency department in a coma or in an unconscious state and there is no direction or guidance as to what this person would really like their treatment to be or how active they would like their treatment to be.
Free forms are available for power of personal care from the provincial government or DWD. It is important that your substitute decision-maker be someone you trust. It is often not wise to have two decision-makers because they may not both be available. But if you use the legal words “jointly and severally" they mean “each of them” can independently make a decision on behalf of the other.
It is equally important that you fill out a “detailed advanced care directive.” This document does not need a lawyer. It’s available free on line from Dying with Dignity at dyingwithdignity.ca . This is a 28 page document with instructions that you give to your decision-maker. This document should be updated regularly and given to your spouse, doctor, children and anybody else that you want to know about your decision. It should be kept readily available.
This document can be a good conversation starter about the end of life. Only now are people beginning to recognize the importance of advanced care directives. We need to be advocates of our own well-being. Dying with dignity advocates that you inform yourself of the choice you have to receive medical assistance. Depending on your stage of life you might change your values for the kind of intervention that we really want at the end of our life. Being better informed about the opportunities and the guidelines with respect to medical assistance in dying is very, very important for us because we do tend to live longer and under sometimes unfortunate circumstances. You have to really talk and unpack what you want for your dying days.
In 2015 the Supreme Court Case called the Carter Case, decriminalized assisted dying in these words: “A competent adult person who clearly consents to the termination of life and has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances in his or her life.”
In Canada the law following came out with a watered-down version with a number of exceptions. Well- meaning opponents to this decision decided to limit those who are eligible for this choice. Currently the federal government has had to deal with the issue that the Charter of Rights has been violated that there should be foreseeable death before one can ask for medical assistance in dying. It means that chronic diseases like ALS and MS or any one of those other prolonged diseases, can take a long time before people to get to the point of their death being imminent or seen to be imminent. And he problem with that term too, was that it seemed to be very subjective as to the length of time which could be anywhere from six months or a year or just fuzzy.
The only problem is that the government said they would deal with this in the month of June (2020). We know what the government is dealing with right now (COVID-19 pandemic). So, we must lobby the government to get on with deciding on this issue and the legislation for it.
The big issue that remains to be addressed is this area is the discrimination against mental health. The disease of mental health, be it a dementia of some sort, means that you cannot, if you have this disease, give your consent which is required at the time administration. You must be able to verbally consent. What is being proposed by those lobbying for medical assistance in dying is that a person could make an advanced-care directive in such a way that would be upheld by law if a person indicated that by some particular time when they reached a critical point in not being able to recognize a member of the family or not being able to communicate, that their substitute decision-maker could speak on their behalf and that their decision made could be implemented. Currently, it is a very awkward area. ___________________________________________________________________________________________________________
Upon conclusion of Don Johns’ presentation, he responded to questions from the members.
John Sneyd thanked Mr. Johns for his presentation.
Next virtual meeting: Thursday, June 18th with Graham Taylor - Advancing Responsible and Ethical AI