Voluntary assisted dying is different to suicide. But federal laws conflate them and restrict access to telehealth
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Voluntary assisted dying is now lawful in every Australian state and will soon begin in the Australian Capital Territory.
However, it’s illegal to discuss it via telehealth. That means people who live in rural and remote areas, or those who can’t physically go to see a doctor, may not be able to access the scheme.
A federal private members bill, introduced to parliament last week, aims to change this. So what’s proposed and why is it needed?
What’s wrong with the current laws?
Voluntary assisted dying doesn’t meet the definition of suicide under state laws.
But the Commonwealth Criminal Code prohibits the discussion or dissemination of suicide-related material electronically.
This opens doctors to the risk of criminal prosecution if they discuss voluntary assisted dying via telehealth.
Successive Commonwealth attorneys-general have failed to address the conflict between federal and state laws, despite persistent calls from state attorneys-general for necessary clarity.
This eventually led to voluntary assistant dying doctor Nicholas Carr calling on the Federal Court of Australia to resolve this conflict. Carr sought a declaration to exclude voluntary assisted dying from the definition of suicide under the Criminal Code.
In November, the court declared voluntary assisted dying was considered suicide for the purpose of the Criminal Code. This meant doctors across Australia were prohibited from using telehealth services for voluntary assisted dying consultations.
Last week, independent federal MP Kate Chaney introduced a private members bill to create an exemption for voluntary assisted dying by excluding it as suicide for the purpose of the Criminal Code. Here’s why it’s needed.
Not all patients can physically see a doctor
Defining voluntary assisted dying as suicide in the Criminal Code disproportionately impacts people living in regional and remote areas. People in the country rely on the use of “carriage services”, such as phone and video consultations, to avoid travelling long distances to consult their doctor.
Other people with terminal illnesses, whether in regional or urban areas, may be suffering intolerably and unable to physically attend appointments with doctors.
The prohibition against telehealth goes against the principles of voluntary assisted dying, which are to minimise suffering, maximise quality of life and promote autonomy.
Doctors don’t want to be involved in ‘suicide’
Equating voluntary assisted dying with suicide has a direct impact on doctors, who fear criminal prosecution due to the prohibition against using telehealth.
Some doctors may decide not to help patients who choose voluntary assisted dying, leaving patients in a state of limbo.
The number of doctors actively participating in voluntary assisted dying is already low. The majority of doctors are located in metropolitan areas or major regional centres, leaving some locations with very few doctors participating in voluntary assisted dying.
It misclassifies deaths
In state law, people dying under voluntary assisted dying have the cause of their death registered as “the disease, illness or medical condition that was the grounds for a person to access voluntary assisted dying”, while the manner of dying is recorded as voluntary assisted dying.
In contrast, only coroners in each state and territory can make a finding of suicide as a cause of death.
In 2017, voluntary assisted dying was defined in the Coroners Act 2008 (Vic) as not a reportable death, and thus not suicide.
The language of suicide is inappropriate for explaining how people make a decision to die with dignity under the lawful practice of voluntary assisted dying.
There is ongoing taboo and stigma attached to suicide. People who opt for and are lawfully eligible to access voluntary assisted dying should not be tainted with the taboo that currently surrounds suicide.
So what is the solution?
The only way to remedy this problem is for the federal government to create an exemption in the Criminal Code to allow telehealth appointments to discuss voluntary assisted dying.
Chaney’s private member’s bill is yet to be debated in federal parliament.
If it’s unsuccessful, the Commonwealth attorney-general should pass regulations to exempt voluntary assisted dying as suicide.
A cooperative approach to resolve this conflict of laws is necessary to ensure doctors don’t risk prosecution for assisting eligible people to access voluntary assisted dying, regional and remote patients have access to voluntary assisted dying, families don’t suffer consequences for the erroneous classification of voluntary assisted dying as suicide, and people accessing voluntary assisted dying are not shrouded with the taboo of suicide when accessing a lawful practice to die with dignity.
Failure to change this will cause unnecessary suffering for patients and doctors alike.
Michaela Estelle Okninski, Lecturer of Law, University of Adelaide; Marc Trabsky, Associate professor, La Trobe University, and Neera Bhatia, Associate Professor in Law, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Self-Care for Tough Times – by Suzy Reading
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A note on the author: while not “Dr. Reading”, she is a “CPsychol, B Psych (Hons), M Psych”; a Chartered Psychologist specializing in wellbeing, stress management and facilitation of healthy lifestyle change. So this is coming from a place of research and evidence!
The kinds of “tough times” she has in mind are so numerous that listing them takes two pages in the book, so we won’t try here. But suffice it to say, there are a lot of things that can go wrong for us as humans, and this book addresses how to take care of ourselves mindfully in light of them.
The author takes a “self-care is health care” approach, and goes about things with a clinical mindset and/but a light tone, offering both background information, and hands-on practical advice.
Bottom line: there may be troubles ahead (and maybe you’re in the middle of troubles right now), but there’s always room for a little sunshine too.
Click here to check out Self-Care For Tough Times, and care for yourself in tough times!
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How To Triple Your Breast Cancer Survival Chances
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Keeping Abreast Of Your Cancer Risk
It’s the kind of thing that most people think won’t happen to them. And hopefully, it won’t!
But…
- Anyone (who has not had a double mastectomy*, anyway) can get breast cancer.
- *and even this depends on the type of double mastectomy and other circumstances, and technically there will always be a non-zero risk, because of complicating factors.
- Breast cancer, if diagnosed early (before it spreads), has a 98% survival rate.
- That survival rate drops to 31% if diagnosed after it has spread through the body.
(The US CDC’s breast cancer “stat bite” page has more stats and interactive graphs, so click here to see those charts and get the more detailed low-down on mortality/survival rates with various different situations)
We think that the difference between 98% and 31% survival rates is more than enough reason to give ourselves a monthly self-check at the very least! You’ve probably seen how-to diagrams before, but here are instructions for your convenience:
(This graphic was created by the Jordan Breast Cancer Program—check them out, as they have lots of resources)
If you don’t have the opportunity to take matters into your own hands right now, rather than just promise yourself “I’ll do that later”, take this free 4-minute Breast Health Assessment from Aurora Healthcare. Again, we think the difference early diagnosis can make to your survival chances make these tests well worth it:
Click Here To Take The Free 4-Minute Breast Health Assessment!
Lest we forget, men can also get breast cancer (the CDC has a page for men too), especially if over 50. But how do you check for breast cancer, when you don’t have breasts in the commonly-understood sense of the word?
So take a moment to do this (yes, really actually do it!), and set a reminder in your calendar to repeat it monthly—there really is no reason not to!
Take care of yourself; you’re important.
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- Anyone (who has not had a double mastectomy*, anyway) can get breast cancer.
7 Minutes, 30 Days, Honest Review: How Does The 7-Minute Workout Stack Up?
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For those who don’t like exercising, “the 7-minute workout” (developed by exercise scientists Chris Jordan and Bret Klika) has a lot of allure. After all, it’s just 7 minutes and then you’re done! But how well does it stand up, outside of the lab?
Down-to-Earth
Business Insider’s Kelly Reilly is not a health guru, and here he reviews the workout for us, so that we can get a real view of what it’s really like in the real world. What does he want us to know?
- It’s basically an optimized kind of circuit training, and can be done with no equipment aside from a floor, a wall, and a chair
- It’s one exercise for 30 seconds, then 10 seconds rest, then onto the next exercise
- He found it a lot easier to find the motivation to do this, than go to the gym. After all “it’s just 7 minutes” is less offputting than getting in the car, driving someplace, using public facilities, driving back, etc. Instead, it’s just him in the comfort of his home
- The exercise did make him sweat and felt like a “real” workout in that regard
- He didn’t like missing out on training his biceps, though, since there are no pulling movements
- He lost a little weight over the course of the month, though that wasn’t his main goal (and indeed, he was not eating healthily)
- He did feel better each day after working out, and at the end of the month, he enjoyed feeling self-confident in a tux that now fitted him better than it did before
For more details, his own words, and down-to-earth visuals of what this looked like for him, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Further reading
Want to know more? Check out…
- How To Do HIIT (Without Wrecking Your Body)
- HIIT, But Make It HIRT ← this is about high-intensity resistance training!
Take care!
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The Better Brain – by Dr. Bonnie Kaplan and Dr. Julia Rucklidge
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We’ve reviewed books about eating for brain health before, but this is the first time we’ve reviewed one written by clinical psychologists.
What does that change? Well, it means it less focus on, say, reducing beta amyloid plaques, and more on mental health—which often has a more immediate impact in our life.
In the category of criticisms, the authors do seem to have a bit of a double-standard. For example, they criticise psychiatrists prescribing drugs that have only undergone 12-week clinical trials, but they cite a single case-study of a 10-year-old boy as evidence for a multivitamin treating his psychosis when antipsychotics didn’t work.
However, the authors’ actual dietary advice is nonetheless very respectable. Whole foods, nutrients taken in synergistic stacks, cut the sugar, etc.
Bottom line: if you’d like to learn about the impact good nutrition can have on the brain’s health, ranging from diet itself to dietary supplements, this book presents many avenues to explore.
Click here to check out “The Better Brain”, and eat for the good health of yours!
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The Surprising Link Between Type 2 Diabetes & Alzheimer’s
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The Surprising Link Between Type 2 Diabetes & Alzheimer’s
This is Dr. Rhonda Patrick. She’s a biomedical scientist with expertise in the areas of aging, cancer, and nutrition. In the past five years she has expanded her research of aging to focus more on Alzheimer’s and Parkinson’s, as she has a genetic predisposition to both.
What does that genetic predisposition look like? People who (like her) have the APOE-ε4 allele have a twofold increased risk of Alzheimer’s disease—and if you have two copies (i.e., one from each of two parents), the risk can be up to tenfold. Globally, 13.7% of people have at least one copy of this allele.
So while getting Alzheimer’s or not is not, per se, hereditary… The predisposition to it can be passed on.
What’s on her mind?
Dr. Patrick has noted that, while we don’t know for sure the causes of Alzheimer’s disease, and can make educated guesses only from correlations, the majority of current science seems to be focusing on just one: amyloid plaques in the brain.
This is a worthy area of research, but ignores the fact that there are many potential Alzheimer’s disease mechanisms to explore, including (to count only mainstream scientific ideas):
- The amyloid hypothesis
- The tau hypothesis
- The inflammatory hypothesis
- The cholinergic hypothesis
- The cholesterol hypothesis
- The Reelin hypothesis
- The large gene instability hypothesis
…as well as other strongly correlated factors such as glucose hypometabolism, insulin signalling, and oxidative stress.
If you lost your keys and were looking for them, and knew at least half a dozen places they might be, how often would you check the same place without paying any attention to the others?
To this end, she notes about those latter-mentioned correlated factors:
❝50–80% of people with Alzheimer’s disease have type 2 diabetes; there is definitely something going on❞
There’s another “smoking gun” for this too, because dysfunction in the blood vessels and capillaries that line the blood-brain barrier seem to be a very early event that is common between all types of dementia (including Alzheimer’s) and between type 2 diabetes and APOE-ε4.
Research is ongoing, and Dr. Patrick is at the forefront of that. However, there’s a practical take-away here meanwhile…
What can we do about it?
Dr. Patrick hypothesizes that if we can reduce the risk of type 2 diabetes, we may reduce the risk of Alzheimer’s with it.
Obviously, avoiding diabetes if possible is a good thing to do anyway, but if we’re aware of an added risk factor for Alzheimer’s, it becomes yet more important.
Of course, all the usual advices apply here, including a Mediterranean diet and regular moderate exercise.
Three other things Dr. Patrick specifically recommends (to reduce both type 2 diabetes risk and to reduce Alzheimer’s risk) include:
(links are to her blog, with lots of relevant science for each)
You can also hear more from Dr. Patrick personally, as a guest on Dr. Peter Attia’s podcast recently. She discusses these topics in much greater detail than we have room for in our newsletter:
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Eyes for Alzheimer’s Diagnosis: New?
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It’s Q&A Time!
This is the bit whereby each week, we respond to subscriber questions/requests/etc
Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!
Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.
(this is in response to last week’s piece on lutein, eyes, and brain health)
We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:
See also:
- Journal of Alzheimer’s Disease (mixture of free and paid content)
- Journal of Alzheimer’s Disease Reports (open access—all content is free)
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