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How Confident Are You?

Self-Confidence is defined as “a feeling of trust in one’s abilities, qualities, and judgment.”  Many equate this confidence to how we look on the outside, but it is only once we move past our outer positives and negatives and look inward that true self-confidence can be achieved.  Take a look at the following from Best Health Magazine that provides great tips on improving your self-confidence and learn more in our previous post “Lessons of Confidence from and Overhand Serve.”

Best Health Magazine:  4 Habits That Will Help You Develop Killer Self-Confidence 

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The Role of Occupational Therapy in Professional-Assisted Death

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written with Pauline Tran, Student Occupational Therapist

Warning – sensitive topic!  Whether you agree or not with the moral, ethical and even religious implications of professional-assisted dying, the emerging laws about this are here and are a hot topic in health care.

Professional-Assisted Death (PAD) Explained

PAD includes both physician-assisted suicide and voluntary euthanasia.

Physician- assisted suicide (PAS) is defined as the process by which a physician (of a sick and/or disabled individual), provides the patient with the medical means or knowledge which directly or indirectly leads to the death of the individual (Radbruch et al., 2015). In this, the authority then lies within the patient who has the choice and ability to either perform the final act themselves, or they can choose to terminate treatments and allow natural disease progression to take its final path.

Euthanasia, on the other hand, is defined as the process of which a medical professional intentionally ends a person’s life through the administration of drugs at the patient’s voluntary and competent request (Radbruch et al., 2015). In this, the authority lies with the medical professional administering the lethal drug.  Euthanasia can only be voluntary as medicalized killing without consent would be considered murder. With voluntary euthanasia, there are 2 types that apply to the involvement of medical professionals and their client(s):

o   Active Euthanasia- refers to when a medical profession or another person engages in an act that causes the patient to die

o   Passive Euthanasia – refers to when a medical professional either withdraws or withholds life- prolonging treatments or medications  leading to the death of the patient

Clearly, with the general healthcare mandate to “do no harm” and to essentially try and preserve life, there are significant ethical, professional and moral considerations and implications for all professionals involved.

The Canadian Government Legalized PAS:  What does this mean?

Bill C-14 (which actually amends the Criminal Code and makes related amendments to other Acts such as medical assistance in dying) was passed by the house of commons of Canada on April 14, 2016. Essentially this Bill legalises physician- assisted death in Canada. However, the following eligibility criteria must be met for those who wish to pursue medical assistance in dying:

a)      Adults must be eligible for health services funded by a government in Canada.

b)     Adults ages 18 years or older who are capable of making decisions in relation to their health.

c)      Have a grievous and irremediable medical condition outlined as:

a.      In the advanced state of a serious incurable disease, illness or disability

b.      Declining in functional capacity

c.      Moving towards end of life

d.      Does not have a specific prognosis or predicted time period for their death

d)     Have made a voluntary request for medical assistance in dying which was not made as a result from external pressure.

e)     They are provided with informed consent to receive medical assistance.

To summarize, Bill C-14 approves the act of medically assisted death for adults who meet the eligibility criteria above.

Motivation behind medical assisted death?

Before being involved in the creation or implementation of an end-of-life plan, it is important that all people understand the purpose behind the person’s desire to contemplate end-of-life options.  As a friend, family member, or healthcare professional, understanding the background and foundation for the person’s desire to die is pivotal to being able to provide helpful support, resources and assistance.

The following are some reasons why patients request help with assisted suicide:

  • Illness- related experiences

o   They suffer from physical, psychological, social or spiritual sufferings.

o   Side effects of medications and treatments

o   Unacceptable and unmanageable symptoms

  • Fear of future

o   Fear of future pain, suffering and pain management

o   Decreased quality of life

  • Sense of self and desire to have control over end of life decisions

o   Loss of control, function, independence

o   Being a burden to family members and others

o   Loss of identity, essence

Understanding the motivation behind requesting or asking about medically assisted death allows for all parties to understand where the patient is coming from and to help identify what they underlying issues the patient may be facing as a result of their illness or disability. This way, the request can be explored further truly client-centered care can be provided.

Occupational Therapy and Assisted Death

As Occupational Therapists (OT), we have a large role in assisting people to obtain a desired quality of life, and to function safely and independently.  However, we are also a client-centered profession that witnesses firsthand the often devastating impact of some illnesses, diseases and disabilities.  As such, we already play an important role in palliative care, and this involvement can extend into end-of-life planning as well.  For example, OT’s can enable people who are dying to engage in meaningful activities, roles, and occupations. OT’s can explore a client’s wish to die, can be part of the team of professionals helping to provide alternatives to end of life decisions, or can move forward with assisting the client to coordinate the process.  Our therapy can involve analyzing, reflecting, and exploring an individual’s life though their past roles and relationships to help bring peace and closure to the dying process.

Occupational Therapists can improve the assisted dying process across Canada as they are equipped agents of change. OT’s contribution to assisted dying care plans include:

o   Assisting with typing up lifetime occupational roles

o   Capacity assessments

o   Exploring alternatives

o   Creating meaningful memories

Through the help of OT, people will be more able to have a meaningful and thoughtful death experience, and can leave a coordinated and chosen legacy following.  OT’s have the skills to offer considerable contribution to end of life care and can help people to create meaningful occupation in death itself.

 

Resources and References

Salubre, J. A. T. (2015). Physician Assisted Suicide.

Pearlman, R. A., Hsu, C., Starks, H., Back, A. L., Gordon, J. R., Bharucha, A. J., … & Battin, M. P. (2005). Motivations for Physician‐assisted Suicide.Journal of general internal medicine, 20(3), 234-239.

assets.documentcloud.org/documents/2803276/C-14-Medical-assistance-in-dying.pdf

www.ncbi.nlm.nih.gov/pmc/articles/PMC1490083/

www.caot.ca/conference/2015/presentations/t26.pdf

onlinelibrary.wiley.com.libaccess.lib.mcmaster.ca/doi/10.1002/oti.89/pdf

www.osot.on.ca/imis15/TAGGED/News/Ontario_Commits_to_Policy_Design_for_Physician-Assisted_Dying.aspx

www.caot.ca/otnow/sept15/otnow_9_15.pdf

www.caot.ca/conference/2015/presentations/t26.pdf

mediasite.otn.ca/Mediasite/Play/3b224828e91740bbb16b7152138cdd381d?catalog=fd668812d87c47f9b1ba6d979fed9af421

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Paying More For Less

As of June 1, 2016 the Statutory Accident Benefits Schedule (SABS) has changed again.  I say “again” because in my relatively short sixteen-year lifespan working in auto, the industry has gone through some major plastic surgery.  It is becoming less and less recognizable as it is nipped and tucked once more, becoming almost unrecognizable as the mandatory product we all purchase to be covered in the event of an accident.

Learn more about how these changes will negatively impact those who are catastrophically injured in automobile accidents and options to protect yourself in the following from the Globe and Mail.  You can also learn more about the changes in our previous post “The Government Gets it Wrong—Again!”

The Globe and Mail:  Ontario’s benefit cuts profoundly affect car accident victims

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Simple Kitchen Tips To Make Life Easier

Unless you truly enjoy the culinary arts, prepping for and cooking meals is often a long and daunting process.  With busy schedules and hectic lives, any solution that makes meal preparation less time consuming will reduce stress and help to ensure you eat healthy, home-cooked meals as often as possible.  The following from Pure Wow provides you with “23 Food Hacks That Will Change Your Entire Life.”  Check it out and bon appetit!

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The CNE Disability Policy Change – What the CNE Did Wrong

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

For years the CNE has allowed people with disabilities and their attendants free admission.  Last year they announced that the policy would end for 2016 in that those with disabilities would be required to pay.  Attendants would remain “free”.

Recently the Toronto Star published an article confirming the change in policy.  The CNE explains that the new policy will: respect “the dignity and independence of all of our guests, including those with disabilities.” However, advocates note that people with disabilities can struggle to earn competitive wages which limits both resources and opportunities, and can result in social and community isolation.  Those advocates give this change a “thumbs down”.

As an occupational therapist and business owner, I think the CNE has made a few mistakes in making this change, and in articulating it.  Here’s why…

I love this comic sent to me by Occupational Therapist Jacquelyn Bonneville:

comic

 

 

 

 

 

 

 

 

 

 

 

 

 

So, if equality is about “sameness” then the CNE has wrongly lumped the community of people with disabilities into the “equal” category.  Yet, it is easy to understand that people with disabilities can have increased difficulties making competitive wages and can be marginalized and secluded based on reduced resources and opportunities for participation in many aspects of daily life.  So, by the CNE saying that the policy respects “the dignity and independence of all our guests” they have wrongly lumped “all guests together” when not “all guests” are equal.  The previous policy was more equitable in that it leveled the playing field in a sense by allowing a more “equitable” experience for people of different means.

Essentially, then, the human issue is that the CNE may now be financially excluding a community who needs leisure more than the average person.  Literature supports leisure participation for all, but even more so for people that have reduced options to take on other commonly productive roles like paid work, volunteering, or even school or parenting.  The previous policy was compassionate and fair, the new policy is not.

From a business perspective, the CNE made another mistake.  They failed to make a logical argument for the change and opened themselves to greater scrutiny.  If they wanted to change the policy because that was a sound business decision (like expenses could no longer support it, they were having a hard time administering the policy, there were privacy and disclosure issues for customers in asking for the free admission, or felt the policy only met the needs of physically disabled people and not people with more “invisible disabilities” etc), then that is different.  In that case, the CNE should have simply said “we have reviewed the policy and while we understand and apologize for the impact this change may have on certain members of our community, our board felt it was in the best interest of the operations and sustainability of the CNE to no longer offer free admission for some customers”.  Or something.  Then, they could have used the announcement as an opportunity to advertise that they will continue to offer the $6 after 5pm fare on Monday to Thursday to keep it financially accessible to a wide range of consumers and that attendants of people with disabilities would remain free.

Of course, they could have been more creative in the first place by developing a “middle ground” policy similar to Hamilton’s Affordable Transit Pass (supports people receiving ODSP or Ontario Works), or could have progressed the policy for a year to “voluntary pay” for people with disabilities to recognize that some can afford it, and may want to pay like “everyone else” at entry.

So, knowing that my readership includes people with disabilities, if the CNE is no longer in the cards for you, or you feel the need to boycott because of the policy change, here are some other “disability friendly” places to consider:

·        Check out all the places that are included in the Easter Seals Access2 Card including:   The Royal Botanical Gardens, The AGO, The ROM, Ontario Science Center, Ripley’s Aquarium, The CN Tower, Great Wolf Lodge and more.

·        The Toronto Zoo offers 50% off admission for people with disabilities.

·        Canada’s Wonderland also has disability-friendly policies, contact them directly for discount information.

·        This resource includes other Toronto Attractions that offer a discount for disabled persons.

I am sure there are others, and if you might qualify for discounts or attendant admissions, consider contacting any park or location before you go to inquire.  I hope that these links will provide my readers with disabilities, or their friends and families, a good start for summer exploring. 

 

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Weekly Mind Bender

As a test you are given a corked bottle with a coin inside it.  You must remove the coin without taking out the cork or breaking the glass, or boring a hole in the glass.  How can you do this and pass the test?

 

Answer

Push the cork in and shake the coin out.

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Text Neck—Are You Guilty?

The posture adopted by many people when leaning over a cellphone while reading and texting is becoming a problem. This bad posture that can put up to 60 pounds of pressure on the upper spine — sometimes for several hours a day, is a growing concern with long-term consequences.  Learn more in the following from The Washington Post and if you are suffering from text neck contact an OT for an individualized solution.

The Washington Post:  Digital disabilities — text neck, cellphone elbow — are painful and growing