Helping patients kill themselves

nehneh14 · Nov 14, 2016

If a professional is unable to perform her/his job to the specifications of the employer, then she/he needs to find another place of employment. Religious beliefs should have no part of whether an employee has met their obligation to the employer and/or the patient. Religion for millions is fantasy, and to think that my health care options are being presented with religion in mind is absolutely crazy making and outrageous. I don't work for Catholic hospitals for a reason: they don't provide equal and comprehensive health care to women. Just as with pharmacists and birth control, if they won't dispense it, then they need to find another job. PAS should be no different. As for the remarks about hospice, I am a former hospice nurse who left hospice largely because of the trauma of watching patients suffer horribly despite "all of the pain techniques and agents available today." Once you've seen a few people die with intractable pain, you'd be the first in line for PAS. You're confusing "choice" with law. Either follow the law, or get out. Your obligation as a nurse is to the patient. If you can't provide legally mandated care options, you have no business being a nurse. That simple.

nehneh14 · Nov 14, 2016

Sadly, there are failures in the case of managing intractable pain. In my past experience as a hospice nurse I cared for 2 individuals for whom no amount of pain measures were able to make them comfortable. We could succeed in completely sedating them to the point of non-communication, but even then body language suggested they remained uncomfortable. Any more analgesia would have likely suppressed the respiratory system resulting in death. I had heard tell of physicians ordering analgesics in doses/frequencies sure to suppress the reflex to breathe but sadly, neither physician for my cases went that route.

Kuriin, BSN, RN · Nov 14, 2016

offlabel, I would recommend you not work in hospice, palliative, or any unit that involves EOL patients. You clearly have an opinion that many patients don't want to hear.

offlabel · Nov 14, 2016

offlabel, I would recommend you not work in hospice, palliative, or any unit that involves EOL patients. You clearly have an opinion that many patients don't want to hear.

Not sure what you mean....what did I write that would be contrary to end of life care? Being opposed to PAS/euthanasia is pretty common among hospice nurses.

Lovemysugar · Nov 15, 2016

Has it really come down to comparing the cost of PAS to a burger?

SMH.

Sorry, carry on.

Simonesays, BSN, RN · Nov 15, 2016

This is obviously a sensitive and divisive topic that invokes passionate responses/opinions. Although there are so many grey areas in medicine, euthanasia tends to be regarded in black and white. People are either for or against it. And, most of the time, people don't seem to shift their positions. I'm definitely not saying that discussions about euthanasia are not worth having: they absolutely are. However, we should probably feel okay agreeing to disagree when it comes to this topic.

One of the questions that has been brought up is this: should practitioners who are ethically opposed to euthanasia who want to opt out of engaging in it be allowed to abstain? On the surface, this seems fair enough. Likely there would still be enough people willing to participate in it. However, this is also where it starts to get more ethically complicated. When we as health care providers restrict our own practices based on individual-level values and beliefs, we simultaneously create opportunity for prejudices to flourish. We enable the possibilities of racism, sexism, and homophobia. It creates this question: where do we draw the line when it comes to allowing personal ethics to guide patient care? Keep in mind that it wasn't that many years ago when patients suffering from AIDS were denied due care because some health care providers morally objected to being gay. Just one example.

Of course, it is naive to think that personal beliefs and biases don't affect the way we interact with and look after our patients. Because they do. We should certainly be aware of them, be mindful of how they affect our practices, and take steps to mitigate any poor outcomes they may have for our patients. However, there is a difference between acknowledging our beliefs/biases and using them as barometers for acceptable standards of care.

Purrsx2 · Nov 15, 2016

I'll just say that I think it's a bad idea because of what we see happening in Europe: Involuntary euthanasia happens at least hundreds of times per year and the criteria for requesting PAS has been reduced to simply being of a certain age and being "tired of living".
It's all right here in a peer reviewed medical journal (Just skip to the last couple of paragraphs to cut to the chase if you don't want to read the whole thing)

Thank you for the provided article, written by J. Pereira . I read it and looked up the sources that were quoted in this article. Some of them were not listed, and others did not have information that he referred to.

No wonder, this ERRATUM IN was posted in the same journal with regards to his article:

Curr Oncol. 2012 Jun;19(3):133-8. doi: 10.3747/co.19.1063.

[h=1]Pereira's attack on legalizing euthanasia or assisted suicide: smoke and mirrors.[/h]Downie J¹, Chambaere K, Bernheim JL.

[h=3]Author information[/h]

[h=3]Erratum in[/h]

Curr Oncol. 2012 Jun;19(3):e227.

[h=3]Abstract[/h][h=4]OBJECTIVE:[/h]To review the empirical claims made in: Pereira J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Curr Oncol 2011;18:e38-45.

[h=4]DESIGN:[/h]We collected all of the empirical claims made by Jose Pereira in "Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls." We then collected all reference sources provided for those claims. We compared the claims with the sources (where sources were provided) and evaluated the level of support, if any, the sources provide for the claims. We also reviewed other available literature to assess the veracity of the empirical claims made in the paper. We then wrote the present paper using examples from the review.

[h=4]RESULTS:[/h]Pereira makes a number of factual statements without providing any sources. Pereira also makes a number of factual statements with sources, where the sources do not, in fact, provide support for the statements he made. Pereira also makes a number of false statements about the law and practice in jurisdictions that have legalized euthanasia or assisted suicide.

[h=4]CONCLUSIONS:[/h]Pereira's conclusions are not supported by the evidence he provided. His paper should not be given any credence in the public policy debate about the legal status of assisted suicide and euthanasia in Canada and around the world.

[h=4]KEYWORDS:[/h]Belgium; Canada; Euthanasia; Netherlands; assisted suicide; evidence; slippery slopes

https://www.ncbi.nlm.nih.gov/pubmed/22670091

Quite embarrassing, eh?

paramedic-RN · Nov 15, 2016

If someone is suffering and has a terminal illness I say let them end their lives on their terms. This reminds me of the girl in Oregon or California? who had terminal brain cancer and she wanted to end her life while she could still converse with her family and stuff rather then wait until she started having seizures and coudn't eat/drink/be continent. In terms of the economics I think we're just calling a spade a spade IT IS cheaper to end life then continue treatment and I don't think that's necessarily insurance companies trying to incentive people but just hard fiscal facts, paying for one cocktail of medication is way cheaper then months of MRI's/CT's/surgery etc.

JerseyTomatoMDCrab, BSN · Nov 15, 2016

Inflammatory title much?

This.

I would 100% support a family member, spouse, patient or friend who was considering this.

There is a beautiful documentary about this topic called "How to Die in Oregon" that explores many sides of this debate. A patient who chooses the medication, a patient who was offered the medication in lieu of cancer treatment, the wife of a patient who lives in a state where it's not legal and desperately wished she did because of the way her husband's cancer robbed him of his health, vitality, personality and quality of life. It's a great film.

You can choose not to participate or support this practice but I think it's very hard to truly know what these patients are going through and therefore we shouldn't judge them or the clinicians who prescribed the meds. It's so much more complex than any of us can realize.

allnurses Guide · Nov 15, 2016

This.
I would 100% support a family member, spouse, patient or friend who was considering this.
There is a beautiful documentary about this topic called "How to Die in Oregon" that explores many sides of this debate. A patient who chooses the medication, a patient who was offered the medication in lieu of cancer treatment, the wife of a patient who lives in a state where it's not legal and desperately wished she did because of the way her husband's cancer robbed him of his health, vitality, personality and quality of life. It's a great film.
You can choose not to participate or support this practice but I think it's very hard to truly know what these patients are going through and therefore we shouldn't judge them or the clinicians who prescribed the meds. It's so much more complex than any of us can realize.

I watched this documentary and found it to be incredibly moving. It only reinforced my support of a patient's choice to end his or her own life on their terms.

We are so much kinder to our pets than to fellow human beings. I would never let my pets suffer through a terminal illness. I would hope someone would respect my wishes if I wanted the same thing for myself.

NurseDiane · Nov 15, 2016

There are many different opinions & beliefs about the ability to choose to end one's own life. People have beliefs based on religion, primarily, and what "God" says they can or cannot do in the face of death.

It seems that the large majority of people would choose to end their own lives in order to prevent the suffering from pain, organ failure & dementia. Additionally, a lot of thought is given to how much of a burden they would be to their family at the end of their life-----there is no guarantee that they will die in one week, or one month, or 6 months. Many people linger for quite a long time. I don't think the term "physician assisted suicide" is really proper when a person is just a beating heart inside a body----"death" is a subjective thing in the end of life. Legally, "death" is the cessation of the heart to beat. But, what about all of the other things---brain function, organ function, mobility, breathing? A beating heart by itself does not constitute "life".

People with terminal diseases are going to die from the disease---there is no chance for a recovery or cure. So, whether a physician/NP/PA "assists" with the decision to end one's life, it really does not make much of a difference. The physician/NP/PA has been involved in their "death" for a long time, just in a different position. There comes a time when everybody must face the inevitable. None of us are going to live forever. Death is part of the life cycle. Where a person no longer has any quality of life, I feel there is really no logical reason to stay alive-----a beating heart isn't the sole condition of "life".

There is a great documentary called "How To Die In Oregon". It is very well done and gives you an excellent perspective of dying with dignity from a terminal cancer patient.

Having said that, I do not think that insurance companies should have ANY input on this matter whatsoever. It shouldn't even be an issue that insurers can consider.

ComeTogether, LPN · Nov 15, 2016

I've seen a few comments I wanted to respond to, but now i've lost them, so I'll just make a general "my two cents" reply.

- I don't think this is the kind of thing that would be presented to a patient as an option, but something a patient would need to ask about.

- If we have pharmacists who can decline to fill birth control scripts, I am sure any practitioner who didn't want to partake would have no problem simply not providing that "service", whether or not that practitioner will at one point be a NP, I don't know. I would tend to think not, since the laws governing the prescribing of the substances that ultimately allow a patient to end their life are extremely strict and regulated.

- I have more to say but I've lost my next thought, blasted night shift!