Palliative Care and Euthanasia

  1. Hi everyone,

    This is my first time posting on allnurses.com. I am a final year nursing student at Napier University, Edinburgh.

    Part of my coursework involves selecting one of the World Health Organisation palliative care principles. I have chosen 'intends neither to hasten or postpone death.' My essay will provide a literature review and analyse wether euthanasia has any place within palliative care - What are your views on this?

    How does the above discussion relate to clinical practice?
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  2. 92 Comments

  3. by   saribeth
    phew...in my point of view euthanasia has noooooooooo place in palliative or hospice care Welcome from across the pond! Bet you have an awesome accent! Good luck with your essay
  4. by   leslie :-D
    as already stated, euthanasia plays no part in hospice whatsoever....NEVER!
    there are many nurses who hesitate to give a dying pt morphine, fearing the morphine will kill them.
    yet as long as your intent is to relieve suffering, then you will not be held liable for anything.
    another important point is it's the disease process the pt. succombs to and not the morphine.
    can the morphine (or whatever narc is being used) hasten the death? yes.
    but when one is in pain, the hormones in your body (cortisol, adrenaline) have escalated to a point where the body just cannot relax. these stressors only serve to exacerbate the existing illness. once the pain has resolved, then the true nature of the disease itself is what the pt. dies from, and not the morphine (i'm using ms04 as the prototype).

    leslie
  5. by   Spidey's mom
    I agree. And will reiterate that euthanasia has no place in palliative care.

    steph
  6. by   sbic56
    Quote from earle58
    as already stated, euthanasia plays no part in hospice whatsoever....NEVER!
    there are many nurses who hesitate to give a dying pt morphine, fearing the morphine will kill them.
    yet as long as your intent is to relieve suffering, then you will not be held liable for anything.
    another important point is it's the disease process the pt. succombs to and not the morphine.
    can the morphine (or whatever narc is being used) hasten the death? yes.
    but when one is in pain, the hormones in your body (cortisol, adrenaline) have escalated to a point where the body just cannot relax. these stressors only serve to exacerbate the existing illness. once the pain has resolved, then the true nature of the disease itself is what the pt. dies from, and not the morphine (i'm using ms04 as the prototype).

    leslie

    I like what you had to say here, but can't it still be said that this explanation is a rationalization for giving the MS for comfort when in fact you are causing death? I remember a personal situation with a family memeber where I wish the nurse would have thought the way you do. (Wouldn't give the MS just because resps were below 10 :angryfire )

    BTW, I believe euthanasia certainly would play a part in hospice if the patient truly desires it.
  7. by   leslie :-D
    Quote from sbic56
    I like what you had to say here, but can't it still be said that this explanation is a rationalization for giving the MS for comfort when in fact you are causing death? I remember a personal situation with a family memeber where I wish the nurse would have thought the way you do. (Wouldn't give the MS just because resps were below 10 :angryfire )

    BTW, I believe euthanasia certainly would play a part in hospice if the patient truly desires it.
    i've had pts w/resp below 10 and still gave the mso4 because of prolonged and agonizing pain. the fact remains is that it's the disease process that kills the patient and yes , morphine will hasten death. and it can cause death in a pt w/a hip replacement because that pt is not terminal. but in a terminal pt, late-stage that is suffering, it is the pathophysiology that will take over once that pain has dissapated.

    a few years ago, i had a long talk with a member of the legal dept from the mass. nurses association. she is the one that said "as long as it is your intent to relieve suffering then there is no liability for the nurse".

    a few yrs back also, i had a pt return from the hospital as cmo. so she was one of my hospice pts. the nm on the gen'l floor (will never know why) verified and changed meds (w/md's approval) from a duragesic patch and mso4 to es tylenol!!!!! :angryfire this pt. had a mastectomy and was dx'd with mets to the bone. she had always been a stoic, independent woman who always said "everything's fine". so in the hospital the summary had indicated her pain was well managed. the nm at our facility evidentally told her primary that she WASN'T in pain thus the reason for dc'ing the patch and the roxanol.
    i scurried to this pt's room and she cried to me "louise (mod dementia) i hurt, i hurt!" i promised her i'd take care of her asap. i called her md within 1 minute, had him paged and informed him of the pain. he said the nm had told him she wasn't in pain (mets to the bones.) so after i told him of what this pt said to me, he prescribed a very commendable order for scheduled and prns. i gave it to her a/o (q2-3h) and it was the last dose of mso4 she finally reported relief and died within the hour.
    now i had given her pretty hefty amts as the md was quite generous and unafraid to prescribe what he did and i took full advantage. even when her resps were 6-8 i was still giving it-no parameters. but it took all that mso4 and oxyfast to get her pain under control. so yes, i could say i hastened her death but she was pain free and her last words (as she cried w/her dtr present) "thank you louise, thank you, thank you, i love you".
    her dtr had asked me if she was getting too much. i asked her dtr if she thought her mum was still in pain and she agreed yes.
    so i gave the dtr a choice; that we can get mum comfortable but will die quicker or have her in pain and linger/suffer. of course the dtr didn't want to see her mum in pain.

    so i did not administer the quantities that i did to kill her but to relieve her pain; nothing more, nothing less. and once all of the roxanol and oxyfast finally took its' effect, her body and the subsequent stressors from the pain, could finally relax and she died from her metastatic ca.

    euthanasia's goal is to actively assist in helping someone die.
    that is never the mission or the goal in hospice. hope i didn't confuse you.

    leslie
  8. by   sbic56
    leslie

    I am with you all the way on this. Thanks for taking time to make the nice post explaining the exemplary care you gave to that woman. You were a wonderful advocate. I am more playing devil's advocate, as one could say by hastening death, despite your intent, that you were performing euthanasia. I'm not saying that. I totaly believe in whatever is necessary to achieve comfort for the dying patient. I applaud your practice and common sense.
  9. by   gwenith
    Euthanasia's original meaning was "gentle death". I can think of no higher purpose in a terminal situation than to ensure a "gentle death" for those who would otherwise be sentenced to horrible and painful lingering demise. I just wish we could get the original meaning back to the word euthanasia but it is too late now.
  10. by   sbic56
    Quote from gwenith
    Euthanasia's original meaning was "gentle death". I can think of no higher purpose in a terminal situation than to ensure a "gentle death" for those who would otherwise be sentenced to horrible and painful lingering demise. I just wish we could get the original meaning back to the word euthanasia but it is too late now.
    I agree. It is for those who agree with the original meaning of euthanasia, that it should be an option. It is not a dark and immoral practice, but to many just the opposite. Just as it is accepted that there is no consensus as to what is right in life, there should be the understanding that there is no one right way in death.
  11. by   ladybird1292
    Quote from earle58
    i've had pts w/resp below 10 and still gave the mso4 because of prolonged and agonizing pain. the fact remains is that it's the disease process that kills the patient and yes , morphine will hasten death. and it can cause death in a pt w/a hip replacement because that pt is not terminal. but in a terminal pt, late-stage that is suffering, it is the pathophysiology that will take over once that pain has dissapated.

    a few years ago, i had a long talk with a member of the legal dept from the mass. nurses association. she is the one that said "as long as it is your intent to relieve suffering then there is no liability for the nurse".

    a few yrs back also, i had a pt return from the hospital as cmo. so she was one of my hospice pts. the nm on the gen'l floor (will never know why) verified and changed meds (w/md's approval) from a duragesic patch and mso4 to es tylenol!!!!! :angryfire this pt. had a mastectomy and was dx'd with mets to the bone. she had always been a stoic, independent woman who always said "everything's fine". so in the hospital the summary had indicated her pain was well managed. the nm at our facility evidentally told her primary that she WASN'T in pain thus the reason for dc'ing the patch and the roxanol.
    i scurried to this pt's room and she cried to me "louise (mod dementia) i hurt, i hurt!" i promised her i'd take care of her asap. i called her md within 1 minute, had him paged and informed him of the pain. he said the nm had told him she wasn't in pain (mets to the bones.) so after i told him of what this pt said to me, he prescribed a very commendable order for scheduled and prns. i gave it to her a/o (q2-3h) and it was the last dose of mso4 she finally reported relief and died within the hour.
    now i had given her pretty hefty amts as the md was quite generous and unafraid to prescribe what he did and i took full advantage. even when her resps were 6-8 i was still giving it-no parameters. but it took all that mso4 and oxyfast to get her pain under control. so yes, i could say i hastened her death but she was pain free and her last words (as she cried w/her dtr present) "thank you louise, thank you, thank you, i love you".
    her dtr had asked me if she was getting too much. i asked her dtr if she thought her mum was still in pain and she agreed yes.
    so i gave the dtr a choice; that we can get mum comfortable but will die quicker or have her in pain and linger/suffer. of course the dtr didn't want to see her mum in pain.

    so i did not administer the quantities that i did to kill her but to relieve her pain; nothing more, nothing less. and once all of the roxanol and oxyfast finally took its' effect, her body and the subsequent stressors from the pain, could finally relax and she died from her metastatic ca.

    euthanasia's goal is to actively assist in helping someone die.
    that is never the mission or the goal in hospice. hope i didn't confuse you.

    leslie
    Wow, I'm impressed with this thread. I am a final year nursing student in Aust, and I am planning to enter Pallative care. Very powerful and to the point. I also have done an assignment on this issue and also know that the goal must be to relieve pain to intentionally cause death is murder, but to relieve pain and hence hasten the inevitable is ok, a nurse must be very clear about this, and the intention when giving the medication. I have just recently completed another assignment regarding pain and wound managment. My research indicates that often Doctors are usually conservative in their med orders, and nurses are further conservative, leading to the pt not receiving adequate pain relief. Congratulation on being a pt advocate.
  12. by   studious
    Quote from bracken
    Hi everyone,

    This is my first time posting on allnurses.com. I am a final year nursing student at Napier University, Edinburgh.

    Part of my coursework involves selecting one of the World Health Organisation palliative care principles. I have chosen 'intends neither to hasten or postpone death.' My essay will provide a literature review and analyse wether euthanasia has any place within palliative care - What are your views on this?

    How does the above discussion relate to clinical practice?
    |
    Last edit by studious on Apr 18, '05
  13. by   soapynurse@adel
    Sadly, I'm retiring from hospice where I had really found my niche. But that's another story entirely.

    I absolutely agree that the patient should be given whatever it takes to make them comfortable (titrate to comfort). Our docs were very good about that and families understood that, yes, the meds may hasten things, but they preferred their loved ones to be comfortable, bottom line.

    I did work with some nurses who were almost stingy with the MSIR & Lorazepam. I tended to be pretty aggressive and it worked for me. I was also very aggressive with bowel regimes as I hated to dis-impact someone because 1. It is so indignant for the patient, so invasive and 2. it's not necessary to do this if following a good bowel regime from the start. Oh yes, the magic poop pills were wonderful, but didn't always work.

    I learned so much and really wish I didn't have to give it up. I leave it with some wonderful memories and confidence that I did a good job.

    Keep up the good work everyone.

    Alice in Virginia
  14. by   talaxandra
    Intent is at the heart of the Doctrine of Double Effect, a Jesuitical concept which allows Catholic carers to administer pain relief even where death is a known potential result, provided the administrators' intent was to relieve pain.
    The alternative would be (as Mother Theresa practiced) withholding pain relief from the dying. (Her rationale was allegedly that pain and suffering are good for the soul).
    As Gwenith pointed out, before asking whether euthanasia plays (or ought to play) a role in palliative care, you will need to define what you mean by 'euthanasia'. If you mean 'a good death' then that's what lies at the heart of palliative care theory. If you mean 'deliberately bringing about an earlier death at patient request' that's a meatier question, and if you mean something like 'ending a patient's suffering without invitation' or 'ending the life of one who's life is not worth living' then you're in very murky water indeed.
    Good luck - it's a really interesting area to research, write about and work in

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