Euthenasia

allnurses Guide · Jul 4, 2003

hmmmm . . . . lots of people looking at this question but not posting.

hmmmmm. . ..

steph

krispynurse · Jul 4, 2003

Dear vettech,

I've always worked with patients (people) not animals. We may have kidded around saying that we were going to do a slow code on a certain patient but when a code happens you take into considerationthe wishes of the patient and the family. Even if you don't agree with this all the time. This is your job as a nurse to follow orders and to do everything humanly and medically possible to not let that patient die. No it's not a very good feeling when you are doing CPR on a 80 year old emaciated sweet little ole lady and you feel her ribs crack under your hands but you do your job. If they didn't want us to our job they would have signed a DNR. And as far as double dosing a patient I can't believe you asked this one.....No I have never double dosed a patient. I have given meds as the doctor has ordered them and this is usually ordered in a way to keep the patient as comfortable as possible until the good Lord feels he/she needs to come home. Does this help you in any way?

gwenith, BSN, RN · Jul 4, 2003

I think this happens less now than it did. It used to be that a code was only for "sudden and unexpected deaths". Over the last 20 years this has changed and now every death is a cardiac arrest/code. This might be a good angle to write your paper from. Do a lit search on Medline for the American Heart foundations guidelines for CPR they came out in '82,'86 and '92 I think. But if you follow this through you will see this slow shift of emphasis within this literature.

Rustyhammer · Jul 4, 2003

I've had MD's tell me to "slow code" a pt. In other words she was a full code but didn't sign the paperwork.

I've never been personally involved with a slow code but I think I wouldn't have a problem if I knew thats what the pt. really wanted.

-Russell

vettech · Jul 4, 2003

Originally posted by krispynurse
Dear vettech,
I've always worked with patients (people) not animals. We may have kidded around saying that we were going to do a slow code on a certain patient but when a code happens you take into considerationthe wishes of the patient and the family. Even if you don't agree with this all the time. This is your job as a nurse to follow orders and to do everything humanly and medically possible to not let that patient die. No it's not a very good feeling when you are doing CPR on a 80 year old emaciated sweet little ole lady and you feel her ribs crack under your hands but you do your job. If they didn't want us to our job they would have signed a DNR. And as far as double dosing a patient I can't believe you asked this one.....No I have never double dosed a patient. I have given meds as the doctor has ordered them and this is usually ordered in a way to keep the patient as comfortable as possible until the good Lord feels he/she needs to come home. Does this help you in any way?

Please, don't misunderstand the concept of "double-effect dosages". The term is commonly used in pro-euthenasia literature. It referrs to a doctor prescribing extremely high dosages of pain killers for the purposes of relieving pain but ignoring the associated risks. It does not refer to giving a lethal dose, as I stated in the question. In other words, when a terminally ill pt is in such severe pain that the "safe" dose prescribed by the FDA is insufficient to relieve the pain so the pt is given a higher dose in order to relieve the pain, but with the knowledge that the pt may suffer life-threatening consequences (i.e. respiratory arrest, hepatotoxicity, etc).

By the way, as you hinted, yes, my having worked with animals for so many years and now switching to working on humans is one of the reasons I picked this topic to write on. However, I also saw my mother die of cancer in 1997. My family and I cared for her as we watched her suffer from debilitating pain and nausea. I watched her spend the last 4 days of her life in dilerium from urea toxicity after her kidneys shut down. She had signed a DNR but that did not help her in her last weeks of life. I knew my mother was in favor of euthenaia and I had to agonize at seeing her suffer, knowing she would end it if she could and knowing I could not help in her greatest moment of need.

As a nurse, both human and veterinary, I have and always will obey orders and do as I'm told. I've had animal pts that have suffered horribly and the clients (owners) wouldn't "let go" and let us end the suffering. I did everything I could to keep my pt alive, despite my personal feelings. And I always will.

Here's a couple of quotes I found very interresting on the topic:

"I am grateful for the advances medical science has made in recent years; neither my wife nor I would be alive today if it were not for them. However, when a person is clearly facing death and has absolutely no hope of recovery, there comes a point where artificial means are no longer prolonging life, but are simply delaying death. I find nothing in scripture that would make us insist on continuing life in such a situation." - Rev Billy Graham

"No decent human being would allow an animal to suffer. It is only to human beings that human beings are so cruel as to allow them to live on in pain, in hopelessness, in living death, without moving a muscle to help them." - Isaac Asimov

"Those who come after us will wonder why we kept a human being alive against his own will when we would have been punished by the state if we kept an animal alive under similar conditions." - British Methodist Minister Rev. Leslie Weatherhead

disher · Jul 4, 2003

If you are looking for an ethical explanation/argument in favour of giving narcotic, then you may want to look at the principle of double effect in Beauchamp and Childress Principles of Bioethics. 4th ed.

Also there was an excellent post on this topic by a poster in nursenet listserv, PM if you cannot locate it.

allnurses Guide · Jul 4, 2003

I've found the following organization very helpful in my quest for answers regarding this subject.

http://www.biotechpolicy.com/BiotechPolicy/ChannelRoot/Welcome/AboutTheCouncil/

Lots of archived articles . ..

steph

Nurse Ratched, RN · Jul 4, 2003

I have never personally been involved in a slow code. I do my best to advocate for my patient who is without hope of long-term survival to make sure they are not put in the position of having to be coded when it's pointless to do so.

Ideally, we bring these topics out in the open with patient and family prior to the moment of death so that someone's passing can be peaceful, not full of activity designed to tear up a body that has outlived its usefulness.

CHATSDALE · Jun 28, 2004

When I First Started Nursing (20 Yr Ago) There Were A Lot Of Slow Step Codes But Now There Are Not Because Families Are Educated To The D N R Facts Of Life And Many People ,myself Included, Would Not Want To 'die Of Suffering' As I Have Seen Many Pts Do. Bottom Line Is The Only Way We Know What The Pt, Or Fly , Want Is For A No Code Vs Do All That Is Necessary Is For Us To Have A Written Order...

pghfoxfan · Jun 28, 2004

I think that many people treat their dying animals with more dignity than a family member. We don't let dogs suffer, why should we let a loved one?

The bottom line is the vast majority of people do NOT want to live to be a burden to their families. They DO NOT want to be kept alive on ventilators and tube feedings when there is no hope for a meaningful recovery.

moia · Jun 29, 2004

I don't believe in slow codes...if anyone suggests it it means no code to me and that means someone needs to get a DNR or here in canada we have the right to deny treatment that has no purpose except to prolong death...we have absolutely no obligation to perform a code even if a patients family wants it...if the only thing a code is going to do is prolong death we dont do it...so nope to slow codes.

I also don't believe in the too much pain drugs killed them theory...its myth and bs and anyone who has any pain education already knows it.....this ridiculous belief that pain medication will stop them breathing comes from uneducated people more concerned with how it "looks" than how the patient feels.

We are all so brainwashed about the evil of drugs we are scared to give them....

They stopped breathing because they died...the drugs didn't kill them...the disease process did.

we don't euthanize...we let people die...our only interventions are to try to make that process as pain free as possible.