Drawing a Line Between Pain Relief and Assisted Suicide

  1. Read this article about Drawing a Line Between Pain Relief and Assisted Suicide.
    http://abcnews.go.com/sections/livin...ing991015.html

    Then come back and post your viewpoints in this forum, by clicking on the "Post Reply".

    The article states "Indeed, a study last year found one in four elderly cancer patients in nursing homes received no treatment for daily pain."

    Do you find that your patients are treated adequately for pain?




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    Brian Short
    WORLDWIDE NURSE: The Internet's Nursing Directory
    wwnurse.com/

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  2. 11 Comments

  3. by   ecb
    Most nurses would check resperations before administering a narcotic, I have had end stage people who are in pain, but the meds were only ordered for Q1-2 hours, and excreated out every 2 hours, and we checked resps before giving.

    I have another resident now who is getting a med in shorter intervals than is technically safe, but she is VERY resistant to the drug (all of em actually) and her rsps do not go down below 16 let alone 10.

    I wish MDs were taught about different kinds of pain, I spend so much time trying to teach that sometimes Tylenol does a better job than Dilauded, and get looked at like I am NUTS (until they try it)

    and if someone is looking for comfort measures, then we should keep them comfortable, if they think we can cure them, we have an obligation to treat them well past any reasonable point because that is our job, WE know we cannot get a contracted atrophied tube fed person OOB and walking, but the famalies and the residents (before all this happens) do not understand. And the euthenasia press makes most of us "Professionals" afraid to educate people, they DO take it wrong when you bring up an advanced directive most of the time.

    I am 34 and have one, as does my father, and after doing his and mine, our 84 year old Lawyer has one too. None of us anticipate needing it, but i will NEVER want my kids to have to come see that I have no sores, or weather or not my TF is being flushed to ensure no dehydration or impaction sets in. I make a point of being sure that does not happen on my time, but i burn out fast if there are corporate or facilety wide problems that lower the minimum standard of care to below mine.

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    *** May we all have the serenity to accept what we cannot change, and the determination to change what we cannot accept. ***
  4. by   mn nurse

    One of the things missing in the article is a discussion between the health care team and the patient/family about the patient's goals. I believe the choice between adequate pain relief (and the associated risks) and tolerating some degree of pain in exchange for a higher level of function belongs to the patient. I have had some choose "no pain, no matter what" and some choose to tolerate the pain in exchange for being more alert and interacting more with their families, and I believe they all chose well for their individual situations. This cannot be legislated.

    The nurses and physicians need to educate themselves and then advocate for their patients in order to help their patients achieve their desired outcomes. If the patient's goal is "no pain", then you do whatever it takes...

    Would I deliver an overdose intended to end a patient's life? No. Would I give additional morphine to a patient whose respirations were 10 if the patient were uncomfortable and the family knew the risk and still wanted to go ahead? Yes, I would.

    [This message has been edited by mn nurse (edited October 18, 1999).]
  5. by   robina
    The surgical floor on which I work is very conscience of Patient pain. This is assessed every hour. Medication, if not continuous, is administered at least every four hours for the first several post op days. Patient's heal faster when pain is under control. This is such a simple fact, yet it is often overlooked by many.
    Education is also very important; both pre-op and post-op. The patient and family have every right to know what to expect. Discussions on what is acceptable discomfort is included as well as pain control options are included in patient teaching. To do otherwise borderlines on neglect.
  6. by   jbresolin
    the line can be drawn at intention. Secondary euthanasia occurs subsequent to pain control. The intention is not to end life. ECB mentioned discussing advanced directives, hopefully it can be started as an outpatient with primary provider when thoughts and emotions are more stable. The patient and family can give some indication of goals. If providers take that into account and understand the meaning of PASSIVE EUTHANASIA the Pain Relief Promotion Act should help.
  7. by   tinkertoys
    I agree that there needs to be a determination whether or not the pt wants maximum pain relief at the expense of degree of alertness, and relief given accordingly. True, respiratory depression, constipation, and other side effects of analgesics need to be considered, but when you are caring for a dying patient, these side effects may, truthfully, be irrelevant. I believe that it is important that loved ones need to understand the possible consequences of the analgesia before it is given, and good documentation should be done. In my experience, most have chosen relief of pain, even at the risk of hastening death.
  8. by   sandygator
    I personally believe in assisted suicide where terminal disease or quality of life is at issue and find it an extremely distasteful invasion of ones privacy to have this personal physician/patient/family decision being legislated at all!
    EVEN with a patient's or family member's understanding of the possible, secondary effect of analgesia being respiratory arrest,(because if they do not understand
    and approve, it's murder) it is still assisted euthanasia! No matter how you justify it.
    When the parents of a terminally ill/injured child decide to spare that child further suffering by requesting that ventilatory support be withdrawn, I have many times seen a dose of pentothal or morphine ordered to relieve their respiratoy agony. The child is dying....and would die...suffering...otherwise.
    And technically, I imagine, this is illegal.
    If a person has a terminal illness, how can it be called suicide?
    It is a shame that physicians are now threatened by litigation if they treat a patients suffering. THAT'S what legislation has already done.
  9. by   traumaliz
    re: adequate pain control---I work in a multitrauma critical care unit and can honestly say that our patients, no matter what the diagnosis, DO have excellent pain control.. We work on the assumption that, even if unable to communicate, there are pain issues. We have a pain management team,who do an excellent job. When a family decides to withdraw support, we provide adequate pain and anxiety relief, but not to the point of assisted suicide. I'm proud to say that, in almost every pt. situation, we are successful with pain control, as verified by both patient and family.

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    Liz
  10. by   lyraesullivan
    Euthanasia? If the patient is dying how can it be euthanasia? Should our patients have to suffer to soothe our sensibilities? Are you afraid to make your patients comfortable in fear you might hasten their death? Why live a day or even only hours longer if every minute is agony? If it was me I'd choose pain relief over a few hours of life. As previously stated it should not be the medical personnels choice to make, if the patient is able to make the decision or if not then the family. Too many people have died a slow death in agonizing pain because doctors don't know how or just won't properly prescribe or caregivers won't administer properly. Quality of life over quantity please.
  11. by   LAS
    I think that you need to look at the
    intent of actions. There is a big
    difference in giving someone an
    injection with the intention of
    ending someone's life and providing
    medication that is going to treat
    pain and alleviate suffering.
  12. by   jbresolin
    I agree with LIZ and LAZ
    Primary intent when giving
    meds is valid. If we fail to
    understand the purpose of a
    medication and make it explicit,
    we are not practicing consciously.
    Caring for terminal patients
    includes helping them arrive at
    closure and understanding of the
    meaning of their life. If we trivialize
    the meanings of what we do, how long
    can our job make sense to us? How we
    define and understand what we do
    makes a big difference.
  13. by   MollyJ
    The media article cited reflects the politicalization of what should be a patient/family/doctor based decision. All of us know that, in the case presented in the article, we would give morphine to relieve pain within the patient's and family's desires and with sensitivity to respiratory depression issues BUT all it takes is this man's son/daughter flying in from far away, laden with guilt, determined to "save daddy" and suddenly things are being looked at and distorted, when everyone thought that the team and the family were on the same page.
    In KS, where I am, we had a doc get charged with murder for using pain meds in a terminal case AND another case which involved an elderly man with a fresh CVA. Clearly, communication issues were central in the case.
    Death and impending death hits at the center of all that we are and brings out the ambivalence in all of us. I truly feel that INTENT makes all the difference in these cases, too, but intent didn't initially help the KS doc cited above. This will continue to be an issue for a society who believes that death is an unnatural act and an unneccessary ending.

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