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Palliative medicine and dying with dignity

Sir, – As individuals and members of the Irish Palliative Medicine Consultants’ Association (IPMCA), we are gravely concerned by any proposal to legislate for assisted suicide and euthanasia in Ireland.

Based on our collective experience over many decades of providing specialist care to thousands of individuals in Ireland and their families each year, we have closely observed the experiences of people who have lived and are living with serious illness.

The threats of the proposed Bill to healthcare in Ireland, to the true meaning of the doctor-patient relationship and to the future of what we know compassionate and supportive specialist palliative care to be are many. We worry about the impact on people who already struggle to have their voices heard in our society – older adults, the disabled, those with mental illness and others. We worry that the most vulnerable are those who may be made to feel a burden to their families and come under pressure to end their lives prematurely.

Our experiences tell us that many in our society don’t really know what dying is like, or how rare it is that severe pain cannot be controlled. Most people do not see that within the easing of physical, psychological or spiritual distress and addressing people’s fears, hopes, sadness and loss, the goal of palliative care remains to enhance the living of each life which often transforms the experiences of living, dying and bereavement for individual patients and their families.

We are convinced that as dying with dignity is already present within healthcare in Ireland, no change to our current laws is required. – Yours, etc,

FEARGAL TWOMEY,

Consultant Physician

in Palliative Medicine,

Limerick and

Chairman of the Irish

Palliative Medicine

Consultants’ Association;

Prof TONY O’BRIEN,

Clinical Professor

of Palliative Medicine,

University College Cork;

Dr MARIE TWOMEY,

Consultant in Palliative

Medicine,

St Luke’s Hospital,

Dublin 6;

Dr NORMA O’LEARY,

Consultant Physician

in Palliative Medicine,

Our Lady’s Hospice

and Care Services and

St James’s Hospital,

Dublin 8,

Dr VAL O’REILLY,

Consultant in Palliative

Medicine,

Limerick;

Prof KAREN RYAN,

UCD Clinical Professor,

Consultant in Palliative

Medicine;

Dr DENISE HAYES,

Consultant in Palliative

Medicine,

University Hospital

Waterford;

FAITH CRANFIELD,

Consultant in Palliative

Medicine,

St Francis Hospice

Blanchardstown and

Connolly Hospital,

Dublin 15;

MARIAN CONROY,

Consultant Physician in Palliative Medicine,

UL Hospitals Group and

Milford Care Centre, Limerick;

Dr MAGS CLIFFORD,

Consultant in Palliative Medicine

Cork Kerry Community Healthcare,

Kerry Specialist

Palliative Care Services,

University Hospital Kerry;

Dr CATHRYN BOGAN,

Consultant in Palliative Medicine

North West Hospice,

Sligo University Hospital;

Dr AISLING O’GORMAN,

Consultant Physician

in Palliative Medicine,

Honorary Clinical Senior Lecturer,

Royal College of Surgeons in Ireland,

Louth & Meath Specialist Palliative

Care Services,

Dóchas Centre,

Our Lady of Lourdes Hospital,

Drogheda;

Dr CLARE MCALEER,

Consultant in Palliative Medicine ,

Beaumont Hospital,

and St Francis Hospice, Raheny;

Dr BARBARA

SHEEHY-SKEFFINGTON,

Locum Consultant

in Palliative Medicine,

Our Lady’s Hospice and Care Services,

and St James’s Hospital, Dublin;

Dr. BERNADETTE BRADY,

Consultant in Palliative Medicine,

Tallaght University Hospital;

Dr EILEEN MANNION,

Clinical Lecturer

Users of blood pressure medicine have a lower risk of dying from influenza and pneumonia

Drugs to lower blood pressure of the type ACE inhibitors or angiotensin II receptor blockers reduce the mortality rate of influenza and pneumonia.

This is the main conclusion of a new reassuring study published in the Journal of the American Heart Association, which Christian Fynbo Christiansen and a number of Danish colleagues are behind. He is consultant, clinical associate professor and PhD at the Department of Clinical Epidemiology, which is part of the Department of Clinical Medicine at Aarhus University and Aarhus University Hospital in Denmark.

In the study, the researchers have compared mortality rates among 500,000 Danish patients who were admitted to hospitals in Denmark with influenza and pneumonia during the period 2005 to 2018. This has been done by correlating information from the National Patient Register (activity at Danish hospitals) with statistics from the Danish Register of Medicinal Products (the consumption of medicine in Denmark).

“A little over 100,000 of the admitted patients took ACE inhibitors or angiotensin II receptor blockers, and the study shows that fewer of them were put on a ventilator and that they had lower mortality rates than the hospitalised patients who took another type of drugs against elevated blood pressure, calcium blockers,” says Christian Fynbo Christiansen.

The study arrives mid in a discussion of treatment which peaked while the corona pandemic was at its height. Some medical doctors and researchers pointed out that ACE inhibitors may actually have the completely opposite effect – that is increasing the risk of dying from COVID-19 as the virus SARS-CoV-2 which causes COVID-19 enters the lungs through the same ACE receptors as the ACE inhibitors.

The hypothesis was that when the ACE inhibitor reduces the level of ACE, the body compensates for this by activating a much greater number of ACE receptors on the surface of the cells, which the SARS-CoV-2 virus then utilises as some kind of access key. The greater the number of access keys available on the surface of the cells, the more easily the virus gains access to the cells.

The theory about increased mortality has been nurtured by the fact that a strikingly large proportion of the patients who were seriously ill due to COVID-19 had elevated blood pressure, which is extensively treated with ACE inhibitors – of the 600,000 Danes who have elevated blood pressure, approximately one-third ( 200,000) of them take ACE inhibitors.

“We haven’t examined whether what applies to patients with influenza and pneumonia can be transferred directly to patients with COVID-19, but there is some evidence to suggest that ACE inhibitors have a protective effect against lung damage which we don’t see in patients who take other types of medicine to lower blood pressure. The first studies find no correlation between ACE inhibitors/angiotensin II receptor blockers and COVID-19. However, further studies are needed using the good Danish registers,” says Christian Fynbo Christiansen.

In Denmark, the discussion for and against the use of ACE inhibitors on corona patients has taken place (in Danish) in e.g. the Journal of

Dying Mom’s Video of Hospital Staff Taunting Her Sparks Outrage Over Racism in Canada: Reports

Facebook

The death of an indigenous woman in the Canadian province of Quebec is sparking outcry and investigations after a shocking video showed her being verbally abused by hospital staff — and many believe it was racially motivated, according to multiple reports.

A heartbreaking livestream by Joyce Echaquan before her death on Monday depicts hospital staff members near her as she cried out in pain at Lanaudière Integrated Health and Social Services Center (CISSS) in Joliette. Echaquan’s Facebook Live footage — which was reviewed by local outlets and could be disturbing to some viewers — was publicly shared by Journal Métro and reportedly features nurses insulting the 37-year-old mother in French.

“You made some bad choices, my dear,” one of the nurses was recorded saying, according to The Guardian‘s translation. “What are your children going to think, seeing you like this?”

“She’s good at having sex, more than anything else,” another nurse said, according to the outlet.

One nurse was heard calling Echaquan “stupid as hell,” Canada’s CBC Television reported.

Echaquan’s husband, Carol Dubé, told the outlet that he believes the nurses meant to humiliate his wife.

“I have seven children who find themselves without a mother,” Dubé said. “I am sad. I am so sad.”

In a statement to PEOPLE, CISSS announced one of the two nurses who were recorded in Echaquan’s video has been fired.

RELATED: Nurse Allegedly Caught Beating Special Needs Boy on Camera as Mom Watches in Horror: ‘It Was Heart-Wrenching’

According to CBC, Echaquan was complaining of stomach pains when she arrived at the hospital two days before her death. A family member told the outlet she suffered from various health conditions and did not trust the hospital due to previous experiences.

“She always said, at the hospital, they never did anything,” Sebastien Moar, Echaquan’s cousin, told CBC. “They just made sure she wasn’t hurting. She always had appointments and she said the nurses seemed fed up with her.”

Two separate investigations — a coroner’s inquiry and an administrative probe — have been launched, the outlet added, citing the Quebec government.

Because she was a member of the Atikamekw people, a community of indigenous inhabitants in Quebec, some believe Echaquan’s treatment was seeded in racism.

“Joyce Echaquan went to the hospital for medical help. Instead, she was told she’s stupid, only good for sex and she would be better off dead as she pleaded for help before dying,” read a statement from the Native Women’s Association of Canada.

RELATED: 2 Women Charged with Sexually Abusing Nursing Home Patients: ‘We Were Shocked’

“This racism in the health care system is deeply disturbing and unacceptable,” the group added.

This sentiment was echoed by Canadian Prime Minister Justin Trudeau, who called the hospital staff’s actions proof of “systemic racism” in the country.

“This is yet another example of systemic racism. It is quite simply unacceptable in Canada,” Trudeau said, according to the Toronto Star.

RELATED VIDEO: Calif. Parents Are Accused of Abuse —

outcry after video shows hospital staff taunting dying Indigenous woman



Photograph: Canadian Press/REX/Shutterstock


© Provided by The Guardian
Photograph: Canadian Press/REX/Shutterstock

A shocking video showing hospital staff in Canada taunting a dying Indigenous woman has left a community in mourning and renewed calls for the country to confront the realities of systemic racism.

Joyce Echaquan, a 37-year-old Atikamekw woman, arrived at a hospital in the Quebec city of Joliette on Monday, complaining of stomach pain.

The mother of seven had previously suffered similar issues and told staff she had a heart condition. Echaquan started livestreaming her experience on Facebook as her pain escalated, and staff at the hospital appeared indifferent to her pleas for help.



a group of people sitting on a bed: People attend a vigil in front of the hospital where Joyce Echaquan died in Joliette, Quebec, on 29 September.


© Photograph: Canadian Press/REX/Shutterstock
People attend a vigil in front of the hospital where Joyce Echaquan died in Joliette, Quebec, on 29 September.

In the footage, Echaquan is seen grimacing as nurses call her “stupid as hell”. “Are you done acting stupid? Are you done?” asked one nurse in French as Echaquan moaned in pain.

“You made some bad choices, my dear,” another nurse said. “What are your children going to think, seeing you like this?”

“She’s good at having sex, more than anything else,” the first nurse said.

Indigenous leaders say the video exposes the grim realities of systemic racism that have long gone ignored throughout the country.

“Discrimination against First Nations people remains prevalent in the health care system and this needs to stop,” the Assembly of First Nations national chief, Perry Bellegarde, said in a statement.

The Quebec premier, François Legault, condemned the actions of the staff, telling reporters at least one of the nurses had been fired.

But the premier rejected the notion that Echaquan’s death was representative of a broader problem of racism within Quebec, despite a public inquiry concluding the opposite.

“I really don’t think we have this kind of way of dealing with First Nations people in our hospitals in Quebec,” he said.

The province’s coroner office has announced an investigation into the circumstances surrounding Echaquan’s death. The local health board is also investigating.

‘‘We will not tolerate any remarks of that type from our personnel,” the board said in a statement.

Related: Violence against indigenous women is woven into Canada’s history | Jaskiran Dhillon and Siku Allooloo

Marc Miller, federal Indigenous services minister, extended his condolences to the community who were traumatized by the “gut-wrenching” video.

“This is the worst face of racism,” Miller told reporters. “This is someone who is at their most vulnerable. And they are dying, having heard racist words expressed towards them.”

Contrary to remarks by Legault, however, Miller said Echaquan’s death was reflective of broader barriers Indigenous peoples still face in Canada.

“This is not an isolated event,” said Miller, pointing to the case of a hospital in British Columbia, where staff allegedly bet on the blood alcohol content of incoming Indigenous patients.

For those who have experienced similar treatment to Echaquan’s, the video marked a jarring reminder of the inequities present within the country’s healthcare system.

“I’m not sure I can adequately explain how