Earlier today there was a thread regarding Dr. Kevorkian's release from prison. Just as I was adding my thoughts, it got moved to the Current Events restricted area.
At that time, it seemed like there was 100% support for him. Honestly, I was surprised, especially since not everyone he killed was terminally ill. (I'm from Michigan, though, so maybe I know more about his history).
So I'm wondering, do nurses generally support the theory of physician assisted suicide?
I still don't understand why Dr. Kevorkian went to jail, yet some hospices continue to "care" for the terminally ill.
Because A) the only state that allows assisted suicide is Oregon and none of the deaths he was a party to happened in Oregon, and B) he did not assist anyone to commit suicide, he actually euthanized people.
65 year-old man with end-stage pulmonary disease arrives to the ED complaining of excrutiating abdominal pain; exam/tests show bowel perforation. Surgery is not an option due to the patient's state of respiratory compromise. How should the nurses and doctors care for this patient?
The patient was admitted to the hospital for comfort care measures. Morphine was given to the patient, which did not touch his pain. The wife was in distress seeing her husband in such pain. But, the patient has pulmonary disease and increasing the morphine dose could potentially have adverse respiratory effects. So, do you withhold the morphine? Or do you continue to give it until the pain is diminished, despite the potential for adverse respiratory effects?
This is a true story. Morphine was titrated until the patient had relief from his pain and suffering. Shortly thereafter, he peacefully took his last breath with his wife at his side.
The ethical principle of "double effect" was followed for this patient. Double-effect basically means that if there are two outcomes to a situation (one good and one bad) and the "good" outcome outweighs the "bad" outcome, then the unintended, harmful effect of an action is defensible.
For all of the posters who say they would never give medication to a patient if it would hasten and/or result in their death: the world is not black and white and death is not always pain-free,. Nursing isn't just about life, as another poster stated. It is about caring for the individual across the lifespan, from birth to death. It is my belief that giving someone a good death is just as rewarding as saving someone's life.
No, I do not support PAS. What we would consider "quality of life" or "contributions to society" are irrelevant to objective reality. Which, by the way, none of us are really in.
YES, YES, and YES!!! If I was in the position of being terminally ill, and in pain, and my QUALITY of life was ziltch, ect., I would want to be able to control the last days/hours of my own life. Also, I have had patients that beg me to "let me die", and "don't let them make me live". Obviously, there is nothing that I can do about these patients, but I want to cry when the family says to "do everything you can do to save Grama", and Grama is a frail 90 lb., contracted, cancer ridden person, or one that has bedsores all over her bottom (OH! by the way, daughter "takes good care of Grama" at home).
Sorry, this is my biggest pet-peve. In my opinion, this is simply cruel and un-usual punishment. I am well aware that many, many of you will disagree with me, and that's O.K. But I have seen way too much of it in my 14 years of nursing.
kmoonshine--this is what we did with my grandfather when he was dying from a delightful combo of COPD, end stage renal failure and cancer. I thank god that we had a kind compassionate doctor who helped him.
There was one nurse who accepted my grandfather at report and then refused to give him his next scheduled dose while he was writhing in pain, telling us "I'm not going to help you do this". I looked her in the eye and said "I'm not going to let you care for my grandfather" and requested (and got) a new nurse.
He was not pain free by any means. But his death was more peaceful and came more expeditiously than it would have without the doctors and nurses involved in his care.
I still don't understand why Dr. Kevorkian went to jail, yet some hospices continue to "care" for the terminally ill.
Because Hospice maintains pts comfort and does not commit euthanasia.
In hospice and comfort care, we do not give pain meds to hasten death. We give meds to maintain comfort....if it does hasten death, that is still not the purpose to cause death and it is not euthanasia.
There is no intent to "cause" death by the use of the meds, but we do not interfere with the process of death.
Allowing someone to die of a terminal process is not euthanasia or assisted suicide. Giving meds to treat legimate symptoms of a terminal disease, which may hasten death is also not euthanasia or assisted suicide.
Giving drugs intentionally to hasten death, for no other reason but to hasten death - not seeking merely to treat symptoms, then it is euthanasia.
Please note that there is a very distinct difference, one clearly recognized by law, by nursing associations, and by medical associations. Granted, it bases itself on knowing "intent". But many murder cases and other court issues turn on "intent".
I have given plenty of high dose narcotic drips and titrated up as appropriate for symptom control. I have cared for plenty of people that have died while on them, some of them friends. And I still refuse to have anything whatsoever to do with assisted suicide, because I believe that it is wrong.
please! let's take you from your home, stuff you in a room, surrounded by (dying) people you don't know and wait until you die. the only one that is spared the physical, psychological and spiritual agony here is the family members who walk out the front door, get in their cars and drive to their nice, safe, comfortable homes.
that's not a very accurate discription of hospice. those people leaving their loved ones and going to their safe homes are wracked with grief. i have never once, not once, in the many many people i've talked to about hospice heard a bad word about hospice. it's not perfect, but it's certainly better than heroic measures.
It's amazing, we have seen so many changes over the years with the amount of resources that become available to assist our patients with death with dignity.
I work in an oncology unit, have done for the last 14 years. I've been a nurse for nearly 25years.
12 years ago I was treating a lady with met breast cancer who was in so much pain that despite anti inflammatories and 1500mg BD of slow release morphine... arm blocks ,her pain remained uncontrolled. The next step would have been an anaesthetic. Back then there wasn't too much to offer in the way of pain management...we all thought that the slow release morphine was going to be her saving grace back then .She died a painful death despite all resources being used.
If this person problem had occurred today,with the resources that are now available she probably have dignity with her death. But back then ,maybe it was a reasonable option for PAS.
At the same time i was looking after a gentleman from the Netherlands. When he became terminal , he took the option of going back home to have assisted euthanasia. I spoke with his daughter after she got back, and even though it was her fathers wish , she had great difficulties in the process of talking to her father who was lucid ..said her good byes...came back 10 minutes later and he was gone.It seemed surreal.
Another area that needs to be considered is the reactive depression related to diagnosis, the over whelming feeling of helplessness.There was a lady in Australia, when diagnosed with incurable cancer wanted PAS, because she didn't want to go through pain etc. . 3 years down the track she was alive, watching her grandchildren growing up. Had good quality of life and regretted her initial reaction and desire to die with PAS.
I think this highlights the timing of a decision like this. You need assess a patient's psychological state and allow patients being fully informed of all treatment options.
My bottom line is, you need to maximise all the resources you have available for you patient to give them a dignified death, if after all resources have been exhausted, then maybe PAS might be an option. I don't think it should be the first option.
yes i do. i have seen some horrible suffering happen at the end of life, even with hospice care. as a resident of oregon, i feel i should share the state of oregon death with dignity act link with you. check out the faq's.
death with dignity - the physician is not euthanizing the patient, it is only at the patient's request that it can be pursued, it is quite an involved process...not merely finding a doctor that will prescribe the medication. the physician may or may not be in attendance, that is the choice of the patient. the patient must be able to administer it (usually a mix of barbituates) to themselves without the aid of another human being...it is not euthanization. so, here are some of the "guidelines" required for the death with dignity act.
a: the death with dignity act (the act) allows terminally-ill oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.
the act was a citizens' initiative passed twice by oregon voters. the first time was in a general election in november 1994 when it passed by a margin of 51% to 49%. an injunction delayed implementation of the act until it was lifted on october 27, 1997. in november 1997, a measure was placed on the general election ballot to repeal the act. voters chose to retain the act by a margin of 60% to 40%.
there is no state "program" for participation in the act. people do not "make application" to the state of oregon or the department of human services. it is up to qualified patients and licensed physicians to implement the act on an individual basis. the act requires the department of human services to collect information about patients who participate each year and to issue an annual report.
q: who can participate in the act?
a: the law states that, in order to participate, a patient must be: 1) 18 years of age or older, 2) a resident of oregon, 3) capable of making and communicating health care decisions for him/herself, and 4) diagnosed with a terminal illness that will lead to death within six (6) months. it is up to the attending physician to determine whether these criteria have been met.
q: how does a patient get a prescription from a participating physician?
a: the patient must meet certain criteria to be able to request to participate in the act. then, the following steps must be fulfilled: 1) the patient must make two oral requests to the attending physician, separated by at least 15 days; 2) the patient must provide a written request to the attending physician, signed in the presence of two witnesses, at least one of whom is not related to the patient; 3) the attending physician and a consulting physician must confirm the patient's diagnosis and prognosis; 4) the attending physician and a consulting physician must determine whether the patient is capable of making and communicating health care decisions for him/herself; 5) if either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination; 6) the attending physician must inform the patient of feasible alternatives to the act including comfort care, hospice care, and pain control; 7) the attending physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. a patient can rescind a request at any time and in any manner. the attending physician will also offer the patient an opportunity to rescind his/her request at the end of the 15-day waiting period following the initial request to participate.
physicians must report all prescriptions for lethal medications to the department of human services, vital records. as of 1999, pharmacists must be informed of the prescribed medication's ultimate use.
q: what kind of prescription will a patient receive?
a: it is up to the physician to determine the prescription. to date, most patients have received a prescription for an oral dosage of a barbiturate.
q: must a physician be present at the time the medications are taken?
a: the law does not require the presence of a physician when a patient takes lethal medication. a physician may be present if a patient wishes it, as long as the physician does not administer the medication him/herself.
This is a politically "hot button" issue that needs to be discussed in the public forum. May I recommend a book that deals with the questions and ramifications. It is Last Rights: Rescuing the End of Life fromthe Medical System. The author is Stephen P Kiernan. It is a worthwile read, especially for anyone in the medical profession. I believe it should be mandatory for all politicians and policy wonks. It is a fascinating take on end-of-life issues that I think you will find worthwile. Thanks ... M
in 2002, the netherlands legalized euthanasia. the law codified a twenty year old convention of not persecuting doctors who have committed euthanasia in very specific cases, under very specific circumstances. the ministry of public health, wellbeing and sports claims that this practice "allows a person to end their life in dignity after having received every available type of palliative care."[29]
despite this laudable aim, euthansia is not a panacea. in a study of 649 patients undergoing euthansia or physician-assisted suicide, 14% of patients undergoing euthanasia had complications such as waking from the coma, spasms or vomiting.[30] thirty-two percent of patients undergoing physician assissted suicide had complications which were troublesome enough in 18% to require their doctors to switch to active euthanasia. this study was approved by the dutch ministry of health, the dutch miistry of justice and the royal dutch medical association, and also looked at the dutch requirement for a physicain to be present. in this study physicians were absent in 28% of cases of euthanasia and 48% of cases of physician-assisted suicide. -from wikipedia
this is scary.
recent debate in switzerland has focused on assisted suicide rights for the mentally ill. a decision by the swiss federal supreme court on november 3, 2006, laid out standards under which psychiatric patients might terminate their lives: "it cannot be denied that an incurable, long-lasting, severe mental impairment similar to a somatic one can create a suffering out of which a patient would find his/her life in the long run not worth living anymore. -from wikipedia
give an inch, take a mile. these are the kinds of things we can expect to see in debate in the united states if we legalize pas.
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TazziRN, RN
6,487 Posts
Because A) the only state that allows assisted suicide is Oregon and none of the deaths he was a party to happened in Oregon, and B) he did not assist anyone to commit suicide, he actually euthanized people.