ronpanzer

"Non-active" euthanasia is more usually called "passive euthanasia." Passive euthanasia is involved when an intervention is not done, with the intent to cause death. For example, not providing a needed medication, dialysis, artificial ventilation support, food, fluids, etc. Death happens on its own because something is not done. Assisted-suicide is never truly "passive euthanasia" (or "non-active" euthanasia) since it involves a conscious act to give something to cause death, even though the patient takes the medication himself or herself. In the case cited by the nurse, concern was about giving the morphine which she thought might cause death.

Euthanasia and assisted suicide are not the same. Assisted suicide is when a physician writes the order for a lethal medication and the patient takes its himself or herself. Euthanasia (active) is when someone (usually a physician or nurse) gives a lethal medication with the intent to end life. Euthanasia is illegal in every state in the United States. The original question dealt with questions about the ethical nature of giving the medication. In the case cited, the nurse had to evaluate whether to give the medication or not. The patient was not taking the medication by herself/himself to end his own life (assisted suicide). There is a huge difference between assisted suicide and euthanasia in the involvement of health care professionals. In assisted suicide, the physician writes the order and the patient takes it, so the nurse is not involved actively giving the medication. In euthanasia, you're giving the medication and are involved.

Melissa, The differing responses are both correct, because the information given is not sufficient to really know what was going on with the patient. To correctly determine the proper course, we would need to know why the morphine was being given exactly and have some information on the clinical needs of the patient. Morphine is given ATC for controlling pain and should be continued even if there is no sign of pain, if there had been severe pain that is now well-handled. The lack of outward sign of pain would indicate good palliation of that condition. The appropriate response would be to check the chart or ask family nearby and learn what the patient's prior condition was. If the patient had been in pain that was now well-controlled, continuing it would be completely appropriate and professional and you would not be hastening death by giving it. On the other hand, there are circumstances where morphine is given, when there is no pain, expressly to hasten death, and to pretend it doesn't happen is really naive. It doesn't happen in all hospices, but it happens in some, and there have been articles in the news about such cases. We are not here to kill, but to care for our patients. Euthanasia is illegal in every state in America. Giving a medication that would certainly prove lethal, if inappropriate, is not part of what we do, and that is part of the code of nursing in every state. Yes, the intent is important and the clinical condition of the patient needs to be known or determined. If a patient is comatose and apneic due to morphine overdose, and is not truly actively dying from an illness, then holding the morphine can be appropriate. If it never happened, why would every hospice "emergency kit" of medications contain Narcan to be titrated in the relief of that overdose. I've seen a patient who got a cartridge of morphine that was twice the concentration ordered by the MD and only because other nurses held that incorrect dosage was the patient saved. Morphine can prematurely end the life of a patient if not given when clinically indicated. On the other hand, it is a true blessing to those in severe pain. And patients do become apneic with widely varying respiratory patterns at the end-of-life due to many different metabolic conditions caused by organ and system failures. Millions of hospice patients have safely been given morphine (or other opioids) for severe pain and have had their suffering lessened thereby. To relieve suffering at the end-of-life is the mission of hospice as envisioned by Dame Cicely Saunders. Ron Panzer Pres., Hospice Patients Alliance http://www.hospicepatients.org