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?
IN our field, is there really any difference between a patient who receives a"hospice" death or a doctor who tells the family there is no hope an they should pull the plug or the md who orders a lethal prescription. The decesion is not the nurses but the patient,doctor,family or hcpoa. As nurses,wherever we work our job is to advocate for our patient and to provide the skilled and compasssionate care irregardless of our personal feelings.
Hey, ponytailman!
I just realized this yesterday-that basically, nurses play a small role in PAS-we just watch, listen and take it. There is so much power in self-determination. Wish everybody used it wisely. Thanks for responding.
IN our field, is there really any difference between a patient who receives a"hospice" death or a doctor who tells the family there is no hope an they should pull the plug or the md who orders a lethal prescription. The decesion is not the nurses but the patient,doctor,family or hcpoa. As nurses,wherever we work our job is to advocate for our patient and to provide the skilled and compasssionate care irregardless of our personal feelings.
I see a tremendous difference in all three of your scenarios
Hey if I am not 99 but still have no quality of life...and all kinds of problems with whatever (Physical)...I can only ask that if I can't sustain life under my own steam...it is time to "go home"...From what I have read in several threads...residents seem to be the "teenagers" of the medical world..very cocky...with no real respect for the patients...Is there anyway to send them after a bucket of slack while a real medical person tends me? (I say this because I would hate to have to suffer when everyone but the resident knows its towel time) OH To all residents who do not fit my words I apologise...I can only hope my advance care directives will be honored..
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?
see link for Oregon's Death with Dignity Act - they are leaders on this topic...
Specializes in Hospice, Palliative Care, Gero, dementia.
I have not read everything on this thread, so if anything I'm saying is a repeat, apologies.
First of all my "credentials" for talking about this:
1) I live in Oregon
2) I've done research on PAS (analysis of transcripts of interviews with hospice RNs and SW about their experiences w/pts requesting PAS)
3) I've taught the subject in both BS and MS/PhD classes.
Right now, Oregon is the only one to legally have PAS. Washington is looking into it. In the 10 years that it has been in effect (stats for 1997-2007) 341 people have used it. That equals about 1/10 of 1% (.01%) of all deaths in the state.
It is not an easy process to acquire a prescription. You have to make two requests, 2 weeks apart. You have to put it in writing. The MD has to get another MD to agree that you have a life limiting illness w/a life expectancy of less than 6 months. I there is any question about decision-making capacity, you have to have a psych eval. You have to be told about all other options (that means that most people exploring PAS get referred to hospice -- in 2007 it was 88%). Not only do you have to have the energy to go through the process, you have to be able to ingest (and keep down) the medication -- these days it's mostly secobarbital -- 9 GRAMS that's 90 capsules. There's also a liquid form, not sure the qty, but the caps cost $500, the liquid $1,500. And you're supposed to self administer. So there's a pretty narrow window within which people can use PAS.
To the person who said they wrote a paper about it and it's all about pain, I don't know what references they were using, but she's wrong. If you go to the DHS site (someone else linked to it) you'll see that that end-of-life concerns are among the stats that have to be reported. Here are the cumulative stats:
vLoss of autonomy (89%)
vDecreased quality of life (87%)
vLoss of dignity (82%)
vLoss of control of bodily functions (58%)
vBurden family/friends (39%)
vPain control (27%)
vFinancial concerns (3%)
In 2007 100% of the people requesting RXs stated that loss of autonomy was their #1 concern. It's about control. That's what we hear from the providers and from the families and their patients. As I think someone else stated, for someone who has wanted to be in control all their life, you think they're going to change when they know they're dying? For a few, yes, it's about pain, or other kinds of suffering, but particularly for those who are enrolled in hospice, there can sometimes be the alternative of palliative sedation -- not what someone who wants control would want!
On a related note, the big "open secret" is that while PAS is only legal in one state, there is another way to control your end of life: VRFF or voluntary refusal of food and fluid. It happens a lot more than people think, and it's not some kind of awful, lingering death for most people. Somehow, because it doesn't involve drugs people are more comfortable with this approach, but I'm not sure that it's all that different.
As for "doing one's death work" hey, I'm a hospice nurse, and I'm all for the kind of transformations that are possible at EOL, but ya know what? not everyone is going to go there, and who are we to tell them that they are "cheating themselves" if they take a different approach?
I will say one thing against PAS--in reading the transcripts of the hospice interviews, the one place that concern was consistently expressed was in terms of the consequences for the family that is left behind. As I said, most of these people were/are very much into control. "Captain of their own ship" "the kind of guy who'd go through a knot hole butt first," "she ran her family with an iron fist in a velvet glove." These are descriptions from these interviews. Sometimes the family doesn't want it, but they are used to being run roughshod over by their patriarch/matriarch. Just like any suicide, I think it is important to at least talk about the consequences for those left behind -- who just might want an opportunity to nurture and care for their loved one.
If you want to know more from a first hand experience, check this out:
Lovelle worked at the local daily paper. She created a video diary about her experience of deciding, pursuing, and using PAS. It puts a face to the stories.
I support it 150%!!! I have seen a few of my own family members lay in bed in extreme pain and suffering, in a comatose state due to heavy narcs, so why let them suffer like this. Just let them go, why prolong the inevitable.
My gosh, if it's me, put me out of my misery. Don't let me lay there while people sit and stare, just waiting for me to die. I DO NOT want to suffer in any way, nor do I want to be "kept comfortable" by using the good old PCA!!
As for "doing one's death work" hey, I'm a hospice nurse, and I'm all for the kind of transformations that are possible at EOL, but ya know what? not everyone is going to go there, and who are we to tell them that they are "cheating themselves" if they take a different approach?
agreed.
i definitely believe in the work necessary to achieve a decent death.
but it's not something one can set out to do.
rather, it is typically a natural series of events that ultimately results in acceptance, peace and closure.
you can't force it.
either the pt is receptive to these 'intrusive' thoughts or they're not.
if they're not, then it's just not going to happen.
lovelle seemed to die ideally.
given the fact that she had this cancer x 5 yrs, i'm confident she did the necessary work and admiringly, died her way.
she controlled the fate of her disease:
versus the disease controlling her.
and isn't that what hospice is about?
allowing our pts to live and die w/any remaining quality...
Specializes in Hospice, Palliative Care, Gero, dementia.
We had a palliative care consult that seemed to illustrate the tension exactly:
Anesthesiologist. Had had cancer for 6 years, no one (including his kids) knew except his wife. Had decided at the onset for forgo treatment. Spent his time traveling and enjoying his life (as well as taking on fiscal responsibility for several other people). Completely fit the image: control freak, intelligent, understood his condition and his options. I wondered about asking him about PAS (not even sure about policy as this was a VA hospital). My mentor/supervisor came right out and asked him if he'd thought about it.
His response was that he would absolutely do it if his religion didn't forbid it (he was Catholic).
jmrnbsn2msn2008
3 Posts
Hey, ponytailman!
I just realized this yesterday-that basically, nurses play a small role in PAS-we just watch, listen and take it. There is so much power in self-determination. Wish everybody used it wisely. Thanks for responding.