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.

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!

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.

Duh Studies - This is news?

I've written before about what I call "Duh Studies" and how I feel about them.

I was first introduced to Duh Studies when I was an editor for a doctor information website. Some of them made me cry out "Seriously?! Someone gave you money to study that?" And when I thought I couldn't find a more ridiculous study, I'd come across another. 

The one that really took the cake was one that determined that the procedures used to warm up bottles to feed an infant were dangerous. Why, you ask? Because of two women. Both women had boiled water in a pot in which they were going to place the baby's bottle to warm. Both women took the pot with scalding water over to a bed and placed the pot on the mattress. Both women decided to lie down on the bed with their baby - next to the scalding water. Yes - you can see what happened next. In both cases, the pot tipped over and the scalding water burned the baby. The study's conclusion? Bottle feeding was dangerous. I kid you not.

I wish I'd thought to keep that study and the many others that had me shaking my head, but I didn't think to. But no worries because there are still many Duh Studies these days. Take these ones gleaned from today's news:

"Healthy lifestyle before conception may increase likelihood of a healthy pregnancy"

This study examined the lifestyles of 5,000 women for a few months before they got pregnant. Amazingly, those who were healthier before they conceived had a more healthy pregnancy. 

"Lowering 3 risk factors could cut obesity-related risk of heart disease by more than half"

Do we really need a study that looked at a pool of almost 2 million people to tell us that if people, particularly obese people, controlled their blood pressure, blood cholesterol, and blood sugar, that their risk of heart disease or stroke would be lower?  

"Heavy drinking is bad for marriage if 1 spouse drinks, but not both"

I do admit that I was a bit surprised to see that if both spouses drank heavily, divorce rates were the same as with those who don't drink, but is it really a new idea that if one spouse drinks heavily, this takes a toll on a marriage? 

Research is vital and there is good work going on around the world as researchers try to find ways to make our lives better, but other than providing work, what is the point of doing research for the point of doing it?

Seriously, we know that for the most part, healthier women will have healthier pregnancies and healthier babies. So we need more on how to ensure women, particularly those in difficult circumstances, get and stay healthy. We know that high blood pressure, cholesterol, and sugar increase the risk of heart disease and stroke, especially among those who are obese. We need to find ways to help people lower these risk factors. And yes, we know that drinking is hard on a marriage. So we need to find ways to help both the drinker and his or her spouse. Otherwise, it's not news - in my opinion.

How Can a Sore Throat Lead to Heart Disease? World Heart Day September 29

When I was a child, my babysitter’s son became very ill with rheumatic heart disease. I remember that he had to go back regularly for injections for months after he was discharged from the hospital, but we didn’t know what they were or what they were for. We just knew not to knock him hard on the side of his butt that next day. We were in awe that we knew someone who had been so sick, but we were scared too, because it was just so unknown to us.

It was when I was older, I learned that Paul had had strep throat that had not been treated. As happens sometimes, the infection, caused by Group A streptococcus, can lead to acute rheumatic fever (ARF). The symptoms of ARF include rash, fever, and painful and swollen joints. This can progress to permanent damage of the heart valves.

Concern about rheumatic heart disease (RHD) is still present. While in many developed countries, a diagnosis of strep throat leads to antibiotic treatment, usually penicillin, this isn’t so easy in many countries in the developing world. Interestingly, researchers learned that most patients in South Africa who had RHD and their parents or guardians had never heard of it before they became ill. In Tanzania, it was the same.

According to a press release issued by the World Heart Federation (WHF), “Currently the burden of disease of RHD is conservatively estimated at 15.6 million prevalent cases with 282,000 new cases and over 233,00 deaths per year.” That being said, experts believe that these numbers are nowhere near the real numbers yet.

The biggest concern is there is no guaranteed supply of the type of penicillin (benzathine penicillin G/BPG) that is needed to not only treat the disease, but to prevent the disease from progressing further.

As with so many other illnesses around, RHD is a preventable one, but it can only be prevented if infections are detected and for that, there must be awareness. There is a push in the developing countries to include RHD alongside the importance of treating more known but fatal diseases such as malaria, HIV, and tuberculosis, rather than as an afterthought.

There is proof that paying attention to rheumatic fever and heart disease works. The WHF refers to a model implemented in Martinique, Guadeloupe, and Cuba, comprehensive 10-year programs involving education, awareness strategies at all levels and primary and secondary prevention that were delivered through a registry. “A rapid decline in ARF incidence was achieved at a modest cost with overall reductions of between 74 percent and 86 percent observed,” said the organization.

But you don’t need to be in a developing country to develop RHD. If you suspect that you have an infection, get it checked. Don’t forget, I work closely with Sepsis Alliance and we have seen all too often how an infection lead to something much more serious and with fatal results.

World Heart Day is Sunday, September 29. We know a lot about heart attacks and heart disease brought on by high cholesterol and high blood pressure. How many of you knew about rheumatic heart disease?

E-Readers May Help People With Dyslexia

Reading is a fundamental need but many people face challenges and barriers to reading effectively. E-readers may be a solution for at least some people, such as those who have dyslexia, say researchers.

A study published in the journal PLOS One, says that the accessibility options available with e-readers are what makes the difference for some readers. The option that had the strongest effect was the ability to reduce the number of words per line, making them shorter than in traditional paper books. This allows the reader to focus more readily on the individual words in front of him or her and not be distracted by too many words of to either side.

Earlier studies in to how e-readers may help people with dyslexia have looked at how fonts and page formatting can be adjusted, but the strongest positive finding to date seems to be that reading is easier when there is more space between letters, as well as words, “counteracting an effect known as crowding that impairs object recognition in the presence of clutter, an effect observed to be more severe in many people with dyslexia,” wrote the authors.

E-readers can be polarizing - some people love them, others hate them - and their reasons vary considerably. However, if it does turn out that the devices can be helpful to people who have difficulty reading, then it would make sense to integrate them into their daily lives, particularly in schools, to boost the students' chances of success.

Yesterday Was World Sepsis Day 2013 - More Awareness Needed

Since 2011, the month of September has been Sepsis Awareness Month in the United States. Last year, September 13th was declared to be World Sepsis Day. The combination of the two, the month and the day, has raised the profile of this little known and little understood disease that kills so many.

Never heard of sepsis or not convinced it's a serious issue? Why not go have a look at the Sepsis Awareness Month Sepsis Victim Counter now and then go back for another look when you've finished reading this piece. See how many people have died in that short period of time. The counter will run throughout the month.

Sepsis Alliance, an organization that I work with, commissions an annual poll with Harris Interactive to gauge sepsis awareness in the United States. While there is some improvement, the results are still disappointing. Four in 10 adults in the United States have not heard the word sepsis. Even worse, many who have heard the word weren't sure what it is. How can we fight a disease so few people know of? The answer is, we can't - we need more awareness and more education.

Sepsis Awareness Month and World Sepsis Day are working. There were several stories online, in print, and on TV in the US, the UK, and elsewhere; many more than there were two years ago this month. People are talking about it, sharing their stories of having survived sepsis or losing a loved one to it.

So, you may be asking - what is sepsis? I've said how serious it is, how people don't know it, but I haven't told you what it is yet. It's very simple: it's your body's over reaction to infection. If you have an infection - influenza, pneumonia, an infected cut, a urinary tract infection, etc., - your body stimulates the systems to fight it. However, sometimes the body over reacts and it not only starts to fight the infection, it starts to fight the body too. As some people say, it's like friendly fire. As your body goes haywire, your blood begins to clot inside the blood vessels, depriving body tissues of much needed oxygen and other nutrients. Body organs begin to malfunction and even shut down. Death is a definite possibility. For many who survive, they live with limb amputations or organs that don't work properly. Many live with post traumatic stress disorder (PTSD) and other cognitive issues. We call this post-sepsis syndrome. But if we think sepsis isn't recognized enough, post-sepsis syndrome is even worse.

It's not unusual for some healthcare professionals to say to a sepsis survivor that they're cured simply because they made it out of the hospital. But what many don't understand is that there are so many lasting issues that affect many of the survivors. Not everyone has problems after surviving sepsis - they recover and they get on with their lives - but others are left with issues that range from mild, nagging problems to life-changing ones.

While sepsis does affect more people on the opposite ends of the life spectrum (the very old and very young), as well as people who are already ill with other issues, it can strike the healthiest of people at any age, of any ethnicity, of any socioeconomic group. You can see a mosaic of faces, at the Faces of Sepsis - to see what this really means.

Often, pictures are better than words, so I recommend you have a look at these videos to learn more about sepsis. If you know about it, you can help protect yourself and loved ones. And don't forget to go back to look at the counter. Look and see how many people died while you were reading this.

Sepsis in Older Americans
In Practice