Euthanasia is a very touchy subject, especially within the medical field. As a healthcare advocate, it is our job as professionals to better the lives of our patients. What happens when there is nothing more you can do?
I understand, being a Home Health Aide that works a lot with Hospice, that comfort care is important. But truly, when a suffering patient looks to you to ease the pain what do you do? Should you apologize and say their is nothing more I can do?
I can hardly say no more treats to my cat when he gives puppy dog eyes, much less a patient dying alone of cancer. In my opinion, for what it is worth, Euthanasia is most certainly not murder and should never be referred to as such.
If Euthanasia was legal, but very strict in regulations and rules, it would be very beneficial to many terminally ill patients. This may be the only healthcare decision a patient makes within their life, and they should be allowed to make such a decision when conditions permit. We all have choices in this world, what gives you or I the right to take such choices away from someone in such a situation.
What is your opinion? Do you agree or disagree? Do you have a story, personal or not that pertains to this topic?
Specializes in NICU, PICU, Transport, L&D, Hospice.
Take for instance a relatively common situation; a patient who is not comfort care and is struggling, but maintaining. We switch them to comfort care which then gets rid of the limits on morphine to avoid reducing that drive which is causing the distress, and with sufficient morphine to treat their symptoms they pass relatively quickly. Is it just coincidence that they were maintaining with less morphine and then pass with appropriate symptom management levels?
I gather from this comment/question that you suspect that the individual might have suffered and lived for a longer period of time had they not been provided sufficient morphine to treat their symptoms.
That may be true, but it may also simply be correlation. It may be that the person, relieved of the physical suffering, is then left to complete the desired and appointed emotional/psychological/spiritual work of letting go of this life and the beloved which occupy it.
I am often struck with the sense that many people who are in the active phase of dying have more "control" or "influence" than one might think in the timing of their death.
Good question.
Currently the data on hospice indicates that those folks who choose hospice actually live slightly longer than do those folks with similar dx and symptom burdens who do not elect the hospice benefit. I think that those people who come to hospice literally hours from death are not representative of how morphine is used to promote comfort without hastening death and to suggest that the morphine hastened their deaths is unreasonable.
Actually, many people seem to think that those of us who disagree should either be forced, or forced to leave health care. I've seen those comments on this very board. How have you not?
Forced to what? Participate in controversial procedures?
I wouldn't say "many people", and I don't recall coming across any posts where that was the consensus, at all.
I'm thinking this is a state to state thing. In my state, the only specialties you'll find regular opiate prescribing is pain management, palliative care, and hospice. Primary care and other specialties don't want to deal with the added frustrations of high volume scheduled med prescribing. I doubt hospice does compliance monitoring, but pain management does. If you want your prescription, you have to pee in a cup first.
Interesting! I wonder if it's also a patient population thing? I work in a SNF, currently on the long term care side. Over half of my 24 residents are on scheduled controlled meds, mostly Norco and Ativan with a few heavy hitters like Fentanyl patches and moderate doses of MS Contin thrown in. I guess the MD's aren't so worried about addiction issues in the elderly.
I suppose though we really are similar to a palliative care unit without the name. Our rounding MD has no problem referring to Hospice as indicated, and no problem with increasing meds for comfort and discontinuing unnecessary meds for those that either don't qualify or don't choose to enroll in Hospice.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I kind of glanced through the replies on this thread and didn't see any mention of the differentiation between euthanasia and physician assisted suicide, which most people don't realize are two different things.
I've noticed that assisted suicide wasn't included in the poll choices either. I think it probably circles back to the issue of having this discussion in the public square. So many people believe that morphine is given to kill their loved one, or have no idea what 92 year old grandpop will have to endure when the family understandably isn't ready to say goodbye and wants to "give it some thought" first.
I will just throw in here something that I wasn't aware of until a few years ago, and that is the UK handles "DNAR" very differently than we do. I honestly believe there are MDs who hate ordering all the "pull out the stops" end-of-life care but are afraid of the adverse consequences they may face if they don't. The NHS policy handles the decision in a multidisciplinary fashion, including the patient or family's wishes but it is ultimately not their decision to make.
In our country if somebody tries to talk about something like this it's called a "death panel" and nobody will touch the topic with a ten-foot pole. It's political now. I just offer the thought that as far as I know nobody claims the NHS policy is euthanasia, or question the citizens devotion to any religion in question (tiptoeing ever so lightly).
I will just throw in here something that I wasn't aware of until a few years ago, and that is the UK handles "DNAR" very differently than we do. I honestly believe there are MDs who hate ordering all the "pull out the stops" end-of-life care but are afraid of the adverse consequences they may face if they don't. The NHS policy handles the decision in a multidisciplinary fashion, including the patient or family's wishes but it is ultimately not their decision to make.
The patient/family have a say but the decision isn't left in their hands? Wow, I'm not sure what to think of that. My first inclination was no way would that be OK with me. Then I thought about cases like that poor girl [Jahi?] who is brain dead but kept going with machines because her family just can't let go and I think maybe it wouldn't be so bad to have the burden of that decision shifted to an impartial party.
Specializes in Med nurse in med-surg., float, HH, and PDN.
I didn't really notice that there had been "no differentiation between euthanasia and PAS" in this thread.. I was surprised to read the posts by nursel56 and Mr Murse stating their observation of this. Seems to me that there HAS been some discussion of the differences. Either that or I understood the difference and didn't 'see' that it wasn't discussed.
(But I'm not inclined to comb back through the posts to back up my perception. Lazy or Time-Impaired? .)
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I didn't really notice that there had been "no differentiation between euthanasia and PAS" in this thread.. I was surprised to read the posts by nursel56 and Mr Murse stating their observation of this. Seems to me that there HAS been some discussion of the differences. Either that or I understood the difference and didn't 'see' that it wasn't discussed.
(But I'm not inclined to comb back through the posts to back up my perception. Lazy or Time-Impaired? .)
Nah it's me being inexact. I meant that the original titles didn't offer the option in their poll. I'll fix it.
Interesting! I wonder if it's also a patient population thing? I work in a SNF, currently on the long term care side. Over half of my 24 residents are on scheduled controlled meds, mostly Norco and Ativan with a few heavy hitters like Fentanyl patches and moderate doses of MS Contin thrown in. I guess the MD's aren't so worried about addiction issues in the elderly.
I suppose though we really are similar to a palliative care unit without the name. Our rounding MD has no problem referring to Hospice as indicated, and no problem with increasing meds for comfort and discontinuing unnecessary meds for those that either don't qualify or don't choose to enroll in Hospice.
I probably should have clarified - I meant outpatient.
I am often struck with the sense that many people who are in the active phase of dying have more "control" or "influence" than one might think in the timing of their death.
You are so right. How many people have you watched linger for days, only to go the second everyone finally leaves the room and stops watching them? Some people need privacy to die. And then there are the ones who wait for a specific family member to arrive, or for the clock to pass midnight so someone's birthday is over before they go.
I'm with you. Many of our actively dying patients are, frankly, obvious about letting us know they decided exactly when to go.
.)
toomuchbaloney
16,074 Posts
I gather from this comment/question that you suspect that the individual might have suffered and lived for a longer period of time had they not been provided sufficient morphine to treat their symptoms.
That may be true, but it may also simply be correlation. It may be that the person, relieved of the physical suffering, is then left to complete the desired and appointed emotional/psychological/spiritual work of letting go of this life and the beloved which occupy it.
I am often struck with the sense that many people who are in the active phase of dying have more "control" or "influence" than one might think in the timing of their death.
Good question.
Currently the data on hospice indicates that those folks who choose hospice actually live slightly longer than do those folks with similar dx and symptom burdens who do not elect the hospice benefit. I think that those people who come to hospice literally hours from death are not representative of how morphine is used to promote comfort without hastening death and to suggest that the morphine hastened their deaths is unreasonable.