Voluntary Euthanasia

[GARY_FL_NURSE]

I think one of the cruelest things we do is let patients lay in nursing home beds without the legal ability to terminate their own lives. I'd be interest in what other nurses think of this.

If you ask active people who are in their 40s and alert and you say to them "when you get older and you lose the capacity to know your surroundings and you no longer recognize your family members, and if you reach a point where someone has to change your brief in a bed or feed you your meals, would you prefer to live your life like that or would you prefer someone terminate your life painlessly and peacefully?"

What do you think most people's response would be???

Mine would be termination of my life! But guess what that is against the law in most states.

I'd be interested in knowing what other nurses think about this. We get trained over and over again about abuse. Well to me, the biggest abuse we commit is we do not allow Voluntary Euthanasia over laying in a soiled brief in a nursing home bed where we can't even feed ourselves anymore. Voluntary Euthanasia is illegal in all states and PAD is allowed only in Washington, Oregon, Montana, and Vermont.

[Esme12, ASN, BSN, RN]

Agree many animals don't. We stayed with my dying dog around the clock, administering pain meds, massages and fireplace fires for her to lay in front of. That was 10 months ago.. I'm still exhausted from the emotional stress. I had to make the call.. to end everybody's suffering.

((HUGS)) I am so sorry for your loss. ((HUGS))

My previous dog was a rescued puppy that was barely big enough to eat out of a bowl She had parvo and I nursed her, at home, in my bathtub, back to health. IVF and all. I had a house fire and she was in the fire at age 11 and the wonderful fire department of Portage Indiana did mouth to snout revived her and took her to a local vet....where I slept on the floor to help and be with her. She got up one day at age 16 and I saw blood....she had almost over night developed a tumor. I decided at her age it was not fair to put her through surgery and chemo if she would even survive the stress....who would I be doing it for...her? No it would be me. I brought her home and she told me when it was time.

I loved her enough to let her go.

When my Dad coded in the hospital and it was clear he would not survive and was not responsive...my sisters and I loved him enough to say Good-bye as well. I do miss him so.....

[MunoRN, RN]

I disagree. An example, hospice pt hadn't had morphine because aside from SOB, didn't appear in pain. A dose of .5 mg morphine recommended by hospice nurse because his respirations were 45 bpm. Dose given and 2 hours later, RR reduced to about 25bpm. No further morphine given. Patient declined and died several hours later that evening. That man was actively dying. The morphine didn't 'speed' up anything, it did what it was designed to do, bring the respirations down from

Morphine isn't administered to STOP breathing. It reduces RR, it doesn't STOP respirations.

There are many situations where morphine is unlikely to hasten death, and probably actually extends life. But there are also many where it doesn't, examples of this are more likely to be found when a patient dies in the ICU or elsewhere in the hospital where the transition from artificial support to no support is much more abrupt. I can tell you from first hand experience, that morhpine-hastened death most certainly occurs.

I know the idea that we can't hasten death with morphine is a popular myth out there, and one that we sort of need to buy into sometimes for our own wellbeing as nurses, but if that's true then a basic premise of opiates would have to be considered false, which there doesn't seem to be any evidence to support, which is that while morphine can be helpful to a point, it can also cause adverse effects, some of which can cause imminent death. The purpose of 'comfort care' is often to take away that limitation of trying to avoid causing imminent death by increasing opiate dosage for complete symptom treatment.

This is mainly true for dyspnea, which is a mismatch between how much we feel we need to ventilate/respirate (breath), and our perceived ability to breath. In a non-comfort care patient, we limit morphine to the amount that treats our ability to breath; by reducing pulmonary vascular congestion, relaxing airways, relaxing the pulmonary artery and take the artificially reduced drive to breath that goes with that because the net effect is still a functional improvement. On comfort care, particularly in situations such as a terminal wean (discontinuing a ventilator and allowing death), the primary purpose of morphine is treat the other component of dyspnea; the perceived effort required to breath in a way that sustains life. Due to various conditions, the brain may be correct in saying that the patient must make a continuously extreme effort to breath to continue living, we use morphine to trick the brain into thinking it doesn't.

[Been there,done that, ASN, RN]

((HUGS)) I am so sorry for your loss. ((HUGS))

My previous dog was a rescued puppy that was barely big enough to eat out of a bowl She had parvo and I nursed her, at home, in my bathtub, back to health. IVF and all. I had a house fire and she was in the fire at age 11 and the wonderful fire department of Portage Indiana did mouth to snout revived her and took her to a local vet....where I slept on the floor to help and be with her. She got up one day at age 16 and I saw blood....she had almost over night developed a tumor. I decided at her age it was not fair to put her through surgery and chemo if she would even survive the stress....who would I be doing it for...her? No it would be me. I brought her home and she told me when it was time.

[ATTACH=CONFIG]15868[/ATTACH]

I loved her enough to let her go.

When my Dad coded in the hospital and it was clear he would not survive and was not responsive...my sisters and I loved him enough to say Good-bye as well. I do miss him so.....

"I loved her enough to let her go." Says it all. Kudos to you my brave friend.

[OCNRN63, RN]

((HUGS)) I am so sorry for your loss. ((HUGS))

My previous dog was a rescued puppy that was barely big enough to eat out of a bowl She had parvo and I nursed her, at home, in my bathtub, back to health. IVF and all. I had a house fire and she was in the fire at age 11 and the wonderful fire department of Portage Indiana did mouth to snout revived her and took her to a local vet....where I slept on the floor to help and be with her. She got up one day at age 16 and I saw blood....she had almost over night developed a tumor. I decided at her age it was not fair to put her through surgery and chemo if she would even survive the stress....who would I be doing it for...her? No it would be me. I brought her home and she told me when it was time.

[ATTACH=CONFIG]15868[/ATTACH]

I loved her enough to let her go.

When my Dad coded in the hospital and it was clear he would not survive and was not responsive...my sisters and I loved him enough to say Good-bye as well. I do miss him so.....

​Awww...

[toomuchbaloney]

There are many situations where morphine is unlikely to hasten death, and probably actually extends life. But there are also many where it doesn't, examples of this are more likely to be found when a patient dies in the ICU or elsewhere in the hospital where the transition from artificial support to no support is much more abrupt. I can tell you from first hand experience, that morhpine-hastened death most certainly occurs.

I know the idea that we can't hasten death with morphine is a popular myth out there, and one that we sort of need to buy into sometimes for our own wellbeing as nurses, but if that's true then a basic premise of opiates would have to be considered false, which there doesn't seem to be any evidence to support, which is that while morphine can be helpful to a point, it can also cause adverse effects, some of which can cause imminent death. The purpose of 'comfort care' is often to take away that limitation of trying to avoid causing imminent death by increasing opiate dosage for complete symptom treatment.

This is mainly true for dyspnea, which is a mismatch between how much we feel we need to ventilate/respirate (breath), and our perceived ability to breath. In a non-comfort care patient, we limit morphine to the amount that treats our ability to breath; by reducing pulmonary vascular congestion, relaxing airways, relaxing the pulmonary artery and take the artificially reduced drive to breath that goes with that because the net effect is still a functional improvement. On comfort care, particularly in situations such as a terminal wean (discontinuing a ventilator and allowing death), the primary purpose of morphine is treat the other component of dyspnea; the perceived effort required to breath in a way that sustains life. Due to various conditions, the brain may be correct in saying that the patient must make a continuously extreme effort to breath to continue living, we use morphine to trick the brain into thinking it doesn't.

They recently tried to hasten death with morphine and versed. It hastened death but took hours to accomplish that end. The inmate was likely pretty comfortable as he slowly died, but the onlookers were decidely uncomfortable with the process.

It is pretty clear that when Morphine is a part of the hospice POC that the intent is NOT to kill the patient but to improve comfort. Intention is the difference.

I really don't care if folks want to complete a suicide it is their choice and I am cool with that. It is no longer illegal in this country and I don't think the state or feds can seize your property or anything after you are dead.

I think that it is important that if they are seeking to kill themselves because of comfort or quality of life issues that they should be aware that other options are available (assuming that there are other options available to them for comfort).

I just don't want to be put into a position to have to "help" them die and I DO get to have a say in that both as a self determining human being and as a health professional.

[MECO28, BSN, RN]

Can I just say that I am happy to be getting gay married next month in my state that allows voluntary euthanasia?

[SionainnRN]

Can I just say that I am happy to be getting gay married next month in my state that allows voluntary euthanasia?

Just don't do it at the same time!!

[tyvin, BSN, RN]

As an experienced Hospice RN of many years I am absolutely in favor of euthanasia. There are some forms of disease where the pain cannot be managed. The current euthanasia laws on the books in OR make it almost impossible to be approved for the treatment, but may the Gods bless the ones who are able to get through the process...it is extremely arduous.

[Esme12, ASN, BSN, RN]

"I loved her enough to let her go." Says it all. Kudos to you my brave friend.

She was my search dog....she was a good girl.

[VivaLaVespaGirl, BSN, MSN]

Don't blame me because you were offended.

They make opiates and other pain medications for animals.

You opted to euthanize the cat rather than attempt to make it comfortable using modern pharmacological agents while allowing a natural death. It would seem that we assume that we cannot keep our pets comfortable and so we kill them.

In your case you state it is/was for reason of compassion, like so many of us might. It is also VERY convenient and less expensive to end their lives.

You are SO off the mark. Sure it is convenient and less expensive to end our pets lives, and there are pet owners who will simply euthanize for a perfectly treatable, manageable condition because it is cheaper and more convenient. But I had a diabetic dog whose expensive daily injections and regular vet visits I happily paid for for years. However, when, at 14 years old, he reached a point where age caught up with him, management of his disease was nearly impossible, and it was obvious that he found no more joy in living, I chose to euthanize. Animals, like humans, find no pleasure in being drugged up, unconscious, and incapable of functioning with any sort of normalcy. I saw the shame he felt when he became incontinent and I heard his misery when he was unable to get up on his own. Do not tell me that I ended my best friend's life out of convenience.

[delphine22]

Lots of different terms at play here. Here's how I understand them, these may not be the legal definitions.

I am for physician-assisted suicide, in which the oriented and consenting pt holds and consumes the lethal drug on their own, prescribed by a physician. To me, the only objection to letting an oriented person who is terminally ill end their life is a religious one, and that doesn't deserve a place in legal issues.

To me, this is the same as a person refusing treatment that will prolong their life and that will ensure their death if they do not get it -- I had a 97-year-old pt with complete heart block who refused a pacemaker, and no one had a problem with that, though she was progressively dyspneic and it was sure to kill her soon.

An alternative to this would be to make oneself a DNR, and then to commit suicide on their own. Granted, it is not always effective.

I am for voluntary and consenting euthanasia, in which an oriented and consenting pt who is UNABLE to administer the drug themselves (for example, ALS) has a healthcare provider do it for them. I would do this if I were the nurse, but if I were not comfortable with it, I would refuse, just as I would refuse to administer any drug I felt was unsafe or inappropriate to my nursing practice. Then someone else would do it.

I am for prior-consent euthanasia, similar to a DNR, in which a pt who is oriented lets their wishes be known ahead of time, and then when they are unable to consent and terminal, the healthcare team can abide by their wishes.

I am for withdrawal of care when someone is actively dying and had made their wishes previously known. For example, extubation, stopping feedings. I am in favor of morphine drips at this time but ONLY FOR COMFORT and not to hasten death. The pt who needs a ventilator will die without one -- make them comfortable with some morphine, but not enough to kill them before the lack of ventilation does.

I am opposed to involuntary euthanasia, which is the active killing/murder of someone who is not actively dying at this time, through the outside administration of drugs that cause them to die. I do not support the withholding of feedings from demented pts who can otherwise maintain their airway and have healthy hearts -- you are essential starving them to death because they're unable to hold a spoon.

It's not just on family members -- there are actually patients out there who, for whatever reason, want everything done for them forever and ever, and buy LTC insurance so they can sit in a nursing home until the good Lord takes them whenever He deems appropriate. Without proper documentation, I can't know their wishes, and am opposed to bringing about the death of someone just because I have judged their quality of life to be inadequate, and they can't tell me otherwise.

Again, these are my opinions, I respect yours.

[toomuchbaloney]

You are SO off the mark. Sure it is convenient and less expensive to end our pets lives, and there are pet owners who will simply euthanize for a perfectly treatable, manageable condition because it is cheaper and more convenient. But I had a diabetic dog whose expensive daily injections and regular vet visits I happily paid for for years. However, when, at 14 years old, he reached a point where age caught up with him, management of his disease was nearly impossible, and it was obvious that he found no more joy in living, I chose to euthanize. Animals, like humans, find no pleasure in being drugged up, unconscious, and incapable of functioning with any sort of normalcy. I saw the shame he felt when he became incontinent and I heard his misery when he was unable to get up on his own. Do not tell me that I ended my best friend's life out of convenience.

Okay, I won't tell you that...