Assisted Suicide

leslie :-D · Mar 26, 2004

Where are my nurse cookie cutter and jello mold?
sean

you're a scary one hogan.

Jay-Jay, RN · Mar 26, 2004

Sometime in the very near future, I may be called upon to put my palliative care knowledge to work a little closer to home.

My husband has just been dx. with Ca. of the bladder. :o :o He's also had a heart attack and a stroke, and is recovering from pneumonia and two bowel obstructions (thank goodness, both resolved spontaneously).

Now, excuse me while I slink off to have a really good cry. Don't think I'll be doing much moderating for the next little while. :crying2:

And Hogan? That post of yours I deleted was a deliberate dig at Agnus, so please don't cry "CENSORSHIP!"

leslie :-D · Mar 26, 2004

you won't be alone jane, in spirit nor in prayer. God be with you.

vanburbian · Mar 27, 2004

Jane said:

"THAT could have been considered assisted suicide, as that lady was not yet ready to go."

no, THAT would have been considered murder/homicide/manslaughter, etc.

assissted suicide, on the other hand, are for those souls who ARE ready to go.

to be quite honest, i am well aware of many, many practitioners who "assist" their patients to die peacefully- does that mean it is assisted suicide, or assisting them to die pain free, comfortably? no one is saying that "aggressive" hospice is euthanasia, i think hogan is just saying that it happens, especially when there is no open dialogue precisely because people are so emotional about this issue.

like it was mentioned earlier, semantics i suppose, but i will continue to know that patients are often treated in a manner that may be considered "aggressive" in order to accomodate their wishes, it's just illegal in every state except oregon.

as far as someone mentioned earlier about narcotics not being responsible for death unless it is in the immediate time period after administration, thats not entirely correct.

the fact is that the MAJORITY(~75%) of patients die from an overdose within the hour of administration, if iv/sl/im-but not all.

death is not necessarily r/t resp. failure only- there are too many complicating issues in this patient population, i.e. metabolic clearance, decreased renal/liver fxn., metabolic acidosis,alkalosis states, etc.

if you really want some very good, RELIABLE info and stats, look at the oregon assisted suicide yearly review and statistics, dr. tolle has a website at OHSU; the hemlock society, and any good reference manual on clinical ethics has remarkable cited info to look up.

if we, as nurses, caregivers, and the ones who usually are the intermediary in this process, can't even agree on WHAT assisted suicide is, how can we ever expect to treat our patients ethically, appropriately, and with compassion?

we can't even have this discussion objectively. it saddens and gravely concerns me.

sheri

Jay-Jay, RN · Mar 28, 2004

Yes, you're right, Hoopschick, it could have been considered murder/homicide. It only would have been assited suicide if the person had asked to die.

sugarnurse · Apr 5, 2004

I do not beleive in assisting anyone take their own life, but I do feel that if a person has wishes that all help be withheld if they are terminally ill, then this wish sholud be hononed. Like IV fluild, feeding tubes, etc. These are my wishes, and all of my children know this. My son is a paramatic, and is power of attorny over my health decisions, just in case I an ever in a wreck or such, and they code me at the scene. I worked for 13 years in ER and was ICU relief, and in a rehab hospital for 4 years. So I have seen the damnage and sorrow that prolonging one's life can cause. There were a lot of people in the rehab that the family just would not let go, and they were all suffering greatly. So everyone should make their wishes known, and do the proper paperwork to follow, so they will be carried out.:)

Agnus · Apr 5, 2004

Ok, so I am back. First thank you to the poster you put my point so beautifully. I was apparently being too direct and flat in my reply.

I keep hearing it is "just semantics". We are talking about a very serious issue and I do not believe it is just semantics. We cannot afford to be that casual about an issue like this. We need to clearly define our terms.

I once (before a nurse but still a CNA) thought assisted suiside was a good thing. I was prone to depression and did not have the nursing eaducation, end of life education and pain control education that I have today.

Studies show that depression comes from lack of pain and comfort measures. The patients that I mentioned earlier were not depressed. They were well cared for and independent strong people who were not willing to allow the ALS to defeat their spirit. The remained productive though they had no use of thier bodies. They used thier intact minds and learned new ways to communicate what wisdom was on thier minds.

My point was they did not look down on those who gave up. They simply did not see the necesity of it. It all has to do with having a purpose for your life. These patients were my Victor Frankle as opposed to the one that Kavorican assisted. That person could define no purpose. AND a big PS it is not our place to define the value or purpose of another's life.

I will tell you a very sad story. I had a daughter (not my daugher) who came to our hospice for her mother who was in a nursing home. She had used another hospice for her dad. This is what she related to us.

The daughter had been caregiver for her dad. One day she overheard the hospice nurse say to her dad. "Your daughter is exhaused from careing for you. If you leave your oxygen off for 5 minutes you will die."

When the nurse came out of the dad's room the daughter gave the nurse what for. and forbade her to ever return.

The daughter later had to run out to the store. When she retuned the father's oxygen was off and he was dead.

The daughter said, yes of course I was tired but I was very happy to be careing for my dad. I was not even close to wanting to stop. I was willing and able and wanting to continue on for a long time.

The nurse's explanation was " we promote death not life that is what hospice is."

If this nurse had truly been educated about hospice she never would have said this. This is entirely contrary to the hospice philosohpy and and mission. Hospice supports you until the end of life. It is meant to make the rest of your life as you would wish it to be. It grants last wishes.

It does not "promote death"

As I said earlier I was lacking knowlege and I was prone to DEPRESSION. In that state I saw death being a desirable thing. Without the depression I can no longer support that statement.

In hospice we not only help with physical pain and discomfort we help with emoational and spirtual pain. I was in emoational and perhaps even spirtual pain as a depression prone person.

This weekend in the acute hospital I had a lady who was in for a possible DX of PE. She had some syncope that prompted the admission. She was a DNR.

We ran the test the CT etc. that was needed for a dx even though she was a DNR. We dx the PE and are treating it.

Yes she came in a DNR. By no means did the patient nor family want her to die. They accepted that if her heart stopped they did not want it restarted. That is very different than having a death wish. It is very different from not wanting treatment.

So often we see DNR and translate it to "do not treat". Or translate it to "palliative care only".

Palliative care is a legitiamate decision for care. However DNR and palliative care are two different things. Just because a person who is on palliative care is usually a DNR does not mean the reverse.

Semantics are very important. Definiation of terms is important. Assumptions are dangerous.

We cannot judge the value of another's life or suffering. Remember the daughter who wanted to care for her dad. Remember the nurse who wrongfully guilted the dad into taking his own life.

hock1 · Apr 6, 2004

How should a nurse respond when a patient begs for a quick and easy death? What is a nurse's role, if any, in the assisted suicide process?

I would demand more morphine etc for my patient. Personally I'd never actually snuff somebody out of existance but there is no need for a painful death either. I don't think I could assist in an actual suicide though.

Agnus · Apr 6, 2004

I received a call at 4 am. nursing home patient. The nurse described to me s/s of immenate death. Already gave ms. Script allowed for q 15 min doses. I told her to give again. and to f/u with another dose 15 minutes later if needed and to call if the third dose did not work But because what she described to me was so obviously immenate and from my experience of careing for patients even without q15 min ms I knew that she would not last 30 minutes. So I got dressed and got a quick bite to eat. 20 min later she called as the pt had passed.

Did she kill the pt. ? NO. This patient was already actively dying. She eased any discomfort the pt was experiencing. This patient was not narcotic naieve. The few mg. that she received in each dose she was already very used to. It was not enought to stop her respers,. MS acutally eases respirations as it opens airways and decreases oxygen demand of the heart.

Yes this pt died within 5 minutes of the last does. no it was not a fatal dose. Could this have happened? Yes, however, in this case she was not narc naieve, she received a small dose, she was in the active throws of active immeniate death. The s/s were those I have seen manytimes of occuring within a few minutes of death with or without ms on board.

Our code of ethics as nurses states that when and if death actually occures as a result of providing adequate and appropriate pain control that is not murder. Yes, there are situations where it does happen. When the intent is to provide comfort and ease pain as opposed to the intent of "ending thier life" then you are not culpable. Putting someone out of thier misery as an euphanism to consiciously ending a life is not the same as easing pain and providing comfort and easing a death.

Ending a life in the manner expressed here as "assisted suicide" is murder in most states. Under the code of ethics for nurses it is murder in anystate. Though it may be legal in some states under the nurses code of ethics it is still murder. Though a code of ethics is not a law it is a standard that must be considered.

We all have our own personal codes. And when we work in a profession that deals with the lives of others sometimes our own codes MUST be set aside for the sake of those we sereve. If that is too distasteful then one owes it to themself and others to consider removeing themselves from situations where they would be expected to violate their personal code in favor of the professional code that is designed to protect both the profession and the public.

There are situations that I will not work in because they require violation of my personal code. We all have things that are not in alignement with what is expected or what is required. This field is wide enought that we should remove ourselves from those cases. Most institutions and employers in this field allow for that.