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Discussion

**Confused about euthanasia**

I just wanna share this story which makes me confused.

I'm on my third week working on RSL as an AIN.

We have this 70 yr old residence who has been diagnosed for having metastatic cancer that has spread from her left breast to her spinal column and ribs. She kept comfortable with medication and nursing care. She also has dementia that cause her to suffer a confused state of mind requiring the nursing staff to restrain her hands to prevent her hitting the staff.

She is very thin , bony and her skin over her coccyx began to break down from pressure of her bopdy against the mattress. We tried to coax her and turning every two hrs, but she cried out from pain so much that we wonder if we really helping her with this nursing intervension routine.

Her oral intake has fallen below life sustaining level. The doctor discusses artificially hydrating and feeding. Her family are divided on what to do and agonise between prolonging her life, maintaining comfort, and introducing extraneous intervention.

Do you have any idea of what ethical principles involved here, ethical dilemmas that the we as staff were facing, and what certain rights and responsibilities the clients has?

does the family has the right to choose what they want such as euthanasia or its only the doctor have the right to decide?

Thanks

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  • Guides

Well.... here in the United States, a patient will most often have a family member designated as their power of attorney, whom will generally be the person who will make all of their medical decisions for them, should that patient become unable to make their own decisions. Often, the patient will let the power of attorney know ahead of time what he or she would like to have done as far as life saving measures go; whether they will want all measures taken to prolong their life, or whether they would like to just be "let go". Then, in a situation similar to what you described, the patient's POA will consult with the doctor, and the doctor may write a "DNR" order... do not ressuscitate.

In a case where there is no POA designated, and the patient never made their wishes known to anyone, usually the next of kin will have to make the decision about what to do in a situation like this. They may consult with the rest of the family, and the whole family may, or may not, agree to just simply let the patient die peacefully. HOWEVER, at least at my hospital, unless a DNR order has been written and signed by the patient's physician... we as nurses are required, pretty much by law, to perform all lifesaving procedures.

You mentioned "euthanasia". What did you mean by that exactly? Is actual euthanasia legal in the Philippeans? Sometimes I think it should be legalized here in the US, so people don't have to suffer if they don't want to, and there's no way anything can really be done to help them, other than dope them up with gallons of Morphine.

The cancer is killing this patient. You can tube feed her and hydrate her all you want the end result is going to be the patient will die from the cancer. Feeding and hydration isn't going to lessen the pain. The MDs need to be very clear about this with the family and the family should be supported whatever they decide. It should be a joint decision between the family and the health care team. The doctor shouldn't be the one ultimately to have the final say, it should be the family.

There is no issue with euthanasia here, as the patient is dying a natural death from a fatal disease. Deciding not to feed or hydrate isn't what is going to kill the patient...the cancer is.

Good luck.

What about pain and terminal sx management? Why is this pt. being made to suffer severe pain? That's cruel!

What a leap to go from not treating her pain to euthanasia!

euthanasia is the deliberate administration of medications with the intent to cause death. it is not the same as giving someone medicaitons to cause comfort (such as narcotics) to ease the pain and causing death due to the side effects of the medications (hypotension, respiratory depression).

what i am getting from your post is that she is not being given adequate pain relief because the pain meds may hasten her death. is that accurate?

there can be a fine line between euthanasia and keeping patients comfortable at the end of life. i have no ideas what it is like in the philipines, but here in the usa, euthanisia illegal in most states (if not all -- i'm not sure what the lastest status is) and hotly debated. however, witholding pain medication from an end-stage cancer patient (esp one with mets to the spine!) because it may hasten her death is definatey unethical.

don't forget, that people become habituated to narcotics. meaning, it takes more and more pain meds to give the same amount of relief as time goes by. i have seen hospice patients on amazing quantities of narcotics, like 100 mg or morphine an hour, talking and alert.

as was said above, her physicians need to be very honest with the family regarding her prognosis.

The state of Oregon has an assisted suicide law. I'm not sure what the exact details are, but I think that it allows physicians to prescribe lethal amounts of medications? Please, someone correct me if I'm wrong.

  • Experts

Pain medication needs to be the first priority here, no matter what else. You cannot let a person suffer because you think that it will hasten their death.

Cancer causes death in many cases, pain should not be left untreated.

Giving adequate pain relief is not euthanasia.

  • Experts
Pain medication needs to be the first priority here, no matter what else. You cannot let a person suffer because you think that it will hasten their death.

Cancer causes death in many cases, pain should not be left untreated.

Giving adequate pain relief is not euthanasia.

I couldnt agree more, pain relief is the priority. :yeahthat:

Pain medication needs to be the first priority here, no matter what else. You cannot let a person suffer because you think that it will hasten their death.

Cancer causes death in many cases, pain should not be left untreated.

Giving adequate pain relief is not euthanasia.

Exactly!

The state of Oregon has an assisted suicide law. I'm not sure what the exact details are, but I think that it allows physicians to prescribe lethal amounts of medications? Please, someone correct me if I'm wrong.

Lethal doses of barbiturates are usually what's prescribed (Seconal is one of the drugs). It is legal in Oregon, and the people there are supportive of it, but Bush is looking to make it illegal. :uhoh3:

Is Hospice services available in the Phillipines? Or at least an agency that specializes in palliative care? There are measures that can be taken to maek this patient much more comfortable than you describe.

As far as the feeding issue, tube feedings into a gut that is shutting down will probably cause more distress than help.

As previously stated persons in high levels of pain are able to tolerate what appear to be megadoses of narcotics with less sedation than you might expect.

Nobody deserves to die in excruciating pain when there are things that can be done. You can not change the final outcome but it can be made a peacful passing.

  • Experts

Hospice care as we know it is not available there, unless to a very wealthy patient who can pay for all of the private care. Most facilities have 30 patients or so per nurse and a family members usually is required to stay to help care for them. Things are very, very different over there.

  • Experts
Lethal doses of barbiturates are usually what's prescribed (Seconal is one of the drugs). It is legal in Oregon, and the people there are supportive of it, but Bush is looking to make it illegal. :uhoh3:

The newer drug used is Fentanyl patches. They are placed more frequently.

You do not see Seconal ordered too much anymore. It doens't help with the pain at the time either. It is strictly for sleep.

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