Assisted Suicide

hogan4736, BSN, RN · Mar 25, 2004

oh, and carrying a low opinion of someone (even facing one's own impending death) who chooses to end it all, is a judgemental, and a self-serving way to see the world...

Live and let live is what we preach to each other here (see the illegal alien discussion on this board)...

Let's continue it AFTER life ends!

Agnus · Mar 25, 2004

Agnus, 30mg morphine is not a good starting dose for most people at least in med/surg. Also, morphine is not the weakest narcotic out there. What about propoxyphene, hydrocodone, etc...

Check your equivancies. It is also the least expensive.

Med surg is one thing most med surg patients are narcotic naieve. 30 mg may not be an initial does but very often in my practice it goes to 30mg very very quickly because lower does are not effective.

And very very often we are giving even bigger doses. One time I have had ms cause resp arest and narcan completely and instantly reversed it.

There aare a lot of myths about ms. the reasearch bears out what I am saying.

First liver pass removes a very large amount of ms. (I don't recall the exact percent If memory serves it is close to 50%) wwwwith oral injestion. So 30 mg po is not large.

I have given 5-10 mg iv q 5-15 minutes. Repeaating the doese several times until effect. with out killing anyone, and withouth the need for narcan.

There is NO excuse to kill with this narcan is very effective.

As for the poster who seems to think I am in some sort of denial, perhaps the denial is that the disease that was killing them in the first place is what did them in.

He seems to take some sort of pride in imagining himself some sort of avenging angle against allowing a disease to follow its natural coorifice to death in clamining that he was the one who caused it.

I am leaveing this fourm. It seems your cup is so full of what you know that there is no room for any more. This is aparently an emoational issue for some here and one cannot deal rationally with that.

Jay-Jay, RN · Mar 26, 2004

Hogan, your attitude is bordering on insulting to palliative care nurses. I have several certificates in palliative care, and am working towards becoming a nurse specialist in this area.

Here is the teaching I have been given, time and time again: It is not the narcotic that kills an end-stage palliative patient, but the DISEASE!

Yes, I have seen patients over-medicated with narcotics. That's another whole story. One instance recently: Doc applied 50 ug. Duragesic patch. Patient who had been walking/talking was now unresponsive, resp. 10. I called the doc, and got an order to reduce the dose to 25 ug. Next day, the patient was sitting up in bed, talking with family, and being assisted to the bathroom. She wasn't pain free, but pain was controlled at about a 2-3 out of 10. She lived for several more weeks.

Second instance: elderly lady, with multiple health problems: diabetes, gangrene, CHF, DVT. Family has decided to let her pass rather than subjecting her to an amputation of her leg. She has been comatose, but is now awake, elevated pulse and RR, groaning in discomfort, BP elevated. She has had little or no intake of food or fluids for several days now. The doctor has left an order for titration of the pain pump, so I increase the dose by one step, and put in a phone call to the doctor on call to get Ativan to help with the respiratory distress. I also override the lockout on the pump, and give her an immediate bolus dose.

Forty-five minutes later, she is still in distress. I increase the dose again. Finally, the doctor calls back with an order for Ativan, .5 mg. SL, and also a scopolamine patch to help dry secretions (so-called 'death rattle', patient is too weak to swallow saliva.) I also suction her and do mouth care.

Half an hour later, she is starting to settle, and doze off. Her respirations are no longer laboured, and you can see that she has relaxed now that the pain is under control. She drifts off to sleep with her daughter sitting beside her, reading the Bible. Several hours later, she draws her last breath.

Did I kill her? NO!! I HELPED HER TO DIE, in as pain-free and dignified a manner as possible. THERE IS A DIFFERENCE! I suggest you take some advanced courses in Palliative care, and find out what they are! If I had allowed Patient A to succumb due to her decreased respiratory rate (Duragesic HAS killed people in this way) THAT could have been considered assisted suicide, as that lady was not yet ready to go.

I have absolutely NO idea where you got the idea that aggressive hospice is assisted suicide. That is one of the most ridiculous statements I have yet to come across on these boards. The goal of hospice is to assist a dying patient to pass in as pain-free and dignified a manner as possible. Assisted suicide is helping someone to VOLUNTARILY end their life, before the disease that is killing them has run its full course. If hospice nurses were allowed to do their jobs without interference from those who wrongly believe that giving adequate pain control is the same as murdering patients, THERE WOULD BE NO NEED FOR ASSISTED SUICIDE!!

gwenith, BSN, RN · Mar 26, 2004

Brilliant post Jane - thank-you - I learn something new every day and I do not regret it.

leslie :-D · Mar 26, 2004

have to agree jane, beautifully put. i truly hope there are certain angels that have read your post so one can understand the true meaning of dying in peace.

Jay-Jay, RN · Mar 26, 2004

I think I got mistaken for an angel that night. The pt's daughter was so grateful to me that she called my manager, AND the CCAC case manager to tell them what a wonderful help and comfort I'd been.

leslie :-D · Mar 26, 2004

I think I got mistaken for an angel that night. The pt's daughter was so grateful to me that she called my manager, AND the CCAC case manager to tell them what a wonderful help and comfort I'd been.

no jane, it was no mistake. you clearly can relate to your pts' needs, wishes, fears and pain, and are proactive in ensuring that they and their tired, broken bodies can rest. not to be confused with the omnipotent, heroic angel of mercy, who takes it upon themself to put the pt. out of their misery with total disregard to what their actual desires are. God, some people just don't have a clue.

Jay-Jay, RN · Mar 26, 2004

Thanks, Earle!

I just found a link to a previous excellent discussion on this same topic. Check it out!

https://allnurses.com/forums/showthread.php?t=1454

Home Health Columnist / Guide · Mar 26, 2004

Jane,

What an eloquent example of NURSING ......post 27 shows!

Don't think I could have expressed as well this statement:

from Jay-Jay
The goal of hospice is to assist a dying patient to pass in as pain-free and dignified a manner as possible. Assisted suicide is helping someone to VOLUNTARILY end their life, before the disease that is killing them has run its full course. If hospice nurses were allowed to do their jobs without interference from those who wrongly believe that giving adequate pain control is the same as murdering patients, THERE WOULD BE NO NEED FOR ASSISTED SUICIDE!!

Agree with your sentiments 100%.

Think I might to move to Canada so you can nurse me in my golden years.:)

jkaee · Mar 26, 2004

Wonderful post, Jane! You expressed so beautifully why I love working in LTC and with hospice patients. Knowing that I can help patients and families at the end is a wonderful, rewarding and humbling experience!

Jennifer

P_RN, ADN, RN · Mar 26, 2004

Jane what can I say? You have given the perfect description of Nursing. Thank you.

hogan4736, BSN, RN · Mar 26, 2004

Where are my nurse cookie cutter and jello mold?

sean