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Helping patients kill themselves

Colorado is now the 5th state to adopt a form of physician-assisted suicide.

O' wait, I said that the wrong way... "Death with dignity" or "Right to die"

What do you think about the law?

Will it, at some point in the future, fall into NPs hands?

Apparently, insurance companies in California feel great about denying a terminally ill mother costly chemo tx and offering to subsidize a life-ending treatment for $1.20.

Can you imagine? I could potentially extend my life, again for my children, for a few months but bankrupt my family or I could end it all for the cost of a cheeseburger...

Assisted-suicide law prompts insurance company to deny coverage to terminally ill California woman - Washington Times

Rose_Queen specializes in OR, education.

Inflammatory title much?

I think the ethics on this will be interesting. It all goes back to patient autonomy- they already have the right to refuse treatment, life sustaining or not. Why not give them the option of choosing a peaceful death in the setting of terminal illness?

Do you have personal experience with those who are simply lingering on earth in misery? I do- multiple. My maternal grandmother spent the last 5 years of her life in a hospital bed in the parlor of her home following a series of devastating strokes. She could not talk, she could not hold her bladder or bowel, she could not feed herself. Eventually, she did regain enough speech ability to utter 3 words: "Let me die". Clearly, she did not wish to continue that poor quality of life.

My paternal grandmother was diagnosed with lymphoma. The first two go rounds, she finally made it into remission after grueling, miserable chemo treatments. Then, it came back out of remission. She opted to forgo chemo a third time. Instead, she spent months in a hospital bed in her living room, dependent on my grandfather and uncle to change her Depends, bathe her, try to get liquids into her. Not a good quality of life, and had she chosen PAS, I would have supported her.

My mother is currently battling stage 4 breast cancer with mets to her spine and colon. At this point in time, she is able to function as long as she medicates for pain. However, she wasn't always in this decent of shape- prior to the tests and diagnosis, she was in so much pain that she could not function at all. Realistically, the outcome will not be good. Chemo is not an option. Radiation treatment was palliative. Eventually, the disease will claim her life.

You speak as though no one has the right to choose. Colorado and other states have chosen differently. Just like with abortion, I don't see anyone being forced to participate. However, you don't have the right to force your beliefs on others when the option for a legal alternative to lingering in misery is available. Again, patient autonomy.

Inflammatory title much?

I think the ethics on this will be interesting. It all goes back to patient autonomy- they already have the right to refuse treatment, life sustaining or not. Why not give them the option of choosing a peaceful death in the setting of terminal illness?

Do you have personal experience with those who are simply lingering on earth in misery? I do- multiple. My maternal grandmother spent the last 5 years of her life in a hospital bed in the parlor of her home following a series of devastating strokes. She could not talk, she could not hold her bladder or bowel, she could not feed herself. Eventually, she did regain enough speech ability to utter 3 words: "Let me die". Clearly, she did not wish to continue that poor quality of life.

My paternal grandmother was diagnosed with lymphoma. The first two go rounds, she finally made it into remission after grueling, miserable chemo treatments. Then, it came back out of remission. She opted to forgo chemo a third time. Instead, she spent months in a hospital bed in her living room, dependent on my grandfather and uncle to change her Depends, bathe her, try to get liquids into her. Not a good quality of life, and had she chosen PAS, I would have supported her.

My mother is currently battling stage 4 breast cancer with mets to her spine and colon. At this point in time, she is able to function as long as she medicates for pain. However, she wasn't always in this decent of shape- prior to the tests and diagnosis, she was in so much pain that she could not function at all. Realistically, the outcome will not be good. Chemo is not an option. Radiation treatment was palliative. Eventually, the disease will claim her life.

You speak as though no one has the right to choose. Colorado and other states have chosen differently. Just like with abortion, I don't see anyone being forced to participate. However, you don't have the right to force your beliefs on others when the option for a legal alternative to lingering in misery is available. Again, patient autonomy.

Passive-aggressive much?

I COMPLETELY agree with you 100% that patients have autonomy. I am truly sorry about both of your grandmothers and mother. I really am. Not to get too personal, but my mother recently passed away and my mother-in-law is going through cancer for the 3rd time.

I get the choice to refuse treatment and embrace EOL care; however, my post is about the horrific "choices" that are given to people when this is a legal option.

Money is only part of the argument. I was legitimately wondering if anyone thought the choice would come to NPs and, if so, how do you feel about potentially making that choice?

The title is only to get more people drawn into the conversation. Glad it got your attention :)

Again, my post isn't to diminish the situations you mentioned. I am sorry you have had such personal experiences with it.

Your reference to abortion completely out of context. The only "(person) being forced to participate" is the baby. And you are right, they don't get a choice. They need, your argument, autonomy.

I agree with rose, I could not imagine being in tremendous pain, with no treatment, for XYZ amount of time. It seems to be indirect torture not to give patients the chose for PAS if they want it. Now presenting it to them in an open matter would be a little harder if they dont ask for it directly.

I'd hate to be the person that hands out pamplets to family members on PAS...

Rose_Queen specializes in OR, education.

Passive-aggressive much?

No, just truly questioning your choice of title.

however, my post is about the horrific "choices" that are given to people when this is a legal option.

But that is simply your opinion. It is now a legal option. Just because you don't agree with it doesn't make it less of a valid option.

Money is only part of the argument. I was legitimately wondering if anyone thought the choice would come to NPs and, if so, how do you feel about potentially making that choice?
I honestly don't know if it will be something that NPs will be expected to participate in. However, if it does come to that, then I hope that there will be NPs who can provide the compassionate care and participate. There should be an opt out procedure for those morally opposed.

Your reference to abortion completely out of context.

No, actually it isn't. It is a similar situation in that those morally opposed to providing such care should have the option to opt out. But just because there are those opposed doesn't mean a legal option shouldn't be available. I think smoking is a poor choice and no one should smoke. Does that mean I think it should be criminalized? No- people have the right to choose to engage in legal activities.

Only downside could be insurance companies trying to hand this stuff out like candy to save $$$$$$$$$$.

gotta keep their hands out of the pot because you know what they will choose for everybody that has some chronic condition.

Allowing to die and bringing about death are very different things. As to the "don't impose your values" canard on those that have an ethical objection to euthanasia and abortion, I'd ask the same of those that don't.

The delusional denial of the inevitable fall back position of "euthanasia is cheaper than treatment" is demonstrably false in "right to die" states. It's cheaper to die and insurance companies EOB's demonstrate that and implicitly encourage it.

If the European model is any indication, and there is no reason to think it won't become conventional wisdom here, participation in abortion and euthanasia will become compulsory for providers in certain specialty areas. It is already that way in many parts of the US with regard to abortion.

So much for "choice".

There should be an opt out procedure for those morally opposed.

Glad you feel that way...hope you're the one that will make that policy, but I'm going to guess you won't be. BTW, for anesthesia providers unwilling to provide abortion procedures in many health systems, there is no other alternative but to find another job or do the case. Pharmacists have had their own problems as well.

While official "Policy" of certain institutions such as ob/gyn and family practice residencies give opt out ability to those with ethical objections to abortion and even surgical/pharmacological sterilization, the cultural implicit directive is that participation is compulsory and non participation is met with varying degrees of difficulty.

But just because there are those opposed doesn't mean a legal option shouldn't be available.

The problem is that there are those in positions of great influence that conflate practitioners unwillingness to participate with a threat to a legal option. The reasoning goes that as long as there is opposition, full access to abortion does not exist. So an ethical objection being honored is not a viable alternative.

If I seem passionate about the topic it's because I have had to leave two separate positions because of an ethical objection to my participation in what I consider morally objectionable procedures.

The irony is that folks that don't agree with me on my objections would object to participating in euthanasia. I've spoken with a couple of them. They are very dismissive of the possibility that they will ever be put in the position of having to participate or not. So for them, the dilemma is facing the possibility of having to decide, not the issue itself.

No decision, no problem. I don't think they realize how quickly things have been changing and how soon they'll share my choices.

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Kuriin specializes in Emergency.

I wrote an ethics research paper on Dying with Dignity and fully support it. I currently work in a stroke telemetry stepdown unit where many of our patients become comfort care because their strokes have progressed to the point of no return. If you worked in a unit where you often see EOL care, I'm sure most people's views would change to be more of a patient advocate.

Yes, there's the slippery slope that many opposing people think about. However, I don't believe it's going to valid as euthanasia in California requires a multitude of steps before you even get the medication.

It is always amazing to me where people who do not believe in a certain thing demand to force their beliefs on everyone else. The right to die is a personal and individual one and should be respected as one. I personally would have no problem assisting someone in pain to die on their own terms rather than suffer a prolonged illness.

It reminds me of my nursing days where we had cancer patients that nurses refused to give IV meds to as they believed it was quickening their death. Patients in pain with their families at their bedside and a nurse refusing to administer medications in the dose needed to relieve the pain. It made me sick back then and it makes me sick now to think how others hold their own weak morals over the actual needs of others.

BSN16 specializes in ICU, trauma.

Obviously you have never taken care of patients who are truly suffering and death would be a gift for them. There are WORSE things than death. And you shouldn't shame people who are done fighting because you disagree with it.

traumaRUs specializes in Nephrology, Cardiology, ER, ICU.

Very timely topic....interesting responses.

Because of my pt population, I frequently deal with end of life issues and withdrawal from life support. It is always a hard decision for pts/families (as it should be) but agree with others that state that sometimes life with no quality of life is not worth living and pts/families should be given the choice in a non-biased manner.

Medical assistance in dying is now available in Canada and I am starting to have clients interested in it, and one that has taken advantage of it (he died last weekend). There are a number of checks and balances in place to try to ensure that folks are competent to make the decision and are not being coerced in any way. NPs can provide MAID in my province in the same ways that a physician can. They can determine eligibility for the procedure, prescribe the medications required, and administer the medication if that's how the client wants it done. Since it is very new, I don't know of any NPs yet who are doing so (not to say there aren't any, just that I don't know them), but I am sure that will change.

If an NP objects to participating in the assessment or the procedure itself, like physicians, they are required to make an "effective transfer" to another provider who can provide the service.

delawaremalenurse specializes in Occ. Hlth, Education, ICU, Med-Surg.

I think you're projecting your values and beliefs unto others. It's hard to say what another will do when faced with a terminal illness, agonizing pain, incontinence, bedsores, sepsis, multiple system organ failure, etc. until it actually happens to you and you're forced to make life determining decisions.

Some will choose quantity at all costs (i.e. do whatever if it gives me another month, 6 mos, etc.). Others will choose quality over quantity and spend their final moments with their loved ones as they choose without being tethered to drug treatments.

Either choice is viable. Either choice is highly personal. And either choice should be respected so long as it is made based on being informed and knowledgeable about treatment choices and outcomes.

Tenebrae specializes in Mental Health, Gerontology, Palliative.

Only downside could be insurance companies trying to hand this stuff out like candy to save $$$$$$$$$$.

gotta keep their hands out of the pot because you know what they will choose for everybody that has some chronic condition.

The benefits on working in a healthcare system that is not profit driven.

My mum is currently undergoing her second round of palliative chemo, giving up has never been an option for her and those treating her when she worried about wasting resources told her in no uncertain terms that as long as the treatment had benefits for her they continue to offer it.

I found this interesting reading

https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf

I support the right of a person who is of sound body and mind and able to express their wishes to choose in the event of illness how they choose to exit. I believe that there needs to be major protections in place to protect those who have no ability to express their wishes

1) Don't like abortion? Don't have one.

2) Don't like to welcome death? Don't do it.

3) As for the rest of it, your choices are not necessarily mine, your reasons are not necessarily mine, and I'll thank you to take your assumptions about "mandatory" vis-a-vis PAS and abortion somewhere else ( see 1) and 2) above)..

My thought is that patients who are in considerable amount of pain and with diseases that will never be curable should have the right to choose whether or not they want to continue treatment or measures that will help end their pain. With that being said, I don't think that I would be able to participate in any procedure or administering any drug knowing that it would end another person's life. It is just something that makes me feel uneasy. However, I do admire those that are able to look beyond their own personal feelings and provide compassion to these patients that have decided that their quality of life is no longer satisfactory.

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