Hospice and Assisted Suicide

Specialties Hospice

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Those hospice nurses living in states where assisted suicide is illegal, how do your hospices handle patient and family admitting to assisted suicide plans with the means to do so?

Leaving OUT your own personal belief system, what are the legal ramifications for hospice knowing ahead of time and therefore becoming complicit in the act? If the legal system charges the spouse, can we be held liable? Are we not mandated reporters in this situation? Or do we handle it within the system of the ID team?

How do your hospices manage this patient?

I found the following from Oregon where assisted suicide is legal.

http://www.cbc-network.org/2010/10/oregon-hospices-right-not-to-cooperate-with-assisted-suicide/

I hope the actual reason is more fundamental, that hospice workers in Oregon understand that facilitating assisted suicide is directly contrary to the hospice philosophy. Indeed, rather than facilitating doctor-prescribed death, hospice professionals are supposed to prevent the suicides of their patients by intervening to provide services or treatments the patient might be lacking, so that they no longer want to die immediately.I can personally attest to how seriously this obligation is taken by hospice administrators. I was trained as a hospice volunteer, and I was told in no uncertain terms that if I even suspected that a patient was suicidal, I was to immediately inform the multidisciplinary team so they could provide preventive mental health and other services—just as medicine would for any other suicidal person.This raises an important question: Why does hospice philosophy oppose assisted suicide? According to the late Dame Cecily Saunders—the creator of the modern hospice concept and one of the great medical humanitarians of the 20th Century—doctor-prescribed suicide denies the equal dignity of hospice patients. As she wrote in the 2002 book, The Case Against Assisted Suicide (chapter, “The Hospice Perspective”), hospice asserts on behalf of the dying patient his or her “common humanity and personal importance” to the moment of natural death.The great American hospice physician, Ira Byock, is similarly opposed to assisted suicide, writing in the Journal of Palliative Care, “The hospice focus is on life and the alleviation of suffering,” whereas “the goal of assisted suicide and euthanasia is death.” Moreover, if a hospice cooperated in doctor-prescribed death, it would abandon that patient to his or her worst fears—that they will die in agony, that they are a burden, that their lives truly are no longer worth living.Thus, when assisted suicide facilitators in Oregon brag that they have assisted the suicides of hospice patients, they are actually admitting that they interfered with the proper medical care of these patients. Indeed, boasting of helping hospice patients kill themselves is akin to patting themselves on the back for helping the patient die after denying them proper pain control—another crucial hospice medical service.This is the bottom line: Hemlock (if you will) and Hospice cannot occupy the same philosophical space. That is why I am very pleased that Oregon hospices are generally keeping assisted suicide at arm’s length. Legal or not, doctor-prescribed death has no place in proper end-of-life care.CBC Special consultant Wesley J. Smith is also a senior fellow in The Discovery Institute’s Center on Human Exceptionalism and a lawyer for the International Task Force on Euthanasia and Assisted Suicide.

I agree with malamud69. I have never worked hospice, so I'm just going off my personal beliefs. If you are in hospice, it is because you are near the end of your journey already. I understand why some, depending on a bunch of reasons, may not want to lay in bed just waiting...and waiting to die. If a person is in such a situation and chooses to end their life, I think having a legal system in place to help them along gently is much kinder then them having to shoot themselves. I remember a story back years ago when an older lady was at a place where it was legal. They had her family all come and I think it was even a pizza party, and when she was ready, she pushed a button on her IV and went out of this life peacefully. I have no other details of that, so for all I know it could've been an urban legend (snopes?) but doesn't that sound much better to go out calmly and surrounded by smiling family? It is no ones choice but the dying one's- and if they want to go, we should let them

I was surprised to see this thread active today - it's been awhile.

Thanks for the comments. As a hospice nurse I have to fight common misconceptions about what we do all the time. People don't come to hospice so we can help them die but for us to help them live fully in the time they have left. We help take care of their pain so they can take their grandson to the fair one last time and ride the carousel. We help them be able to continue a hobby they loved. We help them reconcile with family members who have become estranged. We help them live. Fully. Until the end.

Hospice is set up to admit patients way before they are at death's door although some docs just can't give up on trying to cure their patients and wait for a hospice consult until a few days before. Of course we take patients whenever but it helps them much more if they are given some time. All over the country there is education regarding when and how to use hospice so docs won't wait so long.

My particular question in this thread was related to the fact that a family talked about assisted suicide to hospice team members in a state where that is illegal, what are our legal responsibilites as a hospice? We are under the gun with just regular regulations. If we knowingly allow someone to have their spouse kill them, we would be accomplices.

I said initially, leaving aside your own personal feelings about whether assisted suicide should be legal, help me answer some questions.

We could debate all day about making it legal. It wouldn't change the fact that it is not legal here. I'm not talking about taking your own life under your own power. I'm talking about someone else doing it for you and a medical person knowing ahead of time and not doing anything about it. Legally -that's a mess to get into.

From my first post: "The great American hospice physician, Ira Byock, is similarly opposed to assisted suicide, writing in the Journal of Palliative Care, “The hospice focus is on life and the alleviation of suffering,” whereas “the goal of assisted suicide and euthanasia is death.” Moreover, if a hospice cooperated in doctor-prescribed death, it would abandon that patient to his or her worst fears—that they will die in agony, that they are a burden, that their lives truly are no longer worth living".

It isn't disgusting and selfish to deal with the mental health of someone considering ending their life. If we can help them by alleviating their pain, they might just get that last visit to the fair with their grandson. That patient was in so much pain that of course he didn't want to live. But we helped him. He was able to live for 18 more months - with a pain pump. He saw the birth of a granddaughter. He got a ride on his Harley. He went out into the woods with friends to get firewood. He was driven to the top of a mountain to see the view. He cooked dinner for his wife. He was there for his son when son got out of jail. By intervening with mental health help and with medication for pain, he got to live out his life. He sent me a card with a photo of he and his grandson on that carousel and thanked me for making that possible. I'm going to always try to alleviate pain and depression before I hand someone the means to kill themselves.

As a post script to the original story - the patient changed her mind. She lived for 3 more months and was surrounded by family most of that time. She was grateful she got to stick around.

Here's a really good article by an AN member about hospice:

Article: Hospice - Misunderstood and Underutilized - Geriatrics / Aging / Elderly

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