Wednesday, February 26, 2014

Quebec's Right to Die Bill - Will it Die Before It Can Be Passed?

Ok, it's the end of February and it's been two months since I posted last. Why is it that we tend to leave our own things for "later" and then "later" never comes?

I like writing this blog. It gives me an opportunity to write about topics that catch my attention or are important to me. So I really should give the blog more attention than I am giving it. Today I want to write about a bill that the province of Quebec (Canada) has on the table - it's unofficially called the Right to Die Bill, but it is really "The act respecting end-of-life care bill."

Assisted suicide, the right to die, euthanasia - they are all very contentious topics. Most people I've spoken to about this over the years are very strongly on one side of the issue or the other. And, it's not unusual for their views to change once they find themselves in a situation where a loved one is dying. Is there a right or wrong when it comes to end of life?

I've seen death in many ways. As a nurse who worked in acute care, I've fought to save patients from dying - through providing life-saving treatment that includes CPR. I've been part of a team in an ICU where patients were taken off life support. I've worked in palliative care, where I held the hands of patients as they took their last breath. I've lived through the aftermath of suicide of a relative. I've lost people I love to "natural causes." I've also loved animals and had to make the decision to euthanize a few, because they were suffering too much and I couldn't bear that. So death is not unfamiliar to me. But I still can't tell you where I stand on Quebec's proposed bill.

The bill is as well thought out as I have imagined such a bill would be. It's been four years in the making as politicians and experts discussed the various aspects and ramifications of such a law if it went into effect. According to the rules, the patient must be over 18 years old and of sound mind, capable of understanding the consequences of their decisions. They must have an incurable illness, declining in health and near natural death. The patient must be in constant, unbearable pain.

I have seen many people in that stage. Some begged to let us help them die - others fought to the bitter end.

The law would allow physicians to help the patient die, but only after he or she has ensured that the patient has weighed all the options and a second opinion from another physician concurs with the prognosis - that there is no chance of recovery.

But what is "constant, unbearable pain?" Those who are living with deep depression may say that they can no longer go on. What about those who do have debilitating and constant pain because of a trauma but they are not fatally ill. What if that pain is unbearable and they can't handle the idea of living with it for another 5, 10, or more years? What if the patient is a very smart 16-year-old? What if the patient doesn't really want to die, but is feeling pressured to let go?

Many who are against the bill are afraid that this is opening a door that can't be shut again. More illnesses, conditions, and reasons will be added to the list of who can be helped to die. They fear that decisions will be made for people who aren't able to decide for themselves. They fear that temporary illnesses that might be managed properly, may seem so bleak that lives are cut short before treatment can be effective.

In a perfect world, an assisted-suicide law may be what we need. But we don't live in a perfect world and abuses do happen - that we cannot deny. So those who fear abuses in this case shouldn't be silenced. But... then we go back to, what about those who are suffering - what rights do they have over their body, their time to die?

Unfortunately, because the government is a minority government and it may be calling an election very soon, this bill may not go any further. This bill on dying will, in effect, die on the table. I don't say "unfortunately" because I want the bill to pass or not pass, but because this discussion is very important and so much work as gone in to it that it is frustrating to those involved to see it all for naught. I know that the bill can be reintroduced next session - but the will has to be there. And will it be?

I am leaning towards, yes, I think we need something like this, but I am afraid of that door being jammed open too wide.

Tuesday, December 17, 2013

Thanking My Faithful Readers and Answering Some Questions

I wanted to take a moment to say thank you to the people who read my blog regularly and to those who happen upon it as they search for something. I have received many kind emails and comments from people who have learned something from my posts or because they enjoyed something I wrote.

I also receive some emails of disagreement. What I write isn't always popular and I respect dissenting points of view, as long as they are respectful in turn. And sometimes the emails I get are to tell me that I am wrong. I do try to limit that as much as possible but if I goof up, I admit it and thank the reader for pointing it out.

A few people have asked me how I choose my topics and why my posting can be erratic. Good questions. My topics usually come from the news I read that morning. My routine is I wake up, check email and then browse news releases and stories. If something jumps out at me, I'll write about it. Other times, it's because a particular topic is something I am passionate about or I know a lot about. I write about depression and suicide, because it has touched my life. I write about fibromyalgia because I have it. I write about sepsis because Sepsis Alliance is one of my clients and I strongly support their efforts, and so on. As for the frequency of my posts, that's as much a mystery to me as it is others. I always mean to post more often, but then I get distracted with my work or life in general, and the blog gets pushed aside. I shouldn't let that happen because I'm very proud of the blog and the messages I've gotten out through it. I could say that I'll make a New Year's resolution to post more regularly in 2014, but I'm not so good at keeping resolutions, so I think I'll refrain from that.

Over the past several years, I've also received emails from people, mostly nurses, who want to get in to health writing. They like that I'm a nurse who has taken her work life in a completely different direction. I like to help as much as possible and I answer each email with care, explaining how I got into it and suggesting how others may be able to. What is puzzling though, is that I'd say about half the time, I don't even get a thank you. That is a bit discouraging, but what can you do? Some people have manners, some don't. I hope that some of those who wanted to write have gone on to be successful.

I also get asked sometimes if I still work as a nurse and if not, do I miss it. No, I no longer work clinically as a nurse. The last time was about two years ago when I did some occupational nursing for a large organization. I've worked in areas ranging from postpartum and newborns to palliative care, to geriatrics. I've literally worked with people from birth to death. And while I liked the personal contact, nursing is a very tough job and one that physically drained me. So now, I've found my niche. I get to use the experience and knowledge I've gained over the years and apply it to my writing. It truly is a win-win situation for me. I couldn't be any more content with my professional choices. I do miss the patient contact from time to time, I won't deny that. And I do sometimes feel guilty that I've left the front line because nurses are needed in so many areas. But we need to do what works for us and I don't regret the choice I made.

And now I'm signing off for 2013. If there is any topic in particular that you would like me to address, I'm always open to ideas. After writing this blog for, what, seven years (?), it's sometimes difficult to come up with fresh ideas.

In the meantime, if you celebrate the holidays, I hope they are joyful and peaceful for you. If you do not celebrate, I wish you a calm, healthy, and happy end of the year and beginning of the new one.

See you in January!

Friday, December 13, 2013

Length of Maternity Leave and Postpartum Depression: A Connection?

The topic of maternity leave can get quite heated between certain groups of people. Some feel it is an important period that provides multiple benefits to mother and child, while others feel it is an entitlement and a luxury. Sure, they argue, moms need to have some time to recover from childbirth, particularly if it is a c-section, but extended maternity leaves are just a time to stay away from work without expectations.

So, are maternity leaves important or a luxury? I have to admit that, as a Canadian, I have a very different experience with maternity leave than do many of my colleagues in the United States. And, since I was working clinically as a nurse when I had my children, I even had a different experience than many of my fellow Canadian mothers at the time.

Over 26 years ago, when I had my first (of three) children, Quebec nurses received 20 weeks of 93% of their salary in maternity leave benefits. After that, we could take up to a total of two years from our position, unpaid, and be guaranteed our job or an equivalent one on our return. Other women in Canada who did not have a similar type of union agreement, received 15 weeks of maternity leave, at about 60% of their salary. The first two weeks were unpaid, so it came out to 17 weeks off work.*

I had no idea back then that my US colleagues had no such similar rights to maternity leave. I began to hear stories of women returning to work when their infants were six or seven weeks old because they had used up all their sick leave and holiday time. I couldn’t imagine leaving my babies that young. Some mothers may bounce back right away, but I sure didn’t after my first delivery, my son who was over 9 pounds. He was starving all the time and he didn’t sleep through the night for a long time, which made for a pair of very tired parents.

Now, in 2013, all across Canada, new mothers can take anywhere from 17 weeks to a full year from their job and they are guaranteed their job (or equal equivalent) upon their return. If they’re eligible, they get 15 weeks income of about 55% of their wages from the national employment insurance program (for birth or adoption). Union or contract arrangements can top up the sum, as it did for me back in 1987. A few years ago, changes were made in the program so fathers could benefit from this leave as well, sharing it with the mother.

Sadly, things don’t seem to have improved all that much in the U.S. for new mothers. According to FMLA, the federal Family and Medical Leave Act, childbirth is included in a list of medical conditions that allows for up to 12 weeks of unpaid leave, but even this isn’t available to all as small employers are not required to provide this. Anecdotally, I’ve had colleagues tell me horror stories of how they had to fight for maternity leave - without pay - returning to work when their babies were three months old or younger. And how many can afford to take that time off without any form of income?

Maternity leave is not a luxury. It is important that society realizes that it’s a vital part of keeping our families healthy.

There has been a lot in the news over the past few years about postpartum depression. Sadly, we hear about it most with sensationalist news stories of mothers who murder their children and commit suicide as they can no longer cope with the burden of the depression. A study published in the journal JAMA Psychiatry earlier this year found that 40.1% of 10,000 women experienced depression within the first year of childbirth and 19.3%, almost one fifth, of these women had thoughts of self-harm. Other studies have found a connection between mothers with postpartum depression and child development.

Returning to work before you are physically and/or psychologically ready can increase your risk of developing postpartum depression, says the authors of a study published this week in the Journal of Health Politics and Law. The researchers examined the results of a survey of more than 800 new mothers. The survey asked questions about their return to work and their mental and physical health at six weeks after delivery, 12 weeks, six months, and 12 months. Seven percent of the mothers went back to work by the time their infants were six weeks old, 46% by the time they were 12 weeks old, and 87% by the time they were six months old.

The researchers found that the longer a woman was home with her baby, the lower the depression scores, as were measured on a scale called the Edinburgh Postnatal Depression Scale.

"In the United States, most working women are back to work soon after giving birth, with the majority not taking more than three months of leave," said study co-author Dr. Rada K. Dagher in a press release. "But our study showed that women who return to work sooner than six months after childbirth have an increased risk of postpartum depressive symptoms."

When dealing with an issue as serious as postpartum depression, this needs to be taken seriously. Currently, the U.S. is only one of three countries of 181 that does not offer paid maternity leave. The other two are Papua New Guinea and Switzerland.

Maternity leave isn’t a chance to sit at home and do nothing while being paid. It’s providing both mother and child the best possible start, possibly preventing other costly health issues down the road.

*Nurses were paid by the hospital/government 93% of the salary for the two-week waiting period. For the next 15 weeks, employment insurance pay out was topped up, and this was followed by an additional hospital/government payout of 93% for the last three weeks, for a total of 20 weeks.