[csason]

The problem I experienced here in Florida, especially dealing with CHF in a
Med/Card floor was physicians (and the nurses who administered) 'sleeping
out' end stage CHF patients..

There probably are many situations where the patient, if they knew
where they were going, would want to speed it up, but the subject isn't even broached for the legal (and moral) ramifications..

[Indy]

Originally Posted by OldMareLPN

"AB 2747 allows a physician assistant or a nurse to opine that a patient is 'terminal,' and then push for unnatural death by 'palliative sedation,'" said Randy Thomasson, chief of the Campaign for Children and Families shortly after the vote.


read more...

Ok well the news article that contained the link is terrible. I did pay special attention to the part of the bill that defined "healthcare provider" and I see that it's not, thank goodness, asking nurses to come up with a prognosis for the patient. Just physicians, nurse practitioners, and physician assistants. So in any case, they're not changing the nurse practice act for california, and that's a relief.

As for the rest of the argument, I don't have anything new to say except it's sad that we need a law anywhere to force doctors to have appropriate hospice conversations with their terminal patients.

[azhiker96]

I've only been a nurse a short time but my wife has been a nurse about 30 years and has been in Hospice for over 18 years. Her thoughts on hospice is "We all have to die, we just don't have to die screaming." She has told me of days before hospice in Oregon when patients would literally be screaming in pain because docs were too timid in prescribing pain meds.

Some people want to fight for life every minute they can. Others prefer to call a cease fire and enjoy the best quality of life they can until they die. This bill looks like it just requires the patient be told of the second option.

As a professional, I support my patients' right to choose their care and to refuse care. They may choose differently than I would in the same situation but I don't have the right to impose my reality on them. Instead, I should make sure they have all the information needed to make an informed decision.

[wymnwise]

Wow! I have to say I would not have expected this sort of conversation here. Active euthanasia is nothing new, and passive is as one person pointed out cruel. It has been called pain management, but enough morphine to kill has been provided even in Catholic hospitals forever. Docs have given patients medications and told them very clearly, what a lethal dose would be for the purpose of those folks availing themselves of a timely death. There often comes a point where one has to make a choice b/w excessive pain or cognitive dysfunction, the only other option is death.
When my mom passed I was asked if I wanted a feeding tube for her. I said, no but I do prefer active to passive. A few hours latter enough morphine was administered that mom passed while the injection was being given. In a Catholic hospital. My only regret is that I was not brave enough to do it at home for her with the help of hospice. At home where she wanted to be. When I could not reach them I called in when she slipped into the comma. In spite of being a faithful Christian, mom had said good by the night before (I realize that now.) and dosed herself with liquid morphine the next morning but only managed enough to achieve a comma not passing.

[heron]

[quote=wymnwise;3097483]Wow! I have to say I would not have expected this sort of conversation here. Active euthanasia is nothing new, and passive is as one person pointed out cruel. It has been called pain management, but enough morphine to kill has been provided even in Catholic hospitals forever. Docs have given patients medications and told them very clearly, what a lethal dose would be for the purpose of those folks availing themselves of a timely death. There often comes a point where one has to make a choice b/w excessive pain or cognitive dysfunction, the only other option is death.
When my mom passed I was asked if I wanted a feeding tube for her. I said, no but I do prefer active to passive. A few hours latter enough morphine was administered that mom passed while the injection was being given. In a Catholic hospital. My only regret is that I was not brave enough to do it at home for her with the help of hospice. At home where she wanted to be. When I could not reach them I called in when she slipped into the comma. In spite of being a faithful Christian, mom had said good by the night before (I realize that now.) and dosed herself with liquid morphine the next morning but only managed enough to achieve a comma not passing.[/quote)


Dear wymnwise, I'm so sorry about your mom - I hope you are finding some peace.

I have to confess that I'm having some difficulty understanding your post. The details of your experience are none of our business ... seems like it's still a pretty painful subject. You certainly don't have to justify or explain yourself beyond what you've already shared, so don't feel obligated to engage with me unless you want to, especially if it's still hurting.

I just want to say that I agree that medically assisted suicide has been going on since there was a medical profession. I just don't see comfort care as the same thing as euthanasia, whether active or passive.

In hospice, when we are faced with extreme, intractable suffering that we are obliged to relieve, we really have to do a serious examination of conscience. This is because intent is all. Is an intervention being undertaken with the intent to relieve suffering or the intent to kill?

Intellectual hairsplitting? It certainly is. Hospice caregivers walk with our patients and their families right up to the veil between life and death. The best of us know that we cannot do this carelessly or dishonestly. We cannot afford to deceive ourselves about the necessity of death or about our own motivations. Meanwhile, we remain fallible humans ... doing the best we can ...

... the same as you. Even without knowing any more about your situation, I can see that you gave it all you could. You have nothing to regret.

[wymnwise]

There is a universal taboo in our culture and law against suicide. The problem with law is this universal nature. It is a rare principle that justly applies to every context. The personal is political, in this case medical ethics. I just tend to draw on personal experience in elaborations. My point was that, I also live in Oregon. I value our patient directed end care law. It just seems to me that once managed care no longer meets the patients needs; well, it is their life. Sometimes the intent to kill and the intent to limit suffering amount to the same thing. We just need to know this is the last resort for relief; that is that we have offered the patient all that can be offered.