Assisted Suicide

Trauma Columnist · Mar 18, 2004

I would not actively assist in suicide. However, I know that by giving narcotics, I may depress a pts breathing...but pain needs are paramount. Don't remember who posted this, but what is "agressive hospice?" Never heard that one.

hogan4736, BSN, RN · Mar 22, 2004

I would not actively assist in suicide. However, I know that by giving narcotics, I may depress a pts breathing...but pain needs are paramount. Don't remember who posted this, but what is "agressive hospice?" Never heard that one.

An example of agressive hospice: (I am okay with it)

(actually happened to me last week)

I am working on a Sunday in a LTC setting...John Doe (my patient) was admitted last week, and has had a horrific week of not eating, and living a slow death, if you will...

He was admitted to hospice on Friday, two days ago. I just gave him his two ordered Vicodin (prn) 15 minutes ago, and his MS IR this morning. The hospice nurse makes her daily visit w/ John and his familiy. She comes out to my med cart and says "John is in pain, he was moaning." I reply, "yes, I know, I just medicated him."

Hospice nurse says, "okay, I'll get an order for sublingual MS, q one hour."

The hospice nurse writes the order (calls doc later, sometimes not at all...not a problem though :) ) and I give it. She visits w/ the family for another hour, asks me again if I could now give it, I gladly comply, and the patient dies 3 hours later (pain free thankfully)...

That's agressive hospice, AND legal euthanasia.

I repeat, I THINK IT'S OKAY...

If you disagree, then our debate (from my perspective) is one of semantics only.

I mean, it's the "elephant in the living room" discussion...

:coollook:

sean

jemb · Mar 22, 2004

Ninas is this research for another article?

Exactly what I thought. Why else would a writer, who is not a nurse, ask this question?

Ninas?

ninas · Mar 22, 2004

Exactly what I thought. Why else would a writer, who is not a nurse, ask this question?
Ninas?

You are right. I am not a nurse. However, my editor at the nursing publication for which I was assigned the article says, "Nurses will be faced with this question, so what should they do?" Doesn't it make sense, then, to ask nurses directly what their opinion is on this controversial subject?

sjoe · Mar 23, 2004

You are right. I am not a nurse. However, my editor at the nursing publication for which I was assigned the article says, "Nurses will be faced with this question, so what should they do?" Doesn't it make sense, then, to ask nurses directly what their opinion is on this controversial subject?

Yeah, but you would be trusted more if you had said that in your first post, right?

To answer your question, IF the nurse has enough time, he/she can explore with the patient exactly what this person means, then do a social work AND a psych referral, as well as full charting and a memo to the relevant MD, so that all bases (and butts) are covered.

If the nurse does NOT have enough time (which is usually the case), the first step (exploring the meaning with the patient) can be skipped, but not the others.

IMHO.

vanburbian · Mar 23, 2004

"aggressive hospice"~ i haven't heard it called that, but yes, it is practiced with some regularity, perhaps you are more familiar with the less distasteful term "comfort measures".

i work in oregon, where thank god, assissted suicide is legal. i worked in oncology- FYI, we were never asked nor expected to assist a patient in suicide while they were in the hospital- this is something they have to do at home, on their own, with family/loved ones help. if i were asked though, i would have no qualms about doing it, as long as i was certain in my own mind that this was the patients desire.

as far as treating pain, i agree it's of the utmost importance, and if you're aware of that too, then great- you can treat it, and treat it well, but a patient may still decide it is time to go. pain IS NOT the only measure of a satisfactory life. consider other things that you, and most of us, take for granted.

can you wipe your own butt?

can you eat WHAT you want? swallow it?

can you still read?

walk?

are you so weak that even talking is a chore?

are you restricted so severely that you can not eat or drink anything without aspirating?

has the cancer eaten away at your skin so much that even you can't stand the smell anymore?

can you scratch your own nose?

walk out in your garden?

decide for yourself what you want to wear today?

this list goes on and on, think actively about every single action you take tomorrow, and every decision you make, and decide if this is something you are willing to accede to others.

these, and many other "quality of life" issues, are what factor in as deciding measures for those who choose to end their life when they are ready.

for me, personally, i want to be able to choose the day, what music i hear, who is with me, and which window i look out of, or beach i sit on, or mountain whose view makes me breathless.

i want my death to be "midwived", just like a birth is.

i want to make those choices while i still can.

and i say this after watching too, too many deaths where that choice was either taken from the participant by way of disease, or by well meaning others who thought they knew what was best.

respectfully, and wholeheartedly in agreement with assisted suicide,

sheri escalante, RN,OCN

hogan4736, BSN, RN · Mar 23, 2004

hoops,

bravo for your intelligent and HONEST insight (and for talking about that elephant :) )

unfortunately, most nurses are offended that we would call hospice assisted suicide (in the most terminal cases)

when I see a spade, I recognize it as a spade...

others see it as a shovel, a weapon, etc...

Thanks for your honesty, something many nurses are afraid to express

sean

adrienurse, LPN · Mar 23, 2004

I didn't always think this way but I am now in the mindset that the need for assisted suicide is an indicator that there is a lack of support and symptom control. Not that I think people should be denied the right to exit the world on their own terms.

Agnus · Mar 25, 2004

An example of agressive hospice: (I am okay with it)
(actually happened to me last week)
I am working on a Sunday in a LTC setting...John Doe (my patient) was admitted last week, and has had a horrific week of not eating, and living a slow death, if you will...
He was admitted to hospice on Friday, two days ago. I just gave him his two ordered Vicodin (prn) 15 minutes ago, and his MS IR this morning. The hospice nurse makes her daily visit w/ John and his familiy. She comes out to my med cart and says "John is in pain, he was moaning." I reply, "yes, I know, I just medicated him."
Hospice nurse says, "okay, I'll get an order for sublingual MS, q one hour."
The hospice nurse writes the order (calls doc later, sometimes not at all...not a problem though :) ) and I give it. She visits w/ the family for another hour, asks me again if I could now give it, I gladly comply, and the patient dies 3 hours later (pain free thankfully)...
That's agressive hospice, AND legal euthanasia.
I repeat, I THINK IT'S OKAY...
If you disagree, then our debate (from my perspective) is one of semantics only.
I mean, it's the "elephant in the living room" discussion...

sean

You are not clear on your knowledge of narctotics and are especially unclear in your knowledge about morphine in particular.

You stated the patient died 3 hours after receiving the last dose of any pain med which was morphine.

On the very rare occasion where mso4 depresses respirations to the point that breathing stops all together it happens immediately. After 3 hours more than half the drug has left the body reguardless of what route it was administered.

I am guessing that one does of ms that you gave was any where from 2.5 to 20 mg sublingual. Sub lingual kick in within 3-5 minutes. If it were to cause death it would happen in 3-5 minutes.

Death occuring 3 hours after any size dose, by any route cannot be attributed to being an overdose of mso4.

As I said earlier please, get some education about pain, pain control and the use of narcotics. You are not alone in your misperceptions. Perhaps you are a nurse who has been practicing many many years. Current reasearch does not support the old notion that it kills in this way.

mso4 is the WEAKEST narcotic analgesia there is. It takes much bigger does of ms to create the same pain relief of any other narcotic analgesia. There is no ceiling on what is safe with ms because once the patient is no longer narcotic naieve (he's taken it for 24 hours) you can safely increase dosages until adequate pain relief is achieved. The longer you use it the more you will have to increase the dose but if this is the case again there is no ceiling.

The one or 2 ounce Bottle of ms that you have for your hospice patient does not cotain enough to kill even someone who is narctotic naieve, were they to take the whole bottle at once.

I know you have your opinion however, what I have stated here is not an opinion but a verifiable fact backed by solid reasearch. So it is not merely semantics.

I too believe in calling a spade a spade. Please, check the reasearch for yourself. Take a class on pain control.

My area is critical care. And I can assure you that 30 mg is a small does. It is merely a starting point and doseage and frequency go up from there. I understand in LTC you are not accostomed to giving a lot, frequent or large does to anyone and I know your rules are very strick and confining.

However, in areas where we give strong narcotics freely and regularly to most of our partients they survive. They are not euthanized by the drug.

I am not saying you cannot kill a patient with narcotics. I am saying that is not what happened in the situation you described.

I will congratulate you on your willingness to give them.

Agnus · Mar 25, 2004

Dr. K was famed for assisting an ALS patient to end his own life.

I am acutely aquainted with ALS it is a horrible disease. I have cared for 4 patinets now with the disease. Two of then in the very late stages. thier so called quality of life could not be judged to be as good as the person Kavorican was imprisioned for killing. And they were adament in telling me and others that they would not consider assisted suicide and that they held a low opinon of the person who chose that.

These were all intelligent and well educated people who suffered. but they also valued life and did not see the quality of thier own life as being so low that it should be ended.

Depression can be treated pain and other discomforts can be treated. It is the human spirit that lives and chooses to live even when othe's believe they should give up. Pain depression and other miseries feed off one another. One makes the other worse and esculates. Treat these and the suicide ideations and plans go away.

It is the nature of living things to seek survival at all cost.

Often those of us on the sidelines have a hard time watching someone who is suffering or we beleive is suffering. We project what we believe they are experiencing on to them. we are uncomfortable and we are wishing to put the patient out of our missery.

zacarias, ASN, RN · Mar 25, 2004

Agnus, 30mg morphine is not a good starting dose for most people at least in med/surg. Also, morphine is not the weakest narcotic out there. What about propoxyphene, hydrocodone, etc...

hogan4736, BSN, RN · Mar 25, 2004

angus, you are missing the point...

and the lack of responses, only solidifies my argument: NO ONE is willing to admit helping the arrival of the end...

I was relating a situation to illustrate my point:

Let's say that all you describe (about my patient) is true...There are many cases where death DOES occur in 3-5 minutes post administration (has happened to friends of mine)...THAT is assisted suicide...Why won't anyone admit it?

You are avoiding the obvious discussion...We, as nurses, sometimes assist in bringing on death...That's what happens (in carrying out a doctor's order)

I look in the mirror, and see a spade...

oh, and I have given many LARGE doses (MS 40mg IM, Demerol 175 mg /Vistaril 75 mg IM) of narcs to my patients, and am quite aware of what is a lot...

I know my patients, and if I say that hospice helped him to stop living, then what actually ended his life IS a matter of semantics!

sean