Euthanasia. Murder or Mercy?

[erinmckenziejam]

Euthanasia is a very touchy subject, especially within the medical field. As a healthcare advocate, it is our job as professionals to better the lives of our patients. What happens when there is nothing more you can do?

I understand, being a Home Health Aide that works a lot with Hospice, that comfort care is important. But truly, when a suffering patient looks to you to ease the pain what do you do? Should you apologize and say their is nothing more I can do?

I can hardly say no more treats to my cat when he gives puppy dog eyes, much less a patient dying alone of cancer. In my opinion, for what it is worth, Euthanasia is most certainly not murder and should never be referred to as such.

If Euthanasia was legal, but very strict in regulations and rules, it would be very beneficial to many terminally ill patients. This may be the only healthcare decision a patient makes within their life, and they should be allowed to make such a decision when conditions permit. We all have choices in this world, what gives you or I the right to take such choices away from someone in such a situation.

What is your opinion? Do you agree or disagree? Do you have a story, personal or not that pertains to this topic?

Please Let Me Know! I Want To Know!

[psu_213, BSN, RN]

Euthanasia is a difficult issue and it's tough to just narrow it down to either "moral" or "murder." I believe that if someone has a terminal illness, he/she have a right to decide to end his/her life, and that person then can search out a physician, one that may or may not be assisted by nurses, to end that person's life.

Legally, however, it can be very thorny. Do they have to be terminally ill? Who decides that an illness is terminal? What if the person is incapacitated (i.e. the pt. cannot speak for themselves) when they become terminal? Who makes the decision then? Some would argue that a person can have a advanced directive that would say that if they have a terminal condition, the want to be assisted in dying. We come back to who makes the decision that the condition is terminal? I hate to say it, but just look at the Jahi McMath situation. Yes, I know it is not euthanasia that is the issue, but there are several people with MD after their names who testify that Jahi is alive. In a euthanasia situation, if certain family members do not want to end the life of the patient, they will certainly be able to find someone willing to testify that the condition is not terminal.

I terms of a pure ethics question, it may be easy to just have 2 choices, but there is a lot more at play in the situation than that.

[calivianya, BSN, RN]

I watched someone die excruciatingly over seven hours on the first half of my shift a couple of weeks ago, and it has made me really think about the way we treat the actively dying in ICU. We were on the gray line of the patient being DNR, but we were not withdrawing care. As far as I am concerned, DNRs are the same thing as full codes until their heart stops. I will do everything for a living DNR that I will do for a full code. However, in this case, I think I just actively participated in torturing a dying woman.

Family wasn't there, so I COULD have turned the drips off earlier and let her go... and I really wish I had. I was calling at the beginning of my shift about boluses, adding another pressor, getting potassium and troponin levels because of EKG changes, getting some bicarb after a critical bicarb level, and I should have just asked for a morphine drip instead. I have never seen anyone that actively look like they suffered so much. She was on two pressors, maxed by the time she died. Family was aware she was dying, but didn't want to withdraw care and stop treatment - they wanted her to go if she had to, but not be "killed."

There is nothing natural about dying on 20mcgs/hr of dopamine and 30mcgs/hr of Levophed. There is nothing natural about being mottled for hours and turning purple/black at your extremities because you should be dead but the drugs are keeping you alive. There's nothing natural about pupils being fixed and dilated almost an hour before the heart stops because the drugs just won't let the heart go. And, there is nothing natural about the way her eyes and mouth wouldn't close, her agonal breathing so strong her shoulders were jerking her off the bed, the way the BiPAP broke every single capillary in her face underneath the mask. She seriously looked worse than some of the extras I've seen in The Walking Dead before her heart finally stopped, all with no morphine drip to make her comfortable, and I wish I'd done something about it earlier. I feel tainted just from being a part of letting her suffer for so long.

Euthanasia is definitely mercy, and in hindsight, if I had absolutely known she wasn't going to make it until morning for her family to get there, I would have seriously thought about doing it myself. I should have at least turned off the drips after all neuro things I could measure were gone, at least.

[dudette10, MSN, RN]

I have seen three people--friends/family, not pts--die on hospice in the past two months, and they were extremely peaceful deaths. Morphine drips to take the pain of breathing away, and they eventually just stopped breathing.

to make it more palatable for the masses, the national conversation has to turn away from euthanasia, and instead to hospice. Hospice care was the best invention for the terminally ill ever created.

[Here.I.Stand, BSN, RN]

I don't think I could actively euthanize someone--e.g. give a push dose of KCl or a massive dose of IV insulin with the purpose of ending the life. It's not up to me when someone dies. And for more selfish reasons, I won't risk my freedom over euthanasia in a state where it's illegal.

That said, as an ICU nurse I think the extent to which we go to maintain VS can be downright cruel--and "playing God" just as much as actively killing someone. I have zero issues with extubating someone and giving whatever morphine the patient needs to stop the pain, and to stop the air hunger. In cases like that, it really is the disease or injury that causes the death. I won't withhold pain medication in the terminally ill.

The intent is really the difference in my opinion. I won't give an injection with the purpose of killing someone, but I would give that same injection for pain relief with zero hesitation--even knowing that it *could* suppress respiratory drive. In fact, I have given that last dose of morphine and the pt died minutes later; I never felt a twitch of guilt over it.

[OCNRN63, RN]

I watched someone die excruciatingly over seven hours on the first half of my shift a couple of weeks ago, and it has made me really think about the way we treat the actively dying in ICU. We were on the gray line of the patient being DNR, but we were not withdrawing care. As far as I am concerned, DNRs are the same thing as full codes until their heart stops. I will do everything for a living DNR that I will do for a full code. However, in this case, I think I just actively participated in torturing a dying woman.

Family wasn't there, so I COULD have turned the drips off earlier and let her go... and I really wish I had. I was calling at the beginning of my shift about boluses, adding another pressor, getting potassium and troponin levels because of EKG changes, getting some bicarb after a critical bicarb level, and I should have just asked for a morphine drip instead. I have never seen anyone that actively look like they suffered so much. She was on two pressors, maxed by the time she died. Family was aware she was dying, but didn't want to withdraw care and stop treatment - they wanted her to go if she had to, but not be "killed."

There is nothing natural about dying on 20mcgs/hr of dopamine and 30mcgs/hr of Levophed. There is nothing natural about being mottled for hours and turning purple/black at your extremities because you should be dead but the drugs are keeping you alive. There's nothing natural about pupils being fixed and dilated almost an hour before the heart stops because the drugs just won't let the heart go. And, there is nothing natural about the way her eyes and mouth wouldn't close, her agonal breathing so strong her shoulders were jerking her off the bed, the way the BiPAP broke every single capillary in her face underneath the mask. She seriously looked worse than some of the extras I've seen in The Walking Dead before her heart finally stopped, all with no morphine drip to make her comfortable, and I wish I'd done something about it earlier. I feel tainted just from being a part of letting her suffer for so long.

Euthanasia is definitely mercy, and in hindsight, if I had absolutely known she wasn't going to make it until morning for her family to get there, I would have seriously thought about doing it myself. I should have at least turned off the drips after all neuro things I could measure were gone, at least.

Would you please explain this? It sounds like you're saying you would violate a DNR.

[MunoRN, RN]

I watched someone die excruciatingly over seven hours on the first half of my shift a couple of weeks ago, and it has made me really think about the way we treat the actively dying in ICU. We were on the gray line of the patient being DNR, but we were not withdrawing care. As far as I am concerned, DNRs are the same thing as full codes until their heart stops. I will do everything for a living DNR that I will do for a full code. However, in this case, I think I just actively participated in torturing a dying woman.

Family wasn't there, so I COULD have turned the drips off earlier and let her go... and I really wish I had. I was calling at the beginning of my shift about boluses, adding another pressor, getting potassium and troponin levels because of EKG changes, getting some bicarb after a critical bicarb level, and I should have just asked for a morphine drip instead. I have never seen anyone that actively look like they suffered so much. She was on two pressors, maxed by the time she died. Family was aware she was dying, but didn't want to withdraw care and stop treatment - they wanted her to go if she had to, but not be "killed."

There is nothing natural about dying on 20mcgs/hr of dopamine and 30mcgs/hr of Levophed. There is nothing natural about being mottled for hours and turning purple/black at your extremities because you should be dead but the drugs are keeping you alive. There's nothing natural about pupils being fixed and dilated almost an hour before the heart stops because the drugs just won't let the heart go. And, there is nothing natural about the way her eyes and mouth wouldn't close, her agonal breathing so strong her shoulders were jerking her off the bed, the way the BiPAP broke every single capillary in her face underneath the mask. She seriously looked worse than some of the extras I've seen in The Walking Dead before her heart finally stopped, all with no morphine drip to make her comfortable, and I wish I'd done something about it earlier. I feel tainted just from being a part of letting her suffer for so long.

Euthanasia is definitely mercy, and in hindsight, if I had absolutely known she wasn't going to make it until morning for her family to get there, I would have seriously thought about doing it myself. I should have at least turned off the drips after all neuro things I could measure were gone, at least.

Did you bring up to the Doc that you weren't sure full treatment at that point was appropriate?

[Libby1987]

I watched someone die excruciatingly over seven hours on the first half of my shift a couple of weeks ago, and it has made me really think about the way we treat the actively dying in ICU. We were on the gray line of the patient being DNR, but we were not withdrawing care. As far as I am concerned, DNRs are the same thing as full codes until their heart stops. I will do everything for a living DNR that I will do for a full code. However, in this case, I think I just actively participated in torturing a dying woman.

Family wasn't there, so I COULD have turned the drips off earlier and let her go... and I really wish I had. I was calling at the beginning of my shift about boluses, adding another pressor, getting potassium and troponin levels because of EKG changes, getting some bicarb after a critical bicarb level, and I should have just asked for a morphine drip instead. I have never seen anyone that actively look like they suffered so much. She was on two pressors, maxed by the time she died. Family was aware she was dying, but didn't want to withdraw care and stop treatment - they wanted her to go if she had to, but not be "killed."

There is nothing natural about dying on 20mcgs/hr of dopamine and 30mcgs/hr of Levophed. There is nothing natural about being mottled for hours and turning purple/black at your extremities because you should be dead but the drugs are keeping you alive. There's nothing natural about pupils being fixed and dilated almost an hour before the heart stops because the drugs just won't let the heart go. And, there is nothing natural about the way her eyes and mouth wouldn't close, her agonal breathing so strong her shoulders were jerking her off the bed, the way the BiPAP broke every single capillary in her face underneath the mask. She seriously looked worse than some of the extras I've seen in The Walking Dead before her heart finally stopped, all with no morphine drip to make her comfortable, and I wish I'd done something about it earlier. I feel tainted just from being a part of letting her suffer for so long.

Euthanasia is definitely mercy, and in hindsight, if I had absolutely known she wasn't going to make it until morning for her family to get there, I would have seriously thought about doing it myself. I should have at least turned off the drips after all neuro things I could measure were gone, at least.

That is horrible and I'm sorry for you to have to participate and witness.

The anti euth argument always brings up potential abuse, I wish they'd focus on the inhumane tx that occurs everyday legally. Shameful.

[Libby1987]

Oh and I'm pro euthanasia where there has been legit consent.

[BrandonLPN, LPN]

I have no moral issue with administering high morphine doses to actively dying patients. Few nurses have issue with that, I'd imagine.

But that's not what I think of when I hear the word "euthanasia". That word makes me think of an alert and oriented patient with a terminal prognosis or chronic pain who wants someone to administer a lethal injection. I have major moral misgivings about that, and would not assist in such a scenario even if it were legal.

[Gooselady, BSN, RN]

As healthcare providers it's important for us to wrap our heads around the issue of euthanasia as an issue NOT limited by 'mercy or murder', but more comprehensive than that.

Euthanasia should be 'legal', the personnel highly specialized, and the means generous. A reasonable limit on euthanasia could be that it's a possibility only if the patient has a POLST-like form explicitely giving permission for family/MDs to perform euthanasia, or the patient is conscious and 'of healthy mind' and can ask for it directly. If no such POLST form, and the patient is unconscious, no euthanasia. I'd say the MDs should not have the 'authority' to decide for euthanasia, as they do for a DNR order and comfort care. In my state two consulting MDs can make a family-less person a DNR. Euthanasia should be kept completely separate from standard 'comfort care' or withdrawal of care or DNR status. It should probably be something a person determines for themselves BEFORE the fact, and ought to have a short 'waiting period' before it goes into effect and is 'legal'.

I'm sure I'm missing some important details, but it should be an option *IF* the method is painless and preserves dignity. It should not be 'easy' to get, it should take some over and above effort, possibly including an attorney's involvement.

Making euthanasia 'illegal' is, to me, unnecessary in a modern society. If it's against your religious, social or ethnic ideology(ies), don't do it. If obtaining the 'right' to euthanasia is a deliberate, thoughtful and careful affair, and something MDs cannot decide FOR you as might happen with withdrawal of care/comfort care, then there's nothing to worry about. This 'right' ought not be denied to persons who do not share a religious viewpoint, any more than those with a religious viewpoint want a secular viewpoint thrust upon them.

[calivianya, BSN, RN]

Would you please explain this? It sounds like you're saying you would violate a DNR.

DNR only addresses code status, so the only way to violate DNR is to give chest compressions once the heart stops. There is a major difference between wanting to be allowed to die and not wanting to experience a code. There's no sense in not giving treatment to someone who needs it just because he/she doesn't want his ribs broken, or doesn't want the brain injury that comes from the hypoxia while the heart is stopped, etc. I'm not sure I want that either. I'm pretty sure I'm going to want to be DNR if I end up hospitalized, but I sure as heck don't want to die anytime soon. I would really hope a bunch of people would lose their licenses and could no longer practice as healthcare professionals if I died from something treatable just because I was a DNR.

If a person does not want to be treated, he/she needs to be on an end of life care plan or withdrawal of care, not just be DNR.

MunoRN - I mentioned it, and the physician was very wishy-washy about the whole situation, saying something about the family wanting to be there when she died. I called the family to tell them it wasn't going to be long and if they wanted to see her again, they needed to come right then, but the daughter I talked to said that coming in that night wasn't an option but she really hoped her mother made it until morning. Nobody was quite willing to say it was okay to just make her comfortable, family or physician, so I erred on the side of aggressive treatment just to cover my own butt.