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?
You appear to have put a lot of thought into this topic, and for that I give you credit, but I'm still not clear what the point is your trying to make.
There are undoubtedly relatively rare instances of inappropriate end of life care, you seem to be arguing it is far more common but haven't really put forward anything to support that.
I've worked with enough families of dying patients to know that even otherwise rational people can describe reality in amazingly distorted ways when it comes to a dying family member, resulting from well the well recognized grieving process. If what you're describing is true, there should be well documented events beyond just these stories.
Take for instance the example of Robin Love you provided. Her contention was that her father was not "terminal", yet he had stage 5 Parkinson's and had lost the ability to eat or drink, and a result was being fed artificially by tube. Being unable to eat or drink is most definitely a terminal condition, a feeding tube is artificially prolonging an otherwise terminal condition.
If a patient or their surrogate decides to let a disease or injury run it's natural course and artificial support is withdrawn, that is not euthanasia.
There are some examples that appear reliable of where patients where inappropriately denied food or water, but that's not the common practice and as a standard patients generally have the right to refuse orders to be NPO, although I've never, ever seen an NPO order on patient who is comfort care.
As for terminal sedation, I wonder if we're talking about two different things. If a patient becomes sedated secondary to appropriate symptom management by medications, that not terminal sedation. Terminal sedation is very rare, and in the two regions I've worked it's not done in the home by one nurse. The only place true terminal sedation is done in my experience has been in the ICU, where there are multiple MD's, multiple nurses, multiple pharmacists, usually ethics panel involvement, etc, so it's not really something that can be done covertly or inappropriately.
Well, I have now watched an additional fifteen minutes of the Ron Panser YouTube clip. YouTube Ron seems to have been working with some killer nurses. Between approximately 20.00 and 30.00 a number of nefarious ways that his ex-coworkers used to kill patients/or that can be used to kill patients, are described. Deliberately using "dirty" (as opposed to clean or sterile) technique when doing trach care and handling urinary catheters in order to induce infections was described among others.
Yeah, and apparently the hospice nurses who purposefully kill through dirty technique are called "closers" by Mr Panzer and his followers. I'm surprised they didn't go with "terminators", that would have been so much cooler.
Specializes in Med nurse in med-surg., float, HH, and PDN.
Personally, I like mixing c-diff poop into chocolate pie. a la "The Help". Everybody loves chocolate.
Also, I saved a bottle of Placidyl from 1970 ( a football-shaped maroon-colored gel capsule containing a tranquilizer) which I blend into D5W for the diabetics getting blood transfusions, as the color nicely mimics blood. And when nobody is looking I slam 50cc into the IV line using a syringe I've used on two other patients: one to withdraw a nasty pus-filled urine spec from a catheter's port, and, also used to withdraw stomach contents from an NG tube. And sometimes I push in 100cc if I am feeling particularly nefarious that day.
I never understood people who are against this. if a dog is old and sick they say how horrible that you won't put it down, but it's OK for grandma to suffer?!? When I get old, miserable, and in pain constantly I hope someone loves me enough to morphine me to death.
I never understood people who are against this. if a dog is old and sick they say how horrible that you won't put it down, but it's OK for grandma to suffer?!? When I get old, miserable, and in pain constantly I hope someone loves me enough to morphine me to death.
I never understood people who use the "we put down dogs" analogy. People are not dogs. I find the idea of "putting down" a human being alarming and offensive.
We do not "morphine" patients in order to bring about death. We administer high doses of morphine during the dying process to relieve pain and ease dyspnea. Some may call that splitting hairs. I find it to be an incredibly important distinction.
Just because one does not support euthanasia, that does not mean one is okay with people being in pain. Far from it.
As healthcare providers it's important for us to wrap our heads around the issue of euthanasia as an issue NOT limited by 'mercy or murder', but more comprehensive than that.
Euthanasia should be 'legal', the personnel highly specialized, and the means generous. A reasonable limit on euthanasia could be that it's a possibility only if the patient has a POLST-like form explicitely giving permission for family/MDs to perform euthanasia, or the patient is conscious and 'of healthy mind' and can ask for it directly. If no such POLST form, and the patient is unconscious, no euthanasia. I'd say the MDs should not have the 'authority' to decide for euthanasia, as they do for a DNR order and comfort care. In my state two consulting MDs can make a family-less person a DNR. Euthanasia should be kept completely separate from standard 'comfort care' or withdrawal of care or DNR status. It should probably be something a person determines for themselves BEFORE the fact, and ought to have a short 'waiting period' before it goes into effect and is 'legal'.
I'm sure I'm missing some important details, but it should be an option *IF* the method is painless and preserves dignity. It should not be 'easy' to get, it should take some over and above effort, possibly including an attorney's involvement.
Making euthanasia 'illegal' is, to me, unnecessary in a modern society. If it's against your religious, social or ethnic ideology(ies), don't do it. If obtaining the 'right' to euthanasia is a deliberate, thoughtful and careful affair, and something MDs cannot decide FOR you as might happen with withdrawal of care/comfort care, then there's nothing to worry about. This 'right' ought not be denied to persons who do not share a religious viewpoint, any more than those with a religious viewpoint want a secular viewpoint thrust upon them.
One problem that arises is when a staff member or doctor is opposed to the pt's desire to be let go or assisted to go because of serious pain or being an invalid (often due to severe neuro diseases, for example). Some workers just don't believe in ever ending life, even death penalties for convicted criminals. (And we are hearing more and more how DNA studies exonerate convicted criminals). Very complex issue.
And what about the killing of unborn babies? Some see it as mom's right to choose to be a parent or not, others see it as murdering unborn babies - painfully, with babies having absolutely no say in this choice.
This isn't an answer to your question, just the opposite perspective, we see families who live with the patient, often the patient's home but also can be the family's. When the patient dies, their SS goes with them, which can and has caused financial hardship for the family depending on that income to help keep the home. And then there are those who are reimbursed by IHSS as the patient's caregiver who will lose both the SS and IHSS income. To say that doesn't come into play when resisting transition to hospice when it's glaringly appropriate would be naive. They may be very dedicated caregivers who love grandma but losing their home can be part of the influencing factors.
And other than the spouse or parent of a child, family isn't obligated for the medical bills, though their expenses do eat into potential inheritance. I see occasionally not wanting to place grandma whose liquid and equity funds will drain to pay for it.
When it comes to which side is the worse when considering end of life situations, resisting palliative care is the greater evil.
But mostly I see dedicated family members regardless of any underlying financial motivation.
Do nurses really get involved in the finances of their patients?
Specializes in LTC, assisted living, med-surg, psych.
I never understood people who use the "we put down dogs" analogy. People are not dogs. I find the idea of "putting down" a human being alarming and offensive.
We do not "morphine" patients in order to bring about death. We administer high doses of morphine during the dying process to relieve pain and ease dyspnea. Some may call that splitting hairs. I find it to be an incredibly important distinction.
Just because one does not support euthanasia, that does not mean one is okay with people being in pain. Far from it.
Do nurses really get involved in the finances of their patients?
Where do nurses get this financial information?
When you provide holistic care in inpatient or outpatient settings, you take the time to factor in psychosocial considerations when assessing patients and their situations. Finances is a huge part of that, including when looking at family dynamics. What is the patient capable of, financially, after discharge? A recent patient of mine couldn't afford his HTN meds and as a result of his uncontrolled BP, he is now a dialysis patient because of stg 4 ckd at under 45 years old. A nurse, especially those in case management, looks at finances going forward. How is the patient going to be able to manage this, if he couldn't manage buying his meds each month? A nurse, outside of case management, can bend the ear of the MD to make sure the MD knows that prescribing off the $4 generics list is absolutely required for this patient to be compliant. Understanding how important finances are to the nurse's assessment of the patient makes me wonder how it is a nurse WOULDN'T take the time to understand financial matters, including what those financial matters might influence in guiding future medical decision making, like PAS vs. no PAS.
MunoRN, RN
8,058 Posts
RonPanzer,
You appear to have put a lot of thought into this topic, and for that I give you credit, but I'm still not clear what the point is your trying to make.
There are undoubtedly relatively rare instances of inappropriate end of life care, you seem to be arguing it is far more common but haven't really put forward anything to support that.
I've worked with enough families of dying patients to know that even otherwise rational people can describe reality in amazingly distorted ways when it comes to a dying family member, resulting from well the well recognized grieving process. If what you're describing is true, there should be well documented events beyond just these stories.
Take for instance the example of Robin Love you provided. Her contention was that her father was not "terminal", yet he had stage 5 Parkinson's and had lost the ability to eat or drink, and a result was being fed artificially by tube. Being unable to eat or drink is most definitely a terminal condition, a feeding tube is artificially prolonging an otherwise terminal condition.
If a patient or their surrogate decides to let a disease or injury run it's natural course and artificial support is withdrawn, that is not euthanasia.
There are some examples that appear reliable of where patients where inappropriately denied food or water, but that's not the common practice and as a standard patients generally have the right to refuse orders to be NPO, although I've never, ever seen an NPO order on patient who is comfort care.
As for terminal sedation, I wonder if we're talking about two different things. If a patient becomes sedated secondary to appropriate symptom management by medications, that not terminal sedation. Terminal sedation is very rare, and in the two regions I've worked it's not done in the home by one nurse. The only place true terminal sedation is done in my experience has been in the ICU, where there are multiple MD's, multiple nurses, multiple pharmacists, usually ethics panel involvement, etc, so it's not really something that can be done covertly or inappropriately.