Euthanasia. Murder or Mercy?

[erinmckenziejam]

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?

Please Let Me Know! I Want To Know!

[Spidey's mom, ADN, BSN, RN]

I've also met and communicated off and on through the years with Dr. Ira Byock. I read this a while back and thought I'd link it here.

Physician-Assisted Suicide Is Not Progressive - The Atlantic

I am an outlier, in that I am a registered Democrat and progressive, as well as a physician who has cared for people with life-threatening conditions for more than three decades. I support universal health care, voting rights, disability rights, women's rights, Planned Parenthood, gay marriage, alternative energy, and gun control. I yearn to see an end to the war on drugs and the war in Afghanistan. And, I am convinced that legalization of physician-assisted suicide is something my fellow progressives should fear and loathe.

[Red Kryptonite]

Glycerine, what you describe is not euthanasia or suicide. It's choosing to accept the inevitable consequence of disease. I don't know if medication counts as an extraordinary or heroic measure, but when someone is taking 10, 15, 20 pills a day, I think we might consider it to be.

[wanderlust99]

No, but I believe in administering Morphine for end of life patients to cease pain. If that stops their breathing, to me that doesn't equal euthanasia.

[Red Kryptonite]

No, but I believe in administering Morphine for end of life patients to cease pain. If that stops their breathing, to me that doesn't equal euthanasia.

Since I work hospice you can safely assume I agree.

Intent is key. You don't give the dose intending to kill. You give it intending to relieve pain and/or SOB. It may depress respirations, but the only reason the patient is that close to death anyway is their disease.

[Spidey's mom, ADN, BSN, RN]

Since I work hospice you can safely assume I agree.

Intent is key. You don't give the dose intending to kill. You give it intending to relieve pain and/or SOB. It may depress respirations, but the only reason the patient is that close to death anyway is their disease.

We have to fight that "myth" as well that it is the morphine that killed the patient.

Myth #4: People who take morphine die sooner because morphine causes them to stop breathing.

Fortunately, patients quickly adjust to any effect that morphine may have on their breathing. We prescribe a small initial dose, gradually increasing it if needed. So rarely do breathing problems occur, they are usually not even listed as side effects. In fact morphine is a drug of choice for breathing distress in people with end-stage heart or lung disease: it makes their breathing more comfortable.

Pain Control: Dispelling the Myths

[Mr. Murse]

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.

Basically, euthanasia is the doctor killing the patient, and PAS is the doctor providing the means for the patient to kill themselves. I'm intentionally putting it bluntly because it is what it is.

To me, PAS makes sense. I'm a rather firm believer that our bodies are our to do with as we please. I think there should be some rules and regulations on something like PAS, but if a person wants to end their life then I believe they should be allowed after being counseled and provided with appropriate information regarding their options.

If a patient is unable to make such a decision for themselves, then I'm hesitant to give healthcare employees the power to choose to just end their life intentionally. Letting them die and trying to make it as comfortable a process as possible is different than intentionally ending their life, even if it seems obvious that may be the better option. Also seems like a slippery slope to give certain industries that kind of power.

[Twinmom06, ASN, APN]

I'm very glad that the night my grandmother died the hospitalist on duty was also our Palliative specialist. He took one look at her, filling with fluid, JVD and struggling to breathe, told the nurse to get 5 mg of morphine, turned to my mother and said "she's actively dying, she's a DNR, go say goodby - we're going to make her comfortable" and within 10 minutes she was gone. No pain, no struggle - the only regret I have is that she struggled to breathe in the last 4 hours of her life. She had a massive LV MI and her heart just couldn't pump anymore. I miss her every day but I'm so glad she made her own end of life decisions 20 years before she actually needed to.

[MrChicagoRN, RN]

No, but I believe in administering Morphine for end of life patients to cease pain. If that stops their breathing, to me that doesn't equal euthanasia.

Exactly. As Red Kryptonite points out, it is intent. I remember reading, about 25 years ago, that the Catholic Church accepted that it was ok to give large quantities of Morphine to alleviate pain, even if the dosage may have the effect of bringing death. As long as the intent was to end the pain, it was morally acceptable.

[Libby1987]

I didn't approach this topic as two different issues but..

I'm in favor of right to choose regulated assisted suicide.

I'm in favor of euthanasia by anyone humane enough to end the misery of someone at time of imminent death. I would have liked to have done that for my dad (and I would do it as surely as I'd try to save my child), to have to struggle the last 12 hrs in his non responsive state while his body shut down should be legally avoidable.

I'm very pro hospice but I don't buy into the belief that everyone must pass through whatever dying process they're dealt. We all know not all smooth and peaceful.

[SeattleJess]

I watched someone die excruciatingly over seven hours on the first half of my shift a couple of weeks ago, and it has made me really think about the way we treat the actively dying in ICU. We were on the gray line of the patient being DNR, but we were not withdrawing care. As far as I am concerned, DNRs are the same thing as full codes until their heart stops. I will do everything for a living DNR that I will do for a full code. However, in this case, I think I just actively participated in torturing a dying woman.

Family wasn't there, so I COULD have turned the drips off earlier and let her go... and I really wish I had. I was calling at the beginning of my shift about boluses, adding another pressor, getting potassium and troponin levels because of EKG changes, getting some bicarb after a critical bicarb level, and I should have just asked for a morphine drip instead. I have never seen anyone that actively look like they suffered so much. She was on two pressors, maxed by the time she died. Family was aware she was dying, but didn't want to withdraw care and stop treatment - they wanted her to go if she had to, but not be "killed."

There is nothing natural about dying on 20mcgs/hr of dopamine and 30mcgs/hr of Levophed. There is nothing natural about being mottled for hours and turning purple/black at your extremities because you should be dead but the drugs are keeping you alive. There's nothing natural about pupils being fixed and dilated almost an hour before the heart stops because the drugs just won't let the heart go. And, there is nothing natural about the way her eyes and mouth wouldn't close, her agonal breathing so strong her shoulders were jerking her off the bed, the way the BiPAP broke every single capillary in her face underneath the mask. She seriously looked worse than some of the extras I've seen in The Walking Dead before her heart finally stopped, all with no morphine drip to make her comfortable, and I wish I'd done something about it earlier. I feel tainted just from being a part of letting her suffer for so long.

Euthanasia is definitely mercy, and in hindsight, if I had absolutely known she wasn't going to make it until morning for her family to get there, I would have seriously thought about doing it myself. I should have at least turned off the drips after all neuro things I could measure were gone, at least.

I wish everyone on either side of the issue could read your post. Sounds like you did what you had to do, even though you wished the family and the patient had not created the situation. We need to talk more about end of life situations. It happens to everyone and yet it seems most are unprepared.

Peace be with you. This had to be very hard.

[Ruby Vee, BSN]

Someone who is admitted to the ICU is asked "Do you want everything done?" Of course the answer is "Yes," they want everything done. Or the family wants everything done. The problem is, people have no concept at all of what "everything" looks like. If they did, most would not choose it. Ask 50 people on the street if they want to die comfortably or if they want to die by inches hooked up to machines and on powerful medications to control their blood pressure, most of them will opt out of the machines. But we wait until they're fixing to die before we ask the question.

My father was admitted to the hospital six years ago, paralyzed on one side from an ongoing CVA and with "Tombstone T waves." It was pretty obvious he wasn't walking out of there. Immediately on admission, he was asked if he had an advance directive. Did he want a feeding tube if he was unable to eat? Did he want antibiotics to treat pneumonia? Did he want to be kept as comfortable as possible to die peacefully or did he want to be kept alive on machines as long as possible? He died peacefully and comfortably the next day.

All too often, physicians don't ask the hard questions. Instead, they offer a "solution" to each complication that crops up until people are on tubefeedings, pressors, dialysis, ECMO . . . and then, with nothing left to offer, they continue the "care" until the patient goes ahead and dies anyway after two weeks on ECMO.

Euthanasia is illegal, and I won't participate in that. But withdrawing care -- ECMO, LVADs, ventilators, dialysis, tubefeedings, pressors and the like -- and making a patient comfortable knowing that will allow them to die is something else again.

[Libby1987]

What about the folks who can't be made comfortable? I don't mean would you give a lethal dose but would you be as adamantly against it occurring?