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#31 Old 11-17-2010, 09:36 PM
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Originally Posted by Skeezix View Post

This. ^

The law already permits patients or their surrogates to withhold or withdraw unwanted medical treatment even if that increases the likelihood that the patient will die. No one needs to be hooked up to machines against their will.

However, sometimes just withholding treatment might result in painful death. For example, someone who needs a respirator to breathe has the respirator removed will just die of suffocation...can't say that's a peaceful death. But if euthanasia is legalized, the patient might be able to get an injection that just puts them to sleep where they will die in oblivion.
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#32 Old 11-18-2010, 05:57 AM
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However, sometimes just withholding treatment might result in painful death. For example, someone who needs a respirator to breathe has the respirator removed will just die of suffocation...can't say that's a peaceful death. But if euthanasia is legalized, the patient might be able to get an injection that just puts them to sleep where they will die in oblivion.

My grandmother was on a respirator after a massive brain hemorrhage but wasn't on any other life support. The day after the hemorrhage the doctor said there was no hope, i.e. no brain activity. So the family made the decision to disconnect her. She was already terminally ill with leukemia and had opted to not have radiation and chemotherapy, so she had already made her mind up not to be flogged to pieces; the leukemia would have taken her in a few months if she had not suffered the hemorrhage. She hung on for two days and slipped away very peacefully. That was around this time in 2006, god I miss her.
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#33 Old 11-18-2010, 07:54 AM
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Virtually all pain can be eliminated or in those rare cases where it can't be totally eliminated, it can be reduced significantly if proper treatment is provided.

It is a national and international scandal that so many people do not get adequate pain control. But killing is not the answer. The solution is to mandate better education of health care professionals, to expand access to health care, and to inform patients about their rights as consumers.

With modern advances in pain control, no patient should ever be in excruciating pain. However most doctors have never had a course in pain management so they're unaware of what to do.

If a patient who is under a doctor's care is in excruciating pain, there's definitely a need to find a different doctor. But that doctor should be one who will control the pain, not one who will kill the patient.
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#34 Old 11-21-2010, 04:02 PM
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Originally Posted by delicioso View Post

It would be nice if it were legal, the norm, and we could have death planners, like we have wedding planners.

Read The Giver by Lois Lowry and you'll understand how creepy that is. I believe euthanasia is fine under the right circumstances, even for people (why would I have to say 'even for people' on here?) but planning it is just... yuck. I know that this might not be what you mean but I am imagining a big gathering/celebration.

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#35 Old 12-03-2010, 11:23 AM
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We feel morally responsible for ending an animal's suffering because we know that animal cannot make the choice for themselves, and doesn't have the cognition to think "if I die now, my suffering will end, so I want to die". With humans, the other person in their normal state is capable of making an informed decision. When they are in a vegetative state we know that before the coma, they were capable of deciding, and they might have wanted to live for the chance of regaining consciousness. Therefore we often feel that it is our responsibility to end an animal's suffering, but it is not our decision to end another person's.

Because a non-human animal cannot rationalize that being being killed will end their suffering, it is acceptable to make that decision on their behalf but because a human can, it is not all right to make that decision for them? If the focus is on alleviating suffering (and it should be), then we are justified in euthanizing both humans and non-human animals. The difference is that humans can voice an explicit preference to die whereas with non-human animals, we have to infer whether or not they have a quality of life that is worth continuing (ie. if they suffer intolerably or if the happiness in their life outweighs the pleasure). Whether or not the moral patient is in a coma makes things different. I think the decision in that scenario should be based on how likely it is that they will regain consciousness and live a relatively happy life but, in my view, their prior preference to be kept alive or not holds no weight, in and of itself.

I think everyone should have a legal right to a physician assisted suicide and not just terminally ill people. I don't believe that autonomy has any inherent value, I think that there is a moral imperative to minimize suffering unless doing so conflicts with minimizing or maximizing an even greater amount of suffering or happiness (I have mixed feelings about whether or not happiness and suffering are symmetrical in value but for the time being, I think they are). I don't believe that life has any inherent value or is worth continuing for any other reason than the opportunity to experience happiness.
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#36 Old 12-03-2010, 03:04 PM
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I work in a long term care/rehab facility, this is a very complex issue. I won't even start. I will say though, that many people have never seen a natural death. I've seen both human and my pets. It's a sad thing. But not a horrible thing to see. I think most people don't understand the process. I believe in comfort care and hospice care when it's that time. Hospice is not just for cancer patients. It's for many people at the end stage due to many conditions.
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#37 Old 12-03-2010, 06:22 PM
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Virtually all pain can be eliminated or in those rare cases where it can't be totally eliminated, it can be reduced significantly if proper treatment is provided.

Not true. And one can be significantly, unendingly miserable even without "pain" as such.I,for instance, would rather experience a significant amount of pain rather than nausea, which I find intolerable.
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#38 Old 12-05-2010, 10:30 AM
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You can get palliative care which is basically Morphine and a bunch of other drugs which will send you off to your death in a painless haze if you have a condition that justifies it, but unfortunately, at this point in time, you can't request euthanasia. I really wish you could, because as a nurse, there's been plenty of times when a patient has looked into my eyes and said in desperation "nurse, please kill me" and I can't legally do anything to help them.

Actually, if morphine is given proper amounts and frequency by an experienced prescriber, or by self-administration, there is little or no "haze." The patient is usually more lucid than s-he would otherwize be. Having experienced chronic pain and having been treated with morphine, I know that the pain put me into a haze, and the overall effect of morphine was to increase by mental capacities. While someone who is not in pain will have their mental capacities reduced by morphine, it appears quite evident that for someone who has their mental capacities reduced by pain, the increase of mental capacity caused by pain-relief, exceeds the decrease caused by the morphine, with the result being an net increase.

Although for most of the period of my life during which I had chronic pain, I suffered unnecessarily, because I was not treated adequately with morphine or other opioids, eventually I became one of the minority who got adequate treatment. For most people with chronic pain, unless they are terminally ill, they are not likely to get anywhere near sufficient quantities of morphine for the amount of pain they have. This does appear to be changing though, though slowly.

Not always, but very often, those people who have previously been requesting that someone please kill them, stop making such requests, once they have been getting appropriate doses of opioids. As well, they remain lucid.

We euthanize animals because we are simply unwilling to go through the time and expense of caring for them once they become very ill. Since we (most of us) care more about humans than we do about animals, when humans become sililarly ill, we are more likely to spend time and money on them.
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#39 Old 12-05-2010, 11:40 AM
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Originally Posted by vegkid View Post

Read The Giver by Lois Lowry and you'll understand how creepy that is. I believe euthanasia is fine under the right circumstances, even for people (why would I have to say 'even for people' on here?) but planning it is just... yuck. I know that this might not be what you mean but I am imagining a big gathering/celebration.

I'm not talking party. I'm talking about dying how you choose. Maybe some people want to go out, listening to certain music on their way out or whatever...not creepy, just compassionate and less scary. Rituals help people deal with things better sometimes.
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#40 Old 12-06-2010, 10:18 AM
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Actually, if morphine is given proper amounts and frequency by an experienced prescriber, or by self-administration, there is little or no "haze." The patient is usually more lucid than s-he would otherwize be.

I can assure you that none of the palliative patients I care for are having any lucid conversations as they leave this world - they go out completely off their face, I make sure of it.

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#41 Old 12-06-2010, 12:46 PM
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Originally Posted by Nishani View Post

You can get palliative care which is basically Morphine and a bunch of other drugs which will send you off to your death in a painless haze if you have a condition that justifies it, but unfortunately, at this point in time, you can't request euthanasia. I really wish you could, because as a nurse, there's been plenty of times when a patient has looked into my eyes and said in desperation "nurse, please kill me" and I can't legally do anything to help them.

QFT. I'm a nurse also, I haven't yet had anyone ask me to kill them, but I have seen many suffering people state that they want to die. They should have that choice.

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#42 Old 12-06-2010, 03:57 PM
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I can assure you that none of the palliative patients I care for are having any lucid conversations as they leave this world - they go out completely off their face, I make sure of it.

Except perhaps for those unusual patients who specifically ask to be "completely off their face," what you are doing sounds like malpractice to me.

Everything I've read about palliative care using opioids leans towards a goal of enabling patients to communicate lucidly with their relatives and friends, tie up loose ends, both personal and financial, make amends with anyone that they need to make amends with, and do so in relative comfort. Usually this goal can be achieved. When pain is such that so much oral or injected drug is needed that maintaining lucidity is difficult, there are other dosing methods that may be helpful, such as intrathecal.

I know that my mother was able to get adequate relief from metastatic breast cancer during the last months and days of her life, with nothing but oral morphine and oral hydromorphone (timed release morphine and immediate release hydromorphone for "breakthrough" pain). Withougt these drugs she had agonizing pain, due to invasion by cancer of bones (including legs bones, ribs, and skull), and brain, and she was on fairly high doses of these drugs, yet was quite lucid until the moment she died, and as well her pain was well controlled. Most of the opioids were self-administered, although at times she had some professional help tracking her dosing schedule. Her palliative care was managed by a palliative care group that had a higly regarded reputation in the field of palliative care. Her caretakers not only made sure that she did not go "off her face," but would have been appalled by anyone suggesting this as a goal, or even just using such language. The goal was always maintaining human loving connectivity, and never sending someone "out of it."

Until now, I didn't realize there were health professionals who had a different goal. Frankly, I found your remarks to be very upsetting.
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#43 Old 12-06-2010, 04:50 PM
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Originally Posted by Iam2cool View Post

When an animal is too sick, we put it to sleep and call that HUMANE. When a human is too sick and REQUESTS to be put to sleep, we call that INHUMANE. Can someone please make me understand this? I am very confused.


Beats the hell out of me. I agree with you.

Tam! RUGH!
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#44 Old 12-06-2010, 04:57 PM
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In reply to Iam2cool, saying "When an animal is too sick, we put it to sleep and call that HUMANE. When a human is too sick and REQUESTS to be put to sleep, we call that INHUMANE. Can someone please make me understand this? I am very confused."

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Beats the hell out of me. I agree with you.

Iam2cool asked a question, and did not make an assertion. One can agree with an assertion. But it beats the hell out of me how you can agree with a question. There is nothing to agree with. Being just as confused as someone else is not equivalent to agreeing with them.
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#45 Old 12-06-2010, 06:51 PM
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Except perhaps for those unusual patients who specifically ask to be "completely off their face," what you are doing sounds like malpractice to me.

Not when I'm working within the doctor's drug order it's not.

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Everything I've read about palliative care using opioids leans towards a goal of enabling patients to communicate lucidly with their relatives and friends, tie up loose ends, both personal and financial, make amends with anyone that they need to make amends with, and do so in relative comfort. Usually this goal can be achieved. When pain is such that so much oral or injected drug is needed that maintaining lucidity is difficult, there are other dosing methods that may be helpful, such as intrathecal.

That's correct, but you're talking about the beginning stages of palliative care, I'm talking about the END stage. If a patient is initially on oral MS Contin or Oxycontin B.D for example, of course they can maintain lucidity, but as the dying process gets underway, dosages increase, the drug's route changes to injectable and with that, lucidity decreases.

Quote:
I know that my mother was able to get adequate relief from metastatic breast cancer during the last months and days of her life, with nothing but oral morphine and oral hydromorphone (timed release morphine and immediate release hydromorphone for "breakthrough" pain). Withougt these drugs she had agonizing pain, due to invasion by cancer of bones (including legs bones, ribs, and skull), and brain, and she was on fairly high doses of these drugs, yet was quite lucid until the moment she died, and as well her pain was well controlled. Most of the opioids were self-administered, although at times she had some professional help tracking her dosing schedule. Her palliative care was managed by a palliative care group that had a higly regarded reputation in the field of palliative care. Her caretakers not only made sure that she did not go "off her face," but would have been appalled by anyone suggesting this as a goal, or even just using such language. The goal was always maintaining human loving connectivity, and never sending someone "out of it."

Until now, I didn't realize there were health professionals who had a different goal. Frankly, I found your remarks to be very upsetting.

Australian culture leans towards informality a lot of the time particularly in the way we speak, so therefore, I don't feel the need to always use professional medical terminology unless I'm writing in a patients case notes. Even in the change-of-shift handover, when we nurses are talking amongst ourselves, we often use terms like "away with the fairies" or "off his/her face or "a bit out of it" to describe a patients mental state. I'm also a drug counsellor, and I'm used to speaking with addicts on their level, so sometimes my language crosses over a bit. I'm sorry that my use of a colloquialism upset you so much, that wasn't my intention.

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#46 Old 12-06-2010, 09:33 PM
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It wasn't the colloquial language that upset me, so much as your assertion that you "made sure of it," that the patients were not lucid, that your intention was to make them non-lucid.

From the idea that you intentionally were making patients non-lucid I inferred that you were prescribing, rather than formulating per the instructions of a prescriber. If you are giving patients dosages that were prescribed by a doctor or other professional with a license to prescribe, then that would not be malpractice on your part, but it would sound to me like it may be malpractice on the prescriber's part. Of course there are people with brain injury that cannot be lucid. But I know that many people remain lucid throughout the dying process, despite high doses of opioids, whether oral, injected, or an intrathecal pump - the last of which enables greater pain relief with smaller doses, and more lucidity.

Again, my mother was lucid in both early stages and late stages of palliative care. She was on strictly palliative care for about a year, and was lucid the whole time, despite losing most of her hearing, most of her ability to move, and being confined either to bed or a wheelchair. She was able to have good pain relief with oral dosing. I don't really remember the numbers too well but I think she must have had about a gram of morphine per day as well as 50 mg of hydromorphone. She would sleep alot. But when she awoke she was able to hold a conversation. About 24 hours before she died she communicated to me that she had only hours to live, and gave me clear, specific instructions on what she wanted done with various personal belongings that she would not need after she died. She was able to communicate perfectly clearly, despite substantial head and brain involvement for a number of months.
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#47 Old 12-07-2010, 06:43 AM
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It wasn't the colloquial language that upset me, so much as your assertion that you "made sure of it," that the patients were not lucid, that your intention was to make them non-lucid.

That pretty much is my intention. I consider it my duty of care and the least I can do for them when they've been telling me for weeks or months sometimes that they're sick of living and want to die. And like I said before, some of them have actually asked me to kill them. I can't legally do that of course, but I do my best to keep them in a state that's the next best thing for them which is "out of it".

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#48 Old 12-07-2010, 09:15 AM
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Nishani, you can't legally kill them, intentionally, but it seems likely that what you are doing, with the intention of improving the quality of their lives, is making their lives shorter.
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#49 Old 12-07-2010, 09:59 AM
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I'm talking about patients that are going to die anyway and want a shorter life.

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#50 Old 12-07-2010, 10:09 AM
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That pretty much is my intention. I consider it my duty of care and the least I can do for them when they've been telling me for weeks or months sometimes that they're sick of living and want to die. And like I said before, some of them have actually asked me to kill them. I can't legally do that of course, but I do my best to keep them in a state that's the next best thing for them which is "out of it".

Well said! I totally agree, and have done the same thing.

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Nishani, you can't legally kill them, intentionally, but it seems likely that what you are doing, with the intention of improving the quality of their lives, is making their lives shorter.

I know it sounds harsh to some, but until you work around it, you don't realize that some people are far past improving quality of life. When they are suffering from a terminal illness and reach the point of no longer eating, drinking water, or even able to tolerate being moved, they will most likely never reverse back to even a marginal quality of life. Most of them develop intractable pain in the end stages, and it's better to keep them medicated so that they don't suffer. It may shorten their life to an extent, but it eases their suffering.

I always respect my patients wishes, and if they ever told me they didn't want to be medicated, I wouldn't, but that rarely happens. I also communicate with the patient's family, and most of the time they want the person kept comfortable. I know I would for my family.

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#51 Old 12-07-2010, 11:48 AM
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I'm talking about patients that are going to die anyway and want a shorter life.

Yes of course.
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#52 Old 12-07-2010, 11:51 AM
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Well said! I totally agree, and have done the same thing.



I know it sounds harsh to some, but until you work around it, you don't realize that some people are far past improving quality of life. When they are suffering from a terminal illness and reach the point of no longer eating, drinking water, or even able to tolerate being moved, they will most likely never reverse back to even a marginal quality of life. Most of them develop intractable pain in the end stages, and it's better to keep them medicated so that they don't suffer. It may shorten their life to an extent, but it eases their suffering.

I always respect my patients wishes, and if they ever told me they didn't want to be medicated, I wouldn't, but that rarely happens. I also communicate with the patient's family, and most of the time they want the person kept comfortable. I know I would for my family.

Yes I think i understand.
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