'Right to Die', what's your take on it?

[Shari888, BSN, RN]

So California recently passed the 'right to die' law and I recently saw an episode on 'Vice' where a woman in Europe actually allowed the journalist to record her euthanasia. A nurse was there who set up the heplock in her vein where the medication went in. Wanted to know what other nurses think of the 'right to die' law which is now legal in 5 states and if you would participate in it if there were a nursing job for that?

[LVN fresno]

I have Primary Progressive Multiple Sclerosis. Every day a part of me dies. It would be easy to not accept feeding tube or IV fluids to keep me alive. I feel that I owe it to the ones that I love and that love me to live as long as I can. This is my choice. There is a difference in the right to die law and ending one own life. I do not think either is right but I have no right to make that decision for any one else. As I write this I am at a point that I welcome death. I however will do nothing to make that happen.

[elijahvegas, ASN, RN, EMT-P]

In your minds, what exactly is the difference between turning off life support machines and administering a lethal dose? If you are strong enough to discontinue those measures, how is it so hard to administer medications that manifest the same result ? You know what's coming next when you "pull the plug" so to speak, so how do you draw a line at administering a medication?

Is it a "you let them die" vs a "you killed them" mentality ? Because that's a flimsy argument at best in my opinion.

[Purple_roses]

In your minds, what exactly is the difference between turning off life support machines and administering a lethal dose? If you are strong enough to discontinue those measures, how is it so hard to administer medications that manifest the same result ? You know what's coming next when you "pull the plug" so to speak, so how do you draw a line at administering a medication?

Is it a "you let them die" vs a "you killed them" mentality ? Because that's a flimsy argument at best in my opinion.

It is a "you let them die" and "you killed them" mentality, and it is not a flimsy argument. Let's not trivialize things.

As I've said previously, I'm on board with physician assisted suicide. I'm on board with nurses aiding future patients with this. I'm not comfortable doing it myself though, and that is absolutely ok. No nurse is meant for every specialty.

[ReneeML]

All for it. We are patient advocates, first and foremost, we don't push our beliefs on them we help them and stand by their side, and help voice there decisions. It is their right to go out without suffering, and with dignity. Do you set up a continuous morphine pump on a comfort care patient? Then you know what that is doing. Watch Oregon's right to die on Netflix, it is great information.

[Spidey's mom, ADN, BSN, RN]

In your minds, what exactly is the difference between turning off life support machines and administering a lethal dose? If you are strong enough to discontinue those measures, how is it so hard to administer medications that manifest the same result ? You know what's coming next when you "pull the plug" so to speak, so how do you draw a line at administering a medication?

Is it a "you let them die" vs a "you killed them" mentality ? Because that's a flimsy argument at best in my opinion.

Purple_roses is right - it is not a flimsy argument. Letting nature take its course vs. intentionally pushing a medication via an IV or giving pills that will instantly kill someone are totally different.

. It is their right to go out without suffering, and with dignity. Do you set up a continuous morphine pump on a comfort care patient? Then you know what that is doing..

As hospice, our goal is to help patients die without suffering and with dignity. I've mentioned this a couple of times but this is not an either/or argument.

Either you take an active role in giving the patient medication that will kill them or they have to suffer. That just isn't true.

As to Morphine Sulfate or Dilaudid CADD Pump, yes, I know what that is doing and it is not hastening death. We've had patients on those pumps for months. Some for days and weeks. It gives them a continuous dose of pain medication in order to get on top of pain.

Pain Control: Dispelling the Myths

Fortunately, patients quickly adjust to any effect that morphine may have on their breathing. We prescribe a small initial dose, gradually increasing it if needed. So rarely do breathing problems occur, they are usually not even listed as side effects. In fact morphine is a drug of choice for breathing distress in people with end-stage heart or lung disease: it makes their breathing more comfortable

Does morphine make death come sooner?

We know that morphine and other opioids are not a factor in the death of a person with advanced illness. The following information explains why:

• There is no evidence that opioids such as morphine hasten the dying process when a person receives the right dose to control the symptoms he or she is experiencing. In fact, research suggests that using opioids to treat pain or shortness of breath near the end of life may help a person live a bit longer. Pain and shortness of breath are exhausting, and people nearing the end of life have limited strength and energy. So, it makes sense that treating these symptoms might slow down the rate of decline, if only for a few hours.
  
• If a person has never received morphine, the initial doses given are low. They are gradually increased to relieve the person's level of pain or shortness of breath. After a few days of regular doses, the body adjusts to the morphine. The patient becomes less likely to be affected by morphine's most serious side effect—the slowing of breathing. It would take a large dose increase over a short time to harm someone. Morphine doses are increased gradually and only as needed to maintain comfort.
  
• The last dose is the same as the doses the patient has previously received and tolerated. The way the medication is given might change when someone can't swallow any longer. If the medication needs to be given by a different route, the dose is calculated to equal the amount previously given by mouth.
  
• There's a difference between natural dying and dying from too much morphine. When someone has received too much morphine, he or she usually can't be woken up. The person's breathing becomes very slow and regular. Sometimes only one or two breaths are taken in a minute. The person also appears calm and comfortable
  

https://www.hospiceworld.org/book/morphine.htm

The myths of tolerance, addiction, and respiratory depression have contributed to the poor management of cancer pain. These myths are based on single dose studies in animals and humans without pain. Chronic pain prevents these side effects

[blondenurse12, MSN, NP]

I don't see what religion has to do with that. Plenty of atheists would agree that a person should be of sound mind in order to make such an important decision as that. One could argue many points about those with dementia and their right to die, but most of the arguments would have to do with self determination, not religion.

I was saying generally speaking, we have difficulty even discussing this type of legislation because the religious folk crawl out of the woodwork and say "but only god can say when our horrible lives end!!" The fact that you just gloss over it means you don't really care. Go sit in a memory care unit for 12 hours and if you think god is merciful for letting those poor souls continue to live, then I have no words.

The whole issue for dementia patients is that they lack the ability to make these choices any longer but that condemns them to a horrible existence. Many of them have bodies that are fine, no huge issues but mentally, it's a mess. A lady who lives in the same wing as my grandmother was a delivery nurse. This poor woman thinks she is in a C-section that went wrong and she's stuck in the loop replaying over and over. She's constantly crying and in a panic. Can you imagine living in a panicked state 24 hrs a day? They gave her Seroquel but she was so stoned that she just sat there and drooled on herself so her family said to stop giving it to her.

[elijahvegas, ASN, RN, EMT-P]

I dont find it trivialized at all. You letting someone die in any other manner is a sentinel event that can generally be proven by negligence and failure to act which. The ONLY thing that protects you in this scenario is an advanced directive or health care proxy. So I call it a flimsy argument because you feel comfortable swapping out "negligence through failure to act" with "wanton damages" and the excuse behind it is "well they signed a piece of paper before this happened saying they wanted this so that makes it okay". You stopping interventions IS killing someone all the same.

And a Healthcare proxy makes even less sense to me because one would rather listen to the opinion of a 2nd hand person, saying "I'm sure this is what he would've wanted" but you draw the line when the patient THEMSELVES tells you that this is what they want ?

That's beyond laughable to me.

My stance on this reminds as fortified as ever. Whether it's written on a piece of paper, told by a Healthcare proxy, or out of the horses mouth, if this is what the patient wants, this is what the gets.

[Horseshoe, BSN, RN]

I dont find it trivialized at all. You letting someone die in any other manner is a sentinel event that can generally be proven by negligence and failure to act which. The ONLY thing that protects you in this scenario is an advanced directive or health care proxy. So I call it a flimsy argument because you feel comfortable swapping out "negligence through failure to act" with "wanton damages" and the excuse behind it is "well they signed a piece of paper before this happened saying they wanted this so that makes it okay". You stopping interventions IS killing someone all the same.

And a Healthcare proxy makes even less sense to me because one would rather listen to the opinion of a 2nd hand person, saying "I'm sure this is what he would've wanted" but you draw the line when the patient THEMSELVES tells you that this is what they want ?

That's beyond laughable to me.

My stance on this reminds as fortified as ever. Whether it's written on a piece of paper, told by a Healthcare proxy, or out of the horses mouth, if this is what the patient wants, this is what the gets.

Could you please utilize the "Quote" button at the bottom right corner of the post to which you are referring? You've said "you" in several posts, and it's not clear who you are talking to. "You" as in a specific poster, or "you" as in a general "you"?

[Spidey's mom, ADN, BSN, RN]

People misunderstand the difference between following the wishes of the patient and not intubating, not putting in a feeding tube, not doing CPR, or simply stopping the drugs that are keeping the vital organs working/turning off the vent . . . OR actively pushing a medication that stops the heart.

My dad had a heart attack after colon cancer surgery where the cancer tumor had burst his intestine and flooded his abdomen with feces. Hx of 2 bypass operations, carotid artery "reaming out", diabetes, etc. He had no Advanced Directives but my younger brother was his healthcare proxy. Unfortunately, when he was brought to the ER in the middle of the night via ambulance, he told everyone he had no family because he didn't want to bother us in the middle of the night. He was resuscitated for 10 minutes before they got him back and he suffered brain anoxia and at the end of the day, declared "brain dead". We didn't know about any of this until later in the day.

A family conference was held and we all decided it was best to simply lower his BP meds via IV and let nature take it's course. My brother couldn't be the one to do this though because he felt like he would be "murdering" dad. He gave his proxy over to me and I made the decision. They barely lowered the BP meds and dad died after about 20 minutes.

That is different than pushing a large amount of Morphine Sulfate or other drug to stop his heart.

Still, my brother couldn't make the decision.

One of the reasons I recommended the January 2016 JAMA . . . lots of pro/con discussion to help us understand one another.

[bgxyrnf, MSN, RN]

People misunderstand the difference between following the wishes of the patient and not intubating not putting in a feeding tube, not doing CPR, or simply stopping the drugs that are keeping the vital organs working/turning off the vent . . . OR actively pushing a medication that stops the heart. [/quote']I don't misunderstand the difference at all... nor do I think that most people do.

I simply believe that taking affirmative control over the end of one's life is the business of the individual and the provider, not the government and society.

The attitudes of people with your viewpoint are precisely what might lead me to transition somewhat earlier than I might otherwise need to simply in order to preserve my right... and it is not right, in my opinion, that the collective you are denying me the right to make sovereign choices for myself and possibly denying me extra months or years with my family.

[Spidey's mom, ADN, BSN, RN]

I don't misunderstand the difference at all... nor do I think that most people do.

I simply believe that taking affirmative control over the end of one's life is the business of the individual and the provider, not the government and society.

The attitudes of people with your viewpoint are precisely what might lead me to transition somewhat earlier than I might otherwise need to simply in order to preserve my right... and it is not right, in my opinion, that the collective you are denying me the right to make sovereign choices for myself and possibly denying me extra months or years with my family.

No one is denying you anything. Physician-assisted death just became legal here in CA. Oregon and Washington as well. Many other states are attempting to follow suit.

As a hospice nurse, I'm not going to block a patient from talking to a physician about this. I just won't help.

We are in the midst of writing a protocol for this with a team that is diverse in opinion. Makes for interesting conversations.

[Rose_Queen, BSN, MSN, RN]

As a hospice nurse, I'm not going to block a patient from talking to a physician about this. I just won't help.

I'm just curious about what kind of help you think you'd be expected to do. It's pretty clear that the patient must take the medication his/herself.