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?
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.
Comfort care is NOT euthanasia.
Obviously we've had different experiences, both professionally and personally. My family all agree that no hospice is ever to come near any of us.
I support an individuals right to choose when and how they want to die. We put our pets "to sleep" out of mercy for their medical conditions, yet let our loved ones lay gasping and wasting away in terminal pain before our very eyes. I know I would not want all that time, energy, money and heartache placed on my family watching me die in agony, dragging it out if I could have the choice to be put "to sleep".
"Every time we honor a DNR request we are essentially assisting in suicide."
Could you please elaborate on why you think honoring a DNR request is equivalent to assisting in suicide?
Survival-to-discharge rates in patients who receive CPR are typically under 10% (depending on how long one was down, what was the cause, etc). This percentage decreases with age. If someone was terminal, why would you code them after they took their last breaths? Have you ever done CPR before? CPR on young people creates broken ribs, bruising, trauma; what do you think would happen during CPR to a 90 year-old patient with end-stage cancer?
"Every time we disconnect tube feeds or IV fluids or with-hold treatment, we are assisting suicide."
Additionally, "withholding" IV fluids and tube feedings during the last days of one's life can be beneficial. As the body dies, the kidneys shut down and your body's demand for food ceases. By pumping fluids and tube feedings, you only increase the suffering a patient has because it increases respiratory difficulties (ie excentuating the "death rattle"). We essentially do the exact same thing to manage CHF and renal failure patients: we monitor/limit their fluid intake to provide comfort and prevent exaccerbations of their illness. As a society, we equate food with comfort and caring; but really, there are circumstances in which stopping fluids and feedings provides comfort.
Obviously we've had different experiences, both professionally and personally. My family all agree that no hospice is ever to come near any of us.
Wow...if you had a negative experience with Hospice, then it's an isolated Hospice facility. The idea of Hospice is to provide end of life comfort care, like the poster you quoted said. Just like any other medical facility, there are going to be good ones and bad ones, but I hope you change your feelings to direct them at the Hospice you had your experience with, rather than the whole Hospice organization.
Wow...if you had a negative experience with Hospice, then it's an isolated Hospice facility. The idea of Hospice is to provide end of life comfort care, like the poster you quoted said. Just like any other medical facility, there are going to be good ones and bad ones, but I hope you change your feelings to direct them at the Hospice you had your experience with, rather than the whole Hospice organization.
I agree. There are good and bad experiences with Hospice. In my years here I've never heard one bad thing about Hospice. I've lost a couple of close friends who've had hospice at the end and their spouses both said how wonderful Hospice is. Another close friend lost his sister. My brother in-laws parents were hospice patients at the end. Paitents and family members say the same thing. I've heard dozens and dozens of positive experiences and not one negative, not one.
I'm a huge Hospice fan, for myself and my family members whom I am the health care surrogate for.
I think with expanded and improved Hospice care, the need for PAS should be minimal.
Wow...if you had a negative experience with Hospice, then it's an isolated Hospice facility. The idea of Hospice is to provide end of life comfort care, like the poster you quoted said. Just like any other medical facility, there are going to be good ones and bad ones, but I hope you change your feelings to direct them at the Hospice you had your experience with, rather than the whole Hospice organization.
If it was one hospice I would, but it's been four different hospices in two different states. When I mentioned the name of one hospice, the person I was speaking to said she had heard 'that' about them in particular. And when a family member can tell staff that they're taking mom to the hospice in-patient facility, "but don't tell her", that's wrong. I truly feel that hospice organizations need a lot more regulation, but it's a sticky subject with politicians, which could explain why I never received a reply to my request to have someone look into the situation. That and the fact that there's no proof since charting backs up the actions taken. Sorry, but no hospice in my future.
I'm so sorry, Raven. The Hospice in our area, both the inpt facility and the home health hospice, is wonderful. I'm very sorry that people in your area are not getting the experience that hospice care is supposed to provide.
I do support PAS, for basically the reasons listed here in these posts. The idea that I have the power to make every other decision in my life (both good and bad), but when it comes to this most important decision of how and when to die, I have no choice and no rights...this baffles me. I am a Christian, and firmly believe that God does not want us to suffer in pain for no point. I believe that God doesn't personally step in and lay his hand down and say..."You die now"...I think that god created Physicians, and Nurses, and various other professionals that have the knowledge and the skills that they have. I only hope that if I am terminally ill, God will send one of the caring ones into my life who will help me end things if I so choose.
"Every time we honor a DNR request we are essentially assisting in suicide."
Could you please elaborate on why you think honoring a DNR request is equivalent to assisting in suicide?
Survival-to-discharge rates in patients who receive CPR are typically under 10% (depending on how long one was down, what was the cause, etc). This percentage decreases with age. If someone was terminal, why would you code them after they took their last breaths? Have you ever done CPR before? CPR on young people creates broken ribs, bruising, trauma; what do you think would happen during CPR to a 90 year-old patient with end-stage cancer?
"Every time we disconnect tube feeds or IV fluids or with-hold treatment, we are assisting suicide."
Additionally, "withholding" IV fluids and tube feedings during the last days of one's life can be beneficial. As the body dies, the kidneys shut down and your body's demand for food ceases. By pumping fluids and tube feedings, you only increase the suffering a patient has because it increases respiratory difficulties (ie excentuating the "death rattle"). We essentially do the exact same thing to manage CHF and renal failure patients: we monitor/limit their fluid intake to provide comfort and prevent exaccerbations of their illness. As a society, we equate food with comfort and caring; but really, there are circumstances in which stopping fluids and feedings provides comfort.
OK, I'll elaborate. If, as a nurse, you knowingly with-hold life-saving interventions, even though the family or patient requests it, you are technically committing murder. Let's look at it the other way. If the patient wanted these interventions (but was unable to say so) and the family said no, they would in fact be killing the patient. The only difference is that nobody arrests the nurses (for the most part)....if it went to trial, we'd all be hung out to dry.
This is an ethical dilemma for me. Every time I witness a person die and do nothing, it seems wrong, because the patient in the next bed gets full resusitative measures no matter what. And who's to keep another family member from disputing the DNR after the fact?
Personally, I think it should be a federally protected act to with-hold certain treatments in certain circumstances, but this country will never go there until drastic changes are made to our system of care.
BTW, I also vehemently disagree on using "spare parts" (organ transplants) to artificially keep people alive for a few years (in which the costs of care bankrupt all but the most financially well-off people). This is highly offensive to me.
It's not just the rich who get transplants, all insurance plans cover most organs. The only one that is a problem is Medicare, they will not pay for the meds after two years, but all the others do.
Okay, I'm done with this one or I'll get myself banned for sure.
RunningWithScissors
225 Posts
I did not read the entire list of responses, but i must make this point.
Every time we honor a DNR request we are essentially assisting in suicide.
Every time we disconnect tube feeds or IV fluids or with-hold treatment, we are assisting suicide.
It is not only the active act of doing something, but also the omission of care that directly contributes to the hastening of death.