'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?

[Libby1987]

That is sad. I'm sorry.

Each hospice is different of course; like every hospital or clinic or lab.

Personally, as mentioned, I think physicians wait too long to refer. Even here locally, it has taken awhile for us to get through to the docs. They are better . . . but could be even better.

I have worked many years with a wonderful hospice agency, I am very pro hospice and add my endorsement by promoting and coordinating informational visits.

That said, they are not always peaceful. I live and work in a small community, I get the feedback from my families. They are usually pleased with the services but their loved ones' deaths certainly weren't always peaceful through the end. Friends and family members have given similar feedback.

I have received the best feedback about our local hospice, supporting your statement that not all hospices are the same, which makes sense given the continuum of quality and skill amongst other providers. It's a gamble for sure and a false sense of security for symptom management and support.

I really wish we we could at least be realistic here on this forum with this topic. I don't know how we can have a discussion with integrity if we keep pretending otherwise.

[bigskygirl]

i am pro choice, as i advocate for one's quality of life

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

That said, they are not always peaceful.

I acknowledged in prior posts that we have had some difficult deaths but the vast majority are peaceful and relatively pain free.

[bgxyrnf, MSN, RN]

I've watched (literally) both of my parents die. I've seen my child go through two critical surgeries and multiple intubations and had to come to terms with her mortality. I spent several nerve-wracking weeks with elevated LFTs and ascites on ultrasound which brought my own mortality into sharp focus.

I've been a floor nurse in a sub-acute facility where I cared for several end-of-life patients (cancer, ALS, and MRSA pneumonia), as well as others who were 'husks.' I've been an ED nurse for 6 years and seen any number of unresponsive shells come in from SNFs of various qualities. I've had several patients and families make 'comfort-care' declarations and I've seen a number of those fade away on my watch. I've dealt with grieving families deceased children and I've coded more than a few little ones.

I even spent some time as a mortuary attendant in another life.

I've been around the block and think I've got as much street cred as anybody when it comes to end-of-life.

I believe that it is the height of social arrogance (and downright cruel) that we deem it appropriate to impose our collective wills upon what should be the ultimate choice/decision made by a person in consult with a physician who should absolutely have the license to alleviate suffering in a manner that is mutually acceptable to the patient and the physician.

Outside of capital murder, no person should have death thrust upon them by the state. Neither should any person have someone else's definition of life thrust upon them by the state.

Were it legal, I would certainly be willing to participate in caring for patients taking charge of their deaths.

As a voter, I will ardently and faithfully support moves to further empower physicians and patients to make these decisions without the undue intervention of the state.

[bgxyrnf, MSN, RN]

I forgot to mention what is, I'm sure, a fairly common experience: I've had more than one patient specifically ask me to end their suffering. That is a tough place to be.

I've also had many elderly patients say things like, "Don't you believe it for a second... there's nothing golden about these years."

I'm all for minimal statutory involvement.

My own personal motto is, "Better out a year too early than a minute too late."

[joanna73, BSN, RN]

I don't understand how that view is generally compatible with nursing. If a patient is under your care and needs you to administer treatment for an MI or Sepsis, do you refuse because that would be interfering with God's decision of when this person should die?

Agreed. Thanks to technology and medicine, we are able to keep people alive much, much longer than we probably should in some cases. Average life expectancy continues to increase due to man made interventions. Where does it end?

We have long ago interfered with "God" or whatever higher power you believe in. That's a very weak argument against physician assisted death.

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

Agreed. Thanks to technology and medicine, we are able to keep people alive much, much longer than we probably should in some cases. Average life expectancy continues to increase due to man made interventions. Where does it end?

We have long ago interfered with "God" or whatever higher power you believe in. That's a very weak argument against physician assisted death.

I don't think God put us here to just sit and wait for Him to do things. He gave us brains to think of stuff - like cures for diseases and how to make airplanes.

There are some religious folks who don't believe in using modern medicine because God is in control and we simply must wait on Him to intervene in a positive way by healing us. Or, they say use "natural" cures . . . (aka pseudoscience).

Not that God won't or can't heal us . .. but again, we are not simply mindless robots.

He gave us brains!

[joanna73, BSN, RN]

Yes he did. My comment was in response to the idea that some believe we are interfering with God by determining when or how someone should die.

We are already interfering by keeping people alive using vents, tubes and medicine, so that argument can go both ways.

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

Yes he did. My comment was in response to the idea that some believe we are interfering with God by determining when or how someone should die.

We are already interfering by keeping people alive using vents, tubes and medicine, so that argument can go both ways.

I know - sorry I wasn't more clear.

[nutella, MSN, RN]

In reading a lot of the comments a couple of issues come to my mind.

1.Personal preference - some people want to maintain strict control over when and how they die and assisted suicide gives them control

2. Medicare Reimbursement for hospice care - under current guidelines a pat can not pursue curative tx and hospice at the same time unless they are part of the Medicare trial that combines certain palliative measures with hospice to allow early access to hospice care. I meet with many patients who would hugely improve their quality of care and minimize suffering with hospice care but also still want to get transfusions, palliative chemo, go to see specialists, or to the ER.

3. Medicare conditions of participation - Medicare has become strict because the system was misused. People were on hospice for years on end, especially in facilities. There has to be a reason for hospice ! Just high age with not much other illness is not enough. Life expectancy less than 6 months if the illness was to take it's course. The guidelines are even more strict for dementia. I worked in hospice and as hospice liaison and did evaluations - people are upset when they do not qualify.

4. Late referrals - there is the constant confusion between palliative and hospice care. Early involvement of palliative care can help with symptom control in many cases - endstage COPD is one of those for example. Also, addressing goals for care are important and palliative care talks about it. A lot of people avoid any end of life conversation until the person is literally close to death. When people are clear about what they would want in terms of care , invasive procedures and such, they can plan ahead.

5. Is there suffering that can't be relieved by hospice? Sometimes yes. Hospice can do palliative sedation in those cases at home but not in long-term care facilities. Sometimes those patients need to be admitted to the hospice house or hospital for inpatient hospice care that will include medication in high doses and medication to alter perception and sedate.

[Horseshoe, BSN, RN]

3. Medicare conditions of participation - Medicare has become strict because the system was misused. People were on hospice for years on end, especially in facilities. There has to be a reason for hospice ! Just high age with not much other illness is not enough. Life expectancy less than 6 months if the illness was to take it's course. The guidelines are even more strict for dementia. I worked in hospice and as hospice liaison and did evaluations - people are upset when they do not qualify.

I graduated in 1996. I did home health hospice as one of my clinicals. Even back then one had to have a terminal illness with life expectancy of six months or less to qualify. When was it different? Though some patients outlived their prognosis, they were still considered terminal and qualified to receive hospice.

[LadyFree28, BSN, LPN, RN]

I graduated in 1996. I did home health hospice as one of my clinicals. Even back then one had to have a terminal illness with life expectancy of six months or less to qualify. When was it different? Though some patients outlived their prognosis, they were still considered terminal and qualified to receive hospice.

The only thing that is difference is that if the pt outlived the diagnosis, insurance is not covering for it-they will discharge pts from hospice until they are showing documented symptoms of potential death.