Medical Aid in dying

Tenebrae, BSN, RN · Feb 20, 2024

offlabel said:

After one year, 40% of applicants were permitted to use the medical system to end their lives in NZ. Canada's system has grown by about 30% per year since 2016. The trend is pretty demonstrable and as MAID becomes more and more accepted, the duty to die will become more and more a reality for many, many people that could be treated by competent pain practitioners and mental health professionals. There is a big difference, IMHO, between the medical/nursing establishment being used to directly and intentionally end a life and someone dying secondarily from analgesia not intended to directly cause death. I'm afraid the genie is out of the bottle.

I have yet to see applicants voice the main reason for wanting to die as "being duty bound, or being a burden to their family"'. Working in hospice, family was one of the reasons why people fight for so long

I read something a few years ago out of Oregon (or possibly Vermont cant remember please correct me if I am wrong) that gave the highest reasons for wanting an assisted death included loss of autonomy, fear of pain (96-98), fear of being a burden came in about half way down the list with a 60%ish

When the assisted dying bill was being voted on I remember one of the ads was "did you know your terminal 18 year old can have an assisted death without telling you". The issue with that is in NZ, 18 years old is a legal adult and if a legal adult dealing with a terminal illness doesnt want to tell their parents about their wish to pursue assisted dying. There are likely bigger problems.

SunDazed, BSN, RN · Feb 20, 2024

I have not encountered anyone who thought they owed it to someone to die. I think the statistics for people who get MAID meds in California ends up being something between 40-60% die naturally without using them? Most get to the point where they cannot take them by themselves. And euthanasia is not legal.

I would not want to be involved in something that allowed doctors to decide without patient consent that the patient's life should end. That is horribly unethical.

The closest I have come to patient's being pushed to hospice is the managed HMO-hospital system Kaiser in California. The ED doctors could refer patients to hospice if they thought it was warranted. Most of those patients were surprised and sometimes resentful. So that health system could have slippery slope issues to euthanasia if it were legalized... so far it has not been.

offlabel · Feb 20, 2024

Slippery slope is a term that is used a lot in conversations like these, but I think a better term is 'logical progression'. So called 'involuntary euthanasia' is practiced at least in the Netherlands, which has the longest history of MAID in the developed world. And it progressed to that, it didn't begin with it. Here is a paper detailing the physicians role in MAID. Of particular interest to me was this part:

The Netherlands has the most extensive experience with euthanasia and assisted suicide. In the Netherlands, voluntary euthanasia and physician assisted suicide have been lawful since 2002 but have been permitted by the courts since 1984. At present, involuntary euthanasia is practiced widely in the Netherlands. (Patient Rights Council 2011).

Just a disclaimer on the above article, it is an opinion piece that uses publicly available public health data, but it is at least an indicator of the on the ground situation in the Netherlands.

That the relief of physical and psychological suffering is the primary goal of everyone is not in question. Also not in question is that MAID is the quickest, most efficient way to do that. The question is what are the consequences if the MAID philosophy (as opposed to robust and creative analgesic techniques and psychologic care) is allowed to play out to its logical end?

It's my opinion that the issue is far less about the ones who die than it is about the effect on the medical and nursing establishments over time.

Indigo9899 · Feb 20, 2024

Thank you all for your comments and feedback. I am enjoying watching and learning about everyone's experiences and views. My original question was asked in an attempt to see how people felt about the issue for a research paper. The file attached is the final paper that we wrote. Some information was taken out in order to maintain privacy.

Death with Dignity final paper sharable edited.docx

SunDazed, BSN, RN · Feb 20, 2024

offlabel said:

Slippery slope is a term that is used a lot in conversations like these...

It's my opinion that the issue is far less about the ones who die than it is about the effect on the medical and nursing establishments over time.

Slippery slope is used because it is a core concept taught in most ethics classes that people take on their way to becoming a nurse or doctor in the US. There are 8 logical fallacies that are generally taught/learned.

https://owl.excelsior.edu/argument-and-critical-thinking/logical-fallacies/

What do you perceive are the changes in the medical and nursing establishments over time? If you reference veterinarians, who have to put animals down to end suffering, they have one of the highest suicide rates.

https://www.bbc.com/worklife/article/20231010-the-acute-suicide-crisis-among-veterinarians-youre-always-going-to-be-failing-somebody

During COVID there were many reports of medical and nursing professionals in mental crisis due to all the death they could not prevent, coupled with the refusal of so many to get vaccinated, which was seen as the primary thing to stop the pandemic along with hand washing and not gathering in groups.

offlabel · Apr 15, 2024

SunDazed said:

Slippery slope is used because it is a core concept taught in most ethics classes that people take on their way to becoming a nurse or doctor in the US. There are 8 logical fallacies that are generally taught/learned.

https://owl.excelsior.edu/argument-and-critical-thinking/logical-fallacies/

What do you perceive are the changes in the medical and nursing establishments over time? If you reference veterinarians, who have to put animals down to end suffering, they have one of the highest suicide rates.

https://www.bbc.com/worklife/article/20231010-the-acute-suicide-crisis-among-veterinarians-youre-always-going-to-be-failing-somebody

During COVID there were many reports of medical and nursing professionals in mental crisis due to all the death they could not prevent, coupled with the refusal of so many to get vaccinated, which was seen as the primary thing to stop the pandemic along with hand washing and not gathering in groups.

The problem with 'slippery slope' arguments is that they are groundless speculation. The logical progression I'm identifying (and differentiating from a slippery slope argument) is demonstrable. Look at the Netherlands and it's MAID institutional composition. They have the longest standing euthanasia regime and it has progressed to this: https://www.government.nl/topics/euthanasia/euthanasia-assisted-suicide-and-non-resuscitation-on-request

Just this from the official government website:

"In the Netherlands, euthanasia is performed by the attending physician administering a fatal dose of a suitable drug to the patient." Or Usually the sedative sodium thiopental is intravenously administered to induce a coma. Once it is certain that the patient is in a deep coma, typically after less than a minute, pancuronium is administered to stop breathing and cause death. (Wikipedia)

And this:

Minors may themselves request euthanasia from the age of 12, although the consent of the parents or guardian is mandatory until they reach the age of 16. Sixteen year-olds do not need parental consent in principle.

It all started with death with dignity.