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 Med nurse in med-surg., float, HH, and PDN.
Well, the bumper sticker became available at a time when the Roe vs Wade hullabaloo was going on, so I admit, it is a bit dated. Now that y'all have pointed it out, it loses some of the sizzle it USED to cause. I was just responding to one of Kryzstof's posts about the sovereignty of one's own body, anyway.
Well, the bumper sticker became available at a time when the Roe vs Wade hullabaloo was going on, so I admit, it is a bit dated. Now that y'all have pointed it out, it loses some of the sizzle it USED to cause. I was just responding to one of Kryzstof's posts about the sovereignty of one's own body, anyway.
As Emily Latella used to say, "Never mind,"
No, it was fine. I'm old enough to remember where it came from.
I drive my husband crazy because I pick apart jokes he tells . . "Well, that can't be right because of this and that".
They seem to be dispelling a myth with another myth. It is true that in many end of life care situation morphine is not going to hasten death, even though patients and families might have that concern. But it's just as much of a myth to say that it can't in other patients.
Hospice organizations point to studies that show morphine doesn't hasten death and may even prolong it, but they misleadingly leave out the important qualifier of these studies which is that the only time morphine is unlikely to hasten death is when it's dosing is limited to avoid adverse effects that may hasten death, even if it means not fully treating pain. The problem with that is the whole point of making a patient "comfort care" compared to full care is that you no longer limit the dosing to avoid adverse effects and prioritize pain control over life-limiting effects.
This is less of an issue with outpatient hospice, which is geared towards relatively slowly progressing disease processes and symptoms where morphine dosing can be carefully titrated. But only about 1/3 of Americans die with hospice care at home. About half die in hospitals, often with a much more sudden transition from lack of symptoms to acute end of life symptoms. As a result many nurses, particularly ICU nurses will tell you that they have no doubt they have hastened death with morphine or other symptom management, which is fine because that's the point. When you are terminally extubating a patient, for instance, the doses of morphine required to relieve the distress of going from being vent dependent to being extubated be massive, and the life limiting effects of the morphine can be obvious, particularly when you remember the main reason you're giving the morphine in that situation is to trick the body into thinking they don't really have to work as hard to breath as they think they do, which resolves dyspnea, even though to continue to live that actually do need to work that hard to breath.
I answered the questions presented by the OP. Sorry if you think its "Silly"
I just think there are separate and distinct issues at hand, and it's important for healthcare workers to understand that legalization would not result in their being compelled to participate. It's crossing wires. I apologize if I took your post out of context. I found the comment silly on its own - not you.
They seem to be dispelling a myth with another myth. It is true that in many end of life care situation morphine is not going to hasten death, even though patients and families might have that concern. But it's just as much of a myth to say that it can't in other patients.
Hospice organizations point to studies that show morphine doesn't hasten death and may even prolong it, but they misleadingly leave out the important qualifier of these studies which is that the only time morphine is unlikely to hasten death is when it's dosing is limited to avoid adverse effects that may hasten death, even if it means not fully treating pain. The problem with that is the whole point of making a patient "comfort care" compared to full care is that you no longer limit the dosing to avoid adverse effects and prioritize pain control over life-limiting effects.
This is less of an issue with outpatient hospice, which is geared towards relatively slowly progressing disease processes and symptoms where morphine dosing can be carefully titrated. But only about 1/3 of Americans die with hospice care at home. About half die in hospitals, often with a much more sudden transition from lack of symptoms to acute end of life symptoms. As a result many nurses, particularly ICU nurses will tell you that they have no doubt they have hastened death with morphine or other symptom management, which is fine because that's the point. When you are terminally extubating a patient, for instance, the doses of morphine required to relieve the distress of going from being vent dependent to being extubated be massive, and the life limiting effects of the morphine can be obvious, particularly when you remember the main reason you're giving the morphine in that situation is to trick the body into thinking they don't really have to work as hard to breath as they think they do, which resolves dyspnea, even though to continue to live that actually do need to work that hard to breath.
but they misleadingly leave out the important qualifier of these studies which is that the only time morphine is unlikely to hasten death is when it's dosing is limited to avoid adverse effects that may hasten death, even if it means not fully treating pain
We don't dose like that . . . . dose to avoid adverse effects and not control pain. And I've honestly never given morphine or another drug that hastened death.
That's why you need the well-trained hospice nurses to come in and manage these patients. Or do some in-depth training to the nurses in the ICU.
I've given boatloads of Morphine and Dilaudid . . . and didn't kill anyone.
A patient is getting continuous and boluses of Dilaudid . . . . (deleted details due to privacy) . . . And she walks and talks and eats and laughs.
Specializes in Med nurse in med-surg., float, HH, and PDN.
She makes a good point though. I do agree there should be more violence on television - and less game shows. It's terrible.
At the same time I laughed, I said ....Wait a minute...HUH?.....because actually I don't quite get it. Oh well, sumtymes Ah am a Poh-Sloak, and sometimes I'm quick. This must be a slow day.
We don't dose like that . . . . dose to avoid adverse effects and not control pain.
That's why you need the well-trained hospice nurses to come in and manage these patients. Or do some in-depth training to the nurses in the ICU.
I've given boatloads of Morphine and Dilaudid . . . and didn't kill anyone.
A patient is getting continuous Dilaudid 4 mg q/hr with a bolus of 3 mg q 15 minutes. She got 965 mg in one week. And she walks and talks and eats and laughs.
I've given as much as 400mg an hour of dilaudid, in a patient who still couldn't even sleep due to the pain. I've given only a few mg of morphine to other patients who then are agonal, yet still in pain and distress. There are times where opiates, even large doses have no negative effects, and there are times when it does. The potential for adverse effects, mainly respiratory depression, are extremely well documented, and there is no evidence that someone at the end of life suddenly becomes immune from these effects, and if they were immune it wouldn't work as intended since it's the effect of respiratory depression that we are largely using when treating dyspnea.
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?
At the same time I laughed, I said ....Wait a minute...HUH?.....because actually I don't quite get it. Oh well, sumtymes Ah am a Poh-Sloak, and sometimes I'm quick. This must be a slow day.
The Emily Litella reference you made. Sometimes my obscurity meter gets out of whack. You mean it's not 1975?
Aahhh, yes, I get it now! You did make a little leap there .
It's kind of like when I was 10 or so, and my BFF was in the living room looking at my mother's china cabinet and as she was saying "Hey, you know your mother's china cabinet?", she was walking into the kitchen where I was eating a banana. And she seamlessly went from talking about the cabinet to saying,"Can I have one?"
I just blinked, sat down abruptly and said, ".......What???"
I may be way off base here, so Hospice specialists please correct if I'm wrong.
My guess is it would be difficult to find a primary MD willing to write the orders for controlled substances for pain/anxiety in the doses that Hospice patients require, especially with the current climate regarding prescription med abuse and the requirement for patients to sign narcotic agreements in many places.
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.
If a patient doesn't qualify for hospice, do you think if a doc believes the patient should have the benefit of that kind of care, he/she could work with a Home Healthcare Agency ( as in PDN) and write orders that align with the kind of care hospice might deliver if the patient were qualified? It'd require a doc who didn't mind the extra work that might entail, if a new dx. couldn't be found as in the above example by kbrn2002 ?
This is where palliative care comes in. Palliative care exists for those who are not ready to stop life sustaining treatments or sign up with hospice, but do have chronic conditions that will eventually be fatal. If you have a patient who has chronic renal failure and heart failure, for instance, they might get palliative care, who can assist with air hunger via morphine, anxiety relieve via benzos, counseling for increased quality of life issues, and assisting families with these issues. Palliative care can then be the bridge to hospice when the time comes.
As for hospice if the person doesn't quite qualify yet, our MDs are eager to make hospice referrals whenever they know someone can benefit. On occasion, it won't be clear why the patient is referred - like, what their actual qualifying diagnosis would be. I've only asked about it once, and afterward I realized.... This person may not be end stage, but they're >
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No Stars In My Eyes
5,653 Posts
Well, the bumper sticker became available at a time when the Roe vs Wade hullabaloo was going on, so I admit, it is a bit dated. Now that y'all have pointed it out, it loses some of the sizzle it USED to cause. I was just responding to one of Kryzstof's posts about the sovereignty of one's own body, anyway.
As Emily Latella used to say, "Never mind,"