Helping patients kill themselves

[Cwoods]

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

[jmjlori]

As someone who happened to have 5 surgeries this year, spending 2 weeks in ICU on one occasion, the comments here are very disturbing to me. I guess as a Catholic, I see value in suffering. I'm glad the doctors worked so hard to save my life, and I look back on the days in ICU, where even morphine made my pain worse, as a time of great spiritual growth.

[abbnurse]

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

.

That's my all-time favorite bumper sticker!

[dec2007]

1. Want an abortion? Ask someone else to help...don't force me.

2.Want to commit suicide? Knock yourself out...don't make me participate.

3. As for "choice", when someone has to change jobs because they won't participate in someone else's "choice", there ain't no "choice".

If the European model is any indication, we can expect coerced participation by unwilling providers here. Google it.

And as to the assumption that anyone who sees PAS as problematic clearly has never seen anyone suffer at the end of their life, a more offensive and presumptuous accusation could not be made.

There is no reason at all, with all of the pain techniques and agents available today, that anyone at all need suffer to the extent that is being presumed here. If there is intractable and unbearable pain it isn't because there isn't any more to be done.

It is my understanding that providers have to choose to work in "end of life" care, just as they can choose to work in cosmetic surgery vs trauma surgery, or family medicine rather than oncology. This is a special practice requiring special training. Not all providers will offer these services; one must seek out a provider who is willing to participate in this modality of care. That being said, if you are not comfortable with working with the terminal patient who wishes to control the details of their own death, then you certainly should work in a different field.

I've watched some family members suffer greatly, and I find it very comforting to know that if I ever find myself in that position, I will have the option of choosing how and when to stop suffering and move on. It is not a choice anyone could make for another, but I am grateful to have the choice for myself.

[dec2007]

As someone who happened to have 5 surgeries this year, spending 2 weeks in ICU on one occasion, the comments here are very disturbing to me. I guess as a Catholic, I see value in suffering. I'm glad the doctors worked so hard to save my life, and I look back on the days in ICU, where even morphine made my pain worse, as a time of great spiritual growth.

You are most certainly entitled to your conclusions about suffering; however, for me personally I find NO value in suffering, and want to be allowed control over my own end of life care. I respect your views and wishes. I hope mine will also be accepted.

[wannabeny]

Watched 3 family members suffer through stage 4 cancers. Witnessing the slow & pain disintegration of their bodies and minds is indescribable.

I would participate in assisted suicide...with as much respect, and empathy towards that person as possible. When their quality of life is that poor, they should be able to make that choice.

[annabanana2]

There is no reason at all, with all of the pain techniques and agents available today, that anyone at all need suffer to the extent that is being presumed here. If there is intractable and unbearable pain it isn't because there isn't any more to be done.

I would like to point out that pain is more than physical, and that just because more can be done doesn't necessarily mean the client wants it to be done. Palliative medicine is excellent (and I know this because I work in home hospice care) but it's not magical. If I am having intractable suffering and the end of my life is reasonably foreseeable (this is the language used in the Canadian legislation) then probably I would choose to end it and I am glad to know that I have that choice.

And as for you having to participate in someone else's choice - if you know that's something you're probably going to have to do in your job (and there are very, very, very few nurses that will be involved in supporting medical assistance in dying, so you would know), then you're in the wrong place and should probably move on.

[MarisL]

As someone who happened to have 5 surgeries this year, spending 2 weeks in ICU on one occasion, the comments here are very disturbing to me. I guess as a Catholic, I see value in suffering. I'm glad the doctors worked so hard to save my life, and I look back on the days in ICU, where even morphine made my pain worse, as a time of great spiritual growth.

While I am glad that you gained great spiritual growth through your ordeals from your religion, I am sorry that you had to go through such pain and distress.

Your values gave you a framework for your choices. I'd guess that you would not have wanted some one else to step in and tell you how to decide matters in such a personal situation.

I don't know if things have been different for you than with me. In my surgeries, there has been a point where suffering has been a source of growth, and then beyond that, there has come a point when the suffering became more like torture. I am very grateful that there was workable nonlethal pain relief when it got that far along. I no longer need the pain relief, and have been able to resume life. I can understand that things would look different to some one else with dimmer prospects.

/*This seems like a decision that should be made by the individual. I'm not very comfortable with others directly assisting a choice for end of life in a terminal situation. Oregon's standards seem more appropriate and reasonable. I feel more comfortable with the right of the individual with a certified terminal disease, who has undergone extensive counseling about alternatives, and been offered those alternatives in a realistic manner, choosing to end their own suffering via a med supplied by an MD who has met stringent conditions filtering meeting that patient's request for an end of life med that the patient themselves takes at the point they choose.

/*

I also share the concern others have expressed that we must be vigilant to ensure that this does not become a way for insurance companies to cut costs. We need to ensure that emotional support and pain management are given early on, so that people don't feel that ending their life is the only option.

[kbrn2002, ADN, RN]

I do support PAS, I have seen too many people die that if given the option would have opted for death on their own terms. But I am not going to debate the morality of right to die laws. I will instead address your concerns about the insurance companies as I too have these concerns. As important as the right to die is, equally important is the right to fight to live if the patient chooses. Insurance companies should not ever be given the option to refuse treatment simply on the grounds that death is a cheaper alternative.

As to your question if NP's will ever be expected to provide PAS, that I don't know. As societies opinion and state laws evolve I don't see why an NP or PA wouldn't be able to participate. There may be additional training involved before PAS is allowed, there may not. States already vary widely on various scope of practice issue, why would this be different?

[Jules A, MSN]

There is no reason at all, with all of the pain techniques and agents available today, that anyone at all need suffer to the extent that is being presumed here. If there is intractable and unbearable pain it isn't because there isn't any more to be done.

I'm curious because I truly don't know but my knee jerk reaction was to doubt there are curative treatments for intractable pain such as with some end stage diseases ie bone cancer? however way out of my narrow area of expertise so I'd like to ask others if they have also found this to be true.

[PG2018]

I'm not in favor of it, against it rather, and thus wouldn't participate as a clinician.

[Meeshie]

The ANA position statement maintains that nurses should not participate in assisted suicide and euthanasia because they are both in direct violation of the Code of Ethics for Nurses with Interpretive Statements.

Provision 1.4 in the revised Code that specifically states: Nurses should provide interventions to relieve pain and symptoms in the dying patient consistent with palliative care practice standards, and may not act with the sole intent to end life.”

All that having been said, on a personal level I have no moral or ethical issue with a terminal patient wishing to die with dignity or end their pain through a death of their own choosing.

Colorado's law is very specific in requirements and the patient is required to self medicate, taking the provider completely out of the loop with the exception of writing the prescription. If you're asking whether or not NPs will be required to write those prescriptions... I doubt anyone will ever be required to. It's likely that NPs will be allowed to at some point in Colorado if only because they in Colorado they have full practice authority and do not have to work under a physician's license.

[macawake, MSN]

If the European model is any indication, we can expect coerced participation by unwilling providers here. Google it.

What's the "European model"? The United Kingdom, France, Spain, Italy, Portugal, Greece, Ireland, Andorra, San Marino, Liechtenstein, Monaco, The Vatican City, Luxembourg, Switzerland, The Netherlands, Belgium, Austria, Croatia, Serbia, Slovakia, Slovenia, Bosnia and Herzegovina, Montenegro, Kosovo, The Czech Republic, Moldova, Bulgaria, Malta, Hungary, Romania, Poland, The Ukraine, Russia, Belarus, Latvia, Lithuania, Estonia, Denmark, Norway, Sweden, Finland and Iceland hardly share a common model.

OP, I too find your title inflammatory. How about "advocating for and supporting patients who no longer wish to suffer excruciating and pointless physical and spiritual/existential agony and who express the desire to make an autonomous choice to put an end to their suffering"?

This question isn't very complicated to me. Since I respect the concept of patient autonomy completely, not just paying lip service to the idea, and because I refuse to participate in the torture of human beings I would experience no moral/ethical qualms from helping a person in a situation where it's the patient's expressed wish and there is no longer a chance of cure.

I respect the individuals' right to decide when they don't want to suffer any longer. It's a deeply personal choice and I don't have the right to force another person to live or die according to my values.

When there's no longer any hope for a cure I see no value in suffering at all. None.

OP, as you jest at the beginning of your post; yes you did say it the wrong way. In my opinion this is very much a case of allowing people to die on their own terms with dignity.