Dying with Dignity? Can't Everyone Die with Dignity?

[JaneGilletteRogers]

There is huge support for the recent case in the news about Brittany Maynard who recently took her own life rather than letting cancer take it from her in its own time. While many people believe that what Brittany did was a good and decent thing, a question remains: If the only way to die with dignity is to take your own life, what does it mean if you don't?

As a hospice nurse, I believe all of my patients die with dignity. They die with dignity because they are human persons, with the dignity and worth all human persons deserve. I certainly can speak for the fact that they suffer, that they decline, that they need help and support of others, but that does not exclude the fact that they have dignity. Nor does it diminish their honor that they choose to let nature take its course rather than letting a pharmaceutical cocktail end it for them.

It is my hope that no one believes that there is nothing to live for if you have a terminal disease. I hope all my patients know that. Life isn't always about being a perfect person, without sickness or debility. Steven Hawkings is an excellent example of this, although severely debilitated, and having a terminal illness, he continues to contribute greatly to knowledge, to science, and to many people who care deeply for him as a person.

Being sick or being terminal doesn't have to mean you have no quality of life. Not knowing what Brittany Maynard was told about her condition, I can only hope that she was given the choice to continue life with hospice or palliative care. Such care can give patients quality of life they did not know they could achieve with a terminal or severe illness.

Further, although a person may feel they don't want to live with sickness or debility, what they really may be feeling is that there is no hope, which is never true for anyone. They also may not understand or be informed that the things they fear may not happen at all. Often, health professionals opt to be totally honest with patients and let them know "worst case scenario" and while honesty is generally the best policy, sometimes too much information does a disservice to a vulnerable person. All of us know what happens when we look up diseases or illness on the internet: we learn things we never wanted to know or we learn things that aren't even close to accurate. Someone who has just learned they are terminally ill is someone who needs information but they also need support and at the end of life, one of the best supports is knowing that there is help no matter how dismal things seem.

With hospice or palliative care, many patients realize that their symptoms can be controlled and managed and they can go on living and enjoying each day. It is beyond doubt that most people given a terminal diagnosis fear not only death, but being a burden on others. With supportive care from hospice many of these concerns are ameliorated but a patient doesn't know that if no one tells them.

So before we start to think that the only way to die with dignity is to end a life, let's make sure we offer our patients every option for end of life care we can. Hospice and palliative care can make so much difference and give hope to those who may feel that they have no choices left. Let's make sure that every patient dies with the dignity of end of life care, given by health workers who believe that no one death is less dignified than others.

[lifelearningrn, BSN, RN]

Actually (in Oregon at least) the patient must administer the medication to him or herself - the physician is not allowed to administer the medication because that would be euthanasia, not assisted suicide. After receiving two oral requests at least 15 days apart from each other followed by a written request signed by the patient and two witnesses, AND the patient receives a second opinion confirming the original diagnosis and agreeing that the pt has less than 6 months to live, THEN the physician can prescribe the lethal dose (usually of Seconal or Nembutal). The physician must also explain the process and layout the alternatives (such as hospice care). It is then completely up to the patient when, where, and IF they take the dose. There is also usually a medical professional present to take the pt's pulse every few minutes to determine time of death. (SOURCE)

I personally think the two most important things a healthcare provider can do in ANY case (not just PAS cases) are 1) inform the patient of all their options and 2) advocate for their patient's choice(s) without letting their personal opinions interfere. While there are physicians who disagree with PAS, I think it's important they respect the choice of their patient and value their patient's autonomy. The physician is not administering the lethal dose, they simply write the prescription, and then the patient does whatever they're going to do. Many of these patients end up not taking the medication, but I'm sure it's still nice for them to know that they had that option available to them, and I'm sure it is even more crucial to know that the option is available without judgment (for lack of a better word) from their healthcare provider(s). That's just my personal opinion on the issue.

*Disclaimer: I am not a nurse, nor do I hold any type of medical certificate or license. I am simply a pre-nursing student with an opinion.

Prescribing the drugs and handing them to the patient is still participating. I'm not saying the option shouldn't be there, but at the same time, no HCP should have to participate if they are uncomfortable. I can see a prescriber not wanting to prescribe a drug they know is being taken with the intention to end the patient's life. We also have the "voluntary euthanasia" debate, where someone directs a loved to 'put them down' should they become unable to care for themselves. Again, I wouldn't like being expected to carry out such wishes. Autonomy should go both ways here.

Having said that, I'm sure there are plenty of doctors who are comfortable with it, and will respect their patient's wishes. If a doctor is opposed, they can refer to another practitioner. IMO, the option *should* be available. Unfortunately, there are a lot of docs that won't even refer to hospice, opting every invasive and painful treatment option available to them first. It's sad, really.

You have a right to your opinion here, no matter your licensing status. :)

[MissyWrite]

Clearly we disagree on the definition of death panel.

Yes, death panels do exist. They exist inside the big health insurance corporations that every day make decisions on whether or not people enrolled in their health benefit plans will get the care their doctors believe might save their lives.

Cigna, for example, gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself after protests organized by her family, her friends and community, CNA/NNOC, and netroots activists. Tragically the reversal came too late to save her life.

PacifiCare denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick's family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. "This was his last effort and the procedure had worked before with people in Nick's situation," said his older brother Ricky.

In June 2008, Robin Beaton, a retired nurse from Waxahachie, Texas, found out she had breast cancer and needed a double mastectomy. Two days before her surgery, her insurance company, Blue Cross, flagged her chart and told the hospital they wouldn’t allow the procedure to go forward until they finished an examination of five years of her medical history — which could take three months.

Not long into the investigation, the insurer canceled her policy. Beaton, they said, had listed her weight incorrectly when she bought it, and had also failed to disclose that she’d once taken medicine for a heart condition — which she hadn’t been taking at the time she filled out the application. By October, thanks to an intervention from her member of Congress, Blue Cross reinstated Beaton’s insurance coverage. But the tumor she had removed had grown 2 centimeters in the meantime, and she had to have her lymph nodes removed as well as her breasts amputated because of the delay.

etc...etc...etc...