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?
But 2 could on a opiate naive patient...reread...the patient was already down with resp, groggy, etc...adding ANOTHER 100 mcg patch can and did.
Or maybe he just died? You say opiate naive but he was already getting 100 mcg patches. Maybe he was just ready to die. Agonal breathing is usually a sign that it's going to happen any second.
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?
Your assumptions are showing. Or perhaps it's just your practice level, looking at this from a lower level of understanding. When a suffering patient looks at a nurse and asks to have his pain eased, the nurse has resources to do that which may or may not have anything to do c euthanasia. There is NEVER "nothing more I can do."
Hello everyone! I've been silently reading this thread and I find everyone's views to be knowledgeable and interesting. I am nursing student still, and have not seen many terminally ill patients, but the ones I have seen I can understand the want for assisted suicide. I know if I was terminally ill I would want the opportunity to have a dignified death with less pain.
I just wanted to share a case study I wrote for my medical ethics philosophy course. It's not perfect but I thought you guys might find it interesting :) As it related to this topic in a philosophical way. I wont share the case study question because this article is long enough, but if you wish to see I'll gladly post :). This is fictious in nature, as Julian doesn't really exist, but it does reflect my actual views.
**Warning** this is long:
Let Julian Die: A Case Supporting Assisted Suicide
This case study argues why I will assist Julian in assisted suicide. Julian is a 50 year old male suffering from terminal cancer and has asked me, Dr. May, to assist him in ending his own life without telling his family –a request I will honor. Although I have suggested palliative care for his pain Julian still wishes to end his suffering. Understandably, Julian wishes to die with dignity without burdening his family through a drawn out death. This paper examines how the concepts of autonomy and mercy are directly related to Julian's wish for assistance in suicide, and why these principles should be followed. Moreover, this paper will examine possible objections to my decision in assisting Julian such as act utilitarianism, not informing his family of the decision he has made and the apparent efficacy of pain management techniques.
Autonomy is an important principle to abide by when determining intervention in someone's life. I say this based on Kant's second and third formulations of the categorical imperative. The second formulation asserts that we should not use people because they have intrinsic worth and dignity as rational creatures (Waluchow & Gedge, 2012, p. xxvii). The key to the second formulation, is that it asserts Julian is a rational creature and his actions should not be subjected to the will of another. If people are treated as mere things, then their dignity has not been respected (Waluchow & Gedge, 2012, p.xvii). This is an important thought with regards to Julian's request for assisted suicide. Julian is a rational being, capable of making decisions regarding his life and death. If I am to impose my values upon Julian, and deny his request for assisted suicide, then I am not respecting Julian's intrinsic worth and dignity as a human.
The third formulation of Kant requires we treat people as autonomous agents. This third formulation is closely tied with the second formulation. Consequently, it elucidates why people have dignity and worth. By treating people as ends in themselves we are respecting their autonomy and freedom (Waluchow & Gedge, 2012, p.xvii). Based upon Kant's third formulation: treat people as moral autonomous agents, it would be wrong of me to deny Julian's request for suicide. I would not be respecting Julian's autonomy if I declined his request, as he is fully competent and fully informed with no coercion. Julian has made his will known, and I must respect his freedom and capability to make his own rational choices.
Moreover, autonomy is important because if people have the rights to refuse and or acquire medical treatments, then they ought to have the ability, as autonomous agents, to expect or refuse life ending treatment. Currently, in medicine, people have the right to deny life-saving treatment. Therefore, it seems reasonable to allow individuals the same right to obtain life-ending treatment; both scenarios end the same –with death. We already recognize patient's, like Julian, rights to refuse any or all medical treatments, and hence have duties of noninterference on the part of physicians to not treat people when they refuse it (Battin, pp.329, 1987). However, because Julian is not a physician, and cannot access the proper medications to end his life; he cannot be fully autonomous. Therefore, autonomy produces obligations for the physician to not only respect the patients' choices, but also make it possible for the patient to act upon them (Battin pp.329, 1987). This means supplying the knowledge and equipment to either help a patient stay alive or to allow them death. Therefore, because patients have full autonomy for access and refusal of life saving treatments, medicine should also allow full autonomy in decisions for ending life –including Julian's. Moreover, because patients have the right to knowledge regarding life-saving treatment and access to life saving equipment, the same should apply for life-ending knowledge and supplies; provided by a physician. In short, the principle of autonomy prescribes the rights of individual's access to life saving and life ending resources. It is the patient who has the final say and they must be granted the resources available to them to be fully autonomous –regardless of whether death ensues.
Autonomy is the main reason to respect Julian's wish for assisted suicide, but the principle of mercy also establishes two essential duties that must be respected in Julian's case. These two duties are the duty not to cause further pain and suffering and the duty to end pain or suffering already occurring (Battin, 1987, p. 322). Because Julian is terminally ill, and his pain offers no overriding benefit, it is futile to continue treatment through palliative care where Julian will receive painful tests, procedures, and therapies that do not provide any type of cure (Battin, 1987, p. 322). Since the procedures that Julian will undergo offer no benefit, it is better to terminate his life than let die in a prolonged death, in which he has stated he is against burdening his family with. In short, the principle of mercy dictates that unless painful procedures have an overriding benefit, then they ought not to be done (Battin, 1987, p.322). Moreover, the second principle in mercy states our duty to end pain and suffering already occurring, since Julian is terminally ill he is already suffering and we ought to let him go –if that is his wish. In the name of mercy, I will assist Julian in ending the pain now rather than prolonging his suffering, which has no overriding benefit.
Mercy is important because it is related to two other principles: beneficence and non-maleficence. Accordingly, non-maleficence is the duty to not injure others and beneficence is the duty to improve conditions for others (Waluchow & Gedge, 2012, p.xxx). The duty of non-maleficence asserts that painful treatments and medical tests in Julian's case are causing more harm than good and will simply prolong his suffering. The principle of beneficence suggests that I have a duty to relieve Julian's pain. However, in Julian's case, as I will discuss shortly, pain management is not always sufficient in improving conditions. Which is why assisted suicide for Julian is a more beneficial option. Therefore, in the name of beneficence and non-maleficence, I will assist Julian in ending his suffering –as it is a merciful act.
Assisted suicide is a heated debate and there are reasonable people who will object to my decision. Utilitarianism is an ethical theory originating on the belief that an action is right when it creates the most overall good for all those effected by the action (Waluchow & Gedge, 2012, p.xx). Utilitarianism is a teleological (consequentialist) theory that posits only one fundamental obligation, which is to maximize good and minimize bad (Waluchow & Gedge, 2012, p. xvii). There are two different types of utilitarianism: rule and act. Act utilitarianism views go fully against the decision to assist Julian, while rule utilitarianism might object less. On one hand, Act utilitarian's define the rightness or the wrongness of an action in terms of increased or decreased utility (happiness).While on the other hand, rule utilitarian's see an act as morally correct if and only if it follows a set of rules that generate the most utility (Waluchow & Gedge, 2012, pp. xx-xxiv). For the purpose of my argument, I will discuss objections from act utilitarian's.
Act utilitarian views contrast with my decision to assist Julian in his suicide. By assisting Julian, I will increase his happiness, but decrease his family's happiness; therefore, I make one individual happy, Julian, but disappoint many others –his family. Based upon the teleological utilitarianism view, my action to assist Julian is wrong because it does not increase overall happiness for the most amount of people. However, my decision is not based on utilitarianism. Instead, I have taken a deontological stance utilizing the last two principles in Kant's categorical imperative. The deontological view fixes the issues that arise with the consequentialist teleological view. Based on Kant's deontological ethics, I can justify assisting Julian in his suicide because his autonomy is of importance, and consequences do not matter. I have a deontological theory of obligation which is more than simply maximizing the good and minimizing the bad –as teleological theories dictate (Waluchow & Gedge, 2012 p. xviii). Based on Kant's categorical imperative, we must treat people as an ends to a mean not a means to an end, moreover, we must respect people's autonomy. Which is why the deontological stance makes assisting Julian ethically justifiable.
Some people will object to my reasoning for not involving Julian's family in his decision supporting assisted suicide. However, Julian is fully competent and able to make his own choices regarding information revealed to his family. Julian does not require a proxy decision maker during this stage of his disease, and has made his wishes very clear. It would be problematic for me to reveal to Julian's family his wish for assisted suicide without his consent. Otherwise, patient confidentiality will be breeched. At the most, I can try and convince Julian to involve his family, but I cannot force my idea upon him. Which is why even if I cannot persuade Julian to inform his family, I will assist him in dying painlessly.
Julian does not wish to move to palliative care, although his pain can be managed his loss of bodily functions cannot be. Some individuals argue that pain is a thing of the medical past, and actions like euthanasia or assisted suicide are not necessary to relieve pain (Battin, 1987, p. 323). It is true that we no longer speak of mortal agony†or death throes†due to medical advancements in pain management, but it is incorrect to say we can completely abolish pain and other discomforts (Battin, 1987, p. 323). In Julian's case, he suffers from incontinence and bowel dysfunction and no amount of pain management will relieve the emotional embarrassment and physical discomforts of these processes. Which is why, even with pain management, Julian should be allowed to end his life with dignity.
Moreover, pain management cannot alleviate other discomforts that come with palliative care. As Julian's condition progresses, it is difficult to say for sure that he will not require further medical procedures to make him more ‘comfortable'. For example, some patients pain medication cause a profound state of unease or dissatisfaction (Battin, 1987, p. 324). Moreover, some kinds of pain can be resistant to pain medication. Additionally, it can be difficult to find the correct dosages of pain medication, resulting in sporadic pain relief followed by agony (Battin, 1987, p. 324). To deny somebody the right to assisted suicide, because we have the belief that pain management is fully effective, is punishing. Telling Julian his pain can be managed through palliative care may be true, but it cannot relieve emotional distress, and loss of control over physiological processes. In this context, it does not seem unreasonable to grant the option of assisted suicide –if Julian does not wish to suffer unnecessarily. Thus, because pain management cannot eliminate all pain, at all times, it is not unreasonable to assist Julian in suicide if he so wishes.
References
Battin, M.P. (1987). Euthanasia: The Fundamental Issues. In E. Gedge & W. Waluchow (Eds.), Readings in Healthcare Ethics (2nd ed., p. 98-104). Toronto: Broadview Press.
E. Gedge & W. Waluchow (2012). (Eds.), Readings in Healthcare Ethics (2nd ed., p.161-168). Toronto: Broadview Press.
I agree with euthanasia in situations where a person is terminally ill and no longer have any quality of life. Before I went to uni to become a nurse I watched my pop die from prostate cancer and it was awful. Once he started falling at homehe was moved to a facility and slowly lost his independance. After many months he broke down and cried that he had had enough and asked when it would be over, my strong pop who had never let it show when he was sad or struggling, he couldnt stand to take himself to the toilet or feed himself anymore and he was in agony and miserable. Unfortunately he suffered on many more months after that til he eventually couldnt speak and we doubt he could see or hear, he was just laying there lifeless waiting for something to give out. What I would have given to let him go peacefully before he had to suffer for so long.
Quick or slow some people suffer a great deal and I feel its not fair to allow that to happen to them when a animal would be euthanized where needed to end their suffering or it would be seen as being cruel.
I haven't read all the comments yet. Euthanasia is a touchy subject, and reviews from countries where it is allowed seem to be mixed. Here's my concern--transitioning to a palliative or hospice approach in general in the United States has a *long way* to go. We are really, really good at treating disease, and when treatment doesn't work, finding a new way to treat the disease. If that doesn't work, there's usually a clinical trial we can enroll the patient in for another try.
But the patient's quality of life can sometimes get lost in the fight to treat disease. They slowly lose weight, become more and more fatigued, and can no longer do the activities that once brought them joy. I read an amazing book by Atul Gawande shortly after changing my specialty to hematology-oncology. Saying that it influenced my practice as a nurse would be an understatement. Here's the link...
Gawande's concern is that the fight for Euthanasia will polarize healthcare workers (and the general public), and take the focus away from providing excellent, patient focused, palliative and hospice care. This is similar to the concern that focusing on abortion takes away from the fight for cheap, reliable birth control. Here's a quote from Gawande that I whole-heartedly second.
"Certainly, suffering at the end of life is sometimes unavoidable and unbearable, and helping people end their misery may be necessary. Given the opportunity, I would support laws to provide these kinds of prescriptions to people. About half don't even use their prescription. They are reassured just to know they have this control if they need it. But we damage entire societies if we let providing this capability divert us from improving the lives of the ill. Assisted living is far harder than assisted death, but its possibilities are far greater, as well."
Killing people with intentional overdoses is NOT HOSPICE. That's the opposite of hospice. If you want to do that, move to Oregon, or hey, some places in Europe even allow you to murder children if that floats your boat.
Worst, most judgemental comment ever.
I know that my father received an intentional overdose. He thanked the nurse and passed. We also thanked her for her care.
Agony is not what you want your loved one to experience
Last June, a NY Times reporter attended a death ceremony near Vancouver BC. The patient was terminally ill, and designed the ceremony himself. A minister presided, and an NP administered the drugs.
The story mentions that most Canadian doctors refuse to do assisted death, believing that it violates the Hippocratic Oath. The Ontario College of Physicians is suing the province over it.
I oppose assisted suicide. Health care is all about money, and death is cheap. We already know people die because their insurance plans don't want to pay for care, do we really want to give them the option of killing people? Oregon has had 2 documented cases of cancer patients on Medicaid being rejected for experimental treatment, then rold about assisted suicide.
A competent adult patient has a right to reject care, even if it results in death. Assuming the DEA doesn't crack down too hard on opiates, a morphine drip can keep dying patients comfortable until the end. Allowong medical professionals to activy kill patients, on a system money matters most of all, is a line I don't want to cross.
Last June, a NY Times reporter attended a death ceremony near Vancouver BC. The patient was terminally ill, and designed the ceremony himself. A minister presided, and an NP administered the drugs.
The story mentions that most Canadian doctors refuse to do assisted death, believing that it violates the Hippocratic Oath. The Ontario College of Physicians is suing the province over it.
I oppose assisted suicide. Health care is all about money, and death is cheap. We already know people die because their insurance plans don't want to pay for care, do we really want to give them the option of killing people? Oregon has had 2 documented cases of cancer patients on Medicaid being rejected for experimental treatment, then rold about assisted suicide.
A competent adult patient has a right to reject care, even if it results in death. Assuming the DEA doesn't crack down too hard on opiates, a morphine drip can keep dying patients comfortable until the end. Allowong medical professionals to activy kill patients, on a system money matters most of all, is a line I don't want to cross.
You echo my concerns Not_A_Hat_Person. The United States (in my opinion) needs 1) well funded (covered by all insurance) palliative and hospice care and 2) intensive education for providers on including palliative care in treatment + the transition from a cure oriented goal to a quality of life oriented goal BEFORE even considering assisted death.
In other words, we need to focus on helping people *live* well before we give them the option to "die well".
Canadian doctors write vague orders that advise us to keep the patient comfortable to the end. The family is advised the end is near and that nursing will ensure that their family member is kept comfortable and pain free until the end.
On the floor we knew what the order as for. The report usually mentioned life expectancy of less than 48-72 hours. It was wrong to keep patients in ICU, so they were moved to the floor. Life expectancy was too short to send them to palliative care units.
The spouse or parent understood what was happening. It was only when non involved relatives visited problems arose. ‘I don't think my brother should be getting round the clock morphine' type reactions. I only remember two cases like this and the relative caused see more suffering than the immediate family deserved.
My provider nice doesn't have legalized death laws but we know it happens because we are the ones that are with the family and see their response to what is happening.
tyvin, BSN, RN
1,620 Posts
But 2 could on a opiate naive patient...reread...the patient was already down with resp, groggy, etc...adding ANOTHER 100 mcg patch can and did.