Doctor/Medical Assisted Suicide
 

This spans beyond Dr. Jack Kevorkian.

http://www.msnbc.msn.com/id/48637191...h-health_care/


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There is so much that goes into this topic. GCers, what do you think about the states that have legalized assisted suicide and the states for which it remains illegal? What do you think about the larger issue of assisted suicide?

If you do not want to share your opinion, feel free to just vote in the poll.

That said, the Washington State law makes a lot of sense. The law only serves people with a terminal diagnosis. There was probably some concern that the law would be expanded to include folks without terminal disease or that doctors and/or insurance companies would pressure folks into selecting life-ending treatment, but that simply hasn't happened. Some are going to object on religious grounds. In states like mine, those folks are going to be in the majority for quite some time.

I'm not going to express an opinion at this point, but just as an informational note - Oregon was the first state to pass a Death with Dignity Act (1997 I believe). Washington followed in 2009.

State laws on assisted suicide.


1994. Oregon was ahead of their time.


I agree, especially with the bolded.

Meh. Patients don't need a physician to assist them to commit suicide, IMHO. A physician has a duty to do no harm. I think it puts physicians in a tough position.

"Harm" is an awfully difficult word to define.

At some point, wouldn't not carrying out the express wishes of the patient when they have a very painful death approaching and a no hope terminal diagnosis actually be harmful?

I responded "maybe, depends on the illness" for the record. I don't think physician assisted suicide should be available for anyone without a terminal diagnosis and a short amount of time to live. Once the decision is made, it's awfully tough to reverse course. Also, I don't want anyone with mental illness to think of physician assisted suicide as a means to deal with the symptoms of their illness.

I agree. I actually agree with aspects of both sides of the issue.

Thanks for providing one medical doctor's perspective.

The physician's job is not to carry out every wish of the patient. That does not constitute harm.

I didn't say that at all.

Ever hear the phrase "Doing more harm than good"? Physicians have been known to be guilty of that from time to time despite trying to do no harm. In some cases, the best course of treatment for a patient is for that patient to die. Why not let physician assisted suicide ensure the patient's passing is as peaceful as possible?

Under the Washington law, the physician isn't actually the person pulling the trigger, so to speak. They simply provide a surefire and pain-free means to an end. The physical act of suicide is done by the patient according to the law, even if that means knocking some pills into the feeding tube or whatever.

Yes, there are many, many occasions when the best course of treatment is to let a patient go comfortably. However, there are already procedures in place for that- hospice care.

What many aren't aware of is that often the physician recognizes when artificial life-extending measures are futile and they DO recommend hospice care. It is often the families, who for a whole gamut of reasons (denial, guilt, hope, faith, etc), are unwilling to let the loved one go peacefully and request "full code" status. (this would be the case when loved one is unable to make own medical decisions and next of kin is required)

However, hospice care and families unwilling to let grandmama go peacefully is a whole 'nother topic and not what Dr Phil is asking about. Therefore, I won't dereail. Just wanted to clarify that artificial measures to extend life in a futile situation are done at patient and family request, not because a physician just wants to. There is also not a need for physician assisted suicide to allow a patient to die comfortably. Hospice is an excellent alternative.

#marriedtoanoncologist #heartragicfamilystoriesdaily

Blondie93, please feel free to discuss a range of topics that fuel your opinion on physician assisted suicide.

I tried to include other alternatives in the poll.

I'm for it, not just in terminal illness cases but in severe disability which precludes any quality of life such as quadraplegia at the C1 or C2 level, severe stroke impairment that will not improve, etc. It isn't really possible for all patients to do it by themselves because some are physically unable to obtain the means.

I'm also pro-hospice, but have seen people suffer up until the very last minute, even while hospice was trying to keep them comfortable. If pain is so great that no pain meds can touch it and a patient is terminal and conscious, it's a pretty awful situation.

I also think "do no harm" can be interpreted a lot of ways. I also struggle with the religious arguments against it. The argument I usually hear is that it is "playing God" and such things should be left up to God. But I never hear that argument go in the other direction. Most (not all) are ok with taking all kinds of medical extreme measures to prolong a life. Isn't this playing God too? Where do we draw that line? People used to die from all kinds of infections that we now treat easily with penicillin. People died of heart problems that are much more easily treated now. If our time and manner of death is all predetermined, then why treat anything? For these reasons, I don't buy into that argument. I just can't understand where the line is. It's one of my first questions for Him when I die. (I have a whole list of these types of questions)

These are all reasons why it is important for people to have patient advocates and Living Wills, if they feel strongly about not being in certain circumstances.

I think it should be legal under extremely strict conditions. Just some, but not limited to:

-A terminal illness where the patient will die in a set amount of time (Not necessarily the amount, but 3 months as an example)
-The choice to be able to choose death in this situation must be signed and document FAR prior to the decision being made. A set amount of time AND that the person has not been yet deemed terminal - they need to make the decision to be able to choose death if they want, when they are of a more sane mind
-Over 18, I don't think parents should be able to choose for children. I think any children or ANYONE who is dependent upon someone else's decisions (a mentally retarded person for example) should NOT be eligible for choosing death. It needs to be a decision the person makes themself

Some others, but I think if it is legal, these are certain provisions that must be upheld

Exactly. This is a far different discussion than life extending procedures for the elderly patients that family members just won't let die. SOME physicians may do these procedures in a misguided attempt to make more money, but for the most part, the problem lies with a lack of education (remember the while death panel debate when the Obama administration dared to suggest that physicians get paid for discussing end of life issues with patients) or guilt that prevents patients and their families from agreeing to stop. Futile care is NOT something that physicians enjoy forcing on patients.

The problem with some of these impairments is that these people can't be judged as able to make their own decisions. How can you "assists" them to commit suicide when they are not competent? That isn't suicide or assisted suicide. That is murder, and that is definitely asking too much of a physician. Unfortunately, there is some suffering in this world. I do believe we CAN do better in controlling pain. Treating the pain adequately may hasten death, so be it. I believe in withholding life extending measures, ie. feeding tubes, vents, when those measures will not provide a quality life for the patient or they have no chance of recovery. I do not believe in specifically causing a patient's death, and I thing the vast majority of physicians see it that way.

Your entire second paragraph is nonsensical.

And yet... from the New England Journal of Medicine, an abstract:

http://www.nejm.org/doi/full/10.1056...99602013340507

This, of course, was a survey taken a long time ago, even before Oregon legalized physician assisted suicide. It'd be interesting to see where things stand now, but I couldn't find such an article. From the more recent literature, I think you overstate your case when you say the "vast majority" of physicians feel as you do. I've read several polls at this point, some conducted by professional researchers and I might go so far as to say physicians are 60/40 against physician assisted suicide.

I don't think anyone would suggest that you're wrong. At least not in absolute terms. That doesn't mean that the physician has the sole authority for deciding what is in the patient's best interests and what is harmful. Doesn't the medical community employ ethics panels for that very reason? Because physicians on their own can sometimes lack objectivity?

I'm not in a field where I would know how scientifically valid a study might be, but this one looked like it covered the effects of Oregon's law (or how it was actually working) pretty comprehensively and objectively. It's from 2004, so quite some time after the law went into effect.

http://www.leg.state.vt.us/reports/0...ity_report.htm

I don't understand why we do not allow euthanasia for people. It is my life-if I want to die I should be able to chose this and die with diginity. If I have a terminal disease or I am in chronic pain or even mental anguish (severe depression) and I want to end my life I should be able to do it painlessly and safely. That being said, I will definitely have a bottle of beuth stashed away (or maybe some phenobarb and valium or propofol) if the time ever comes and I am in a situation where I can no longer lead a productive, happy life. For me it is about QUALITY, not quantity. I have dealt with hospice (my father passed away 2 years ago) and frankly there is no way I am going to go through that. I will not go to a nursing home. We all are going to die someday-you cannot escape it-why not make it peaceful and painless??

I suppose vets see it differently than most people b/c we perform euthanasia everyday-and I thank the lord we can.

Yup, I have heard the playing God argument before as well, but we play God everyday by prolonging life that likely would have ended if we had no treatment available. I admit, I am not really religious so God does not play a part in it for me. If you don't believe in euthanasia ("good death") that is fine but do not prevent me from choosing this for myself. I tried to put a clause in my will to euthanize me if I got into an accident and I was not going to be able to be a full functioning adult again but, unfortunately, my lawyer said it would do me no good and that legally I have to be provided with some medical treatment-so I chose pain meds and IV fluids only-I think it is sad that I would have to starve to death (which would take 1-2 weeks) to die.

The gentleman next to my father was dying of some type of neuromusclar disease. It was horrible seeing him waste away. He finally came down with penumonia-I would visit my father for hours and hear this poor man struggle to breath-and yes he was conscious during the process-he could not sleep because he was coughing so much and drowning in his own fluids-it broke my heart. This lasted about 3 days-how friggin awful.

Man with locked-in syndrome, Tony Nicklinson, dies at home week after losing euthanasia court case


This could perhaps explain why assisted suicide is sometimes frowned upon for conditions such as locked-in syndrome.

I think those two are very different. Tony Nicklinson was asking for himself where Richard Marsh was unable to. Taking Richard Marsh off of life support machines is not assisted suicide.

That depends. Taking someone off life support can be called different things depending on the circumstances. Luckily, no one "made" Richard Marsh die and he was able to fight for his life (even if unbeknownst to anyone but himself). Marsh says he was fully conscious during much of the ordeal but no one knew that.

I was moreso saying that some people would not support assisted suicide (regardless of how the person requests it or whether a family member is able to request it) because of the rare instances like Marsh's where people fully recover from a condition.

To me this is not about "making anyone die". From the article I gathered that he wanted to live no matter what-that is his choice. He recovered quickly compared to the guy in the other article who had been a prisoner in his own body for 5 years-maybe Mr. Marsh would have a different opinion if he had been unable to lead a normal life for years, maybe not? The point is we should have a choice-it is my life. I do have a clause in my will to give me 6 months if on a ventilator (my firend talked me into this I was going to give myslef a maximum of 3 months). But overall, if I cannot lead a normal life-meaning get up and got to work, live independently, then I don't want to be here anymore.

Well I tried to correct my spelling but it won't let me edit-so please ignore the crappy spelling:)

I use "made" in reference to Richard Marsh because he was unable to express his desire to live. They could have very well turned off the ventilator which some interpret as a family-doctor-consent assisted suicide (some would consider it murder) for which Marsh was unable to consent.

Correct and Marsh believes that people have a right to live or die if they so choose. He wanted to live but he was unable to express his choice either way.

My point is that:

1.) Some people who are opposed to assisted suicide are opposed because they believe in the potential for someone to recover as Marsh did.

2.) There are instances where taking someone off life support is "making them die." People can rationalize and word it however they choose but it is what it is in these instances. If they had turned off Marsh's ventilator before his body was able to recover on its own, that could have "made" him die.

I don't like the idea of people suffering needlessly, but I have to say, I don't think I'd have the cojones to "finish someone off" if they asked me to and I knew that they were suffering.

I think my trepidation comes from knowing that my Judeo-Christian guilt would haunt me...hard to say when dealing in hypotheticals.....(and I'm not super religious).

My uncle died of AIDS several years ago. He was a physician, as was his partner, and we're pretty sure that a group of their friends had a pact to help anyone in the group die should they begin to suffer hugely. He had almost no symptoms for years and suddenly, everything descended on him. His partner called my mom and said, "Your brother died a few hours ago and he was cremated a couple of hours later so you guys don't really have to come if you're busy." :eek:

I forgot what hints we got over the years but the death pact theory really began to make sense after awhile. Part of me gets why they did it and part of me is horrified by the idea of putting a lucid human to death. I really, really have mixed feelings.

That is why it is so important to make your wishes known before something happens. I have very specific instructions in my will b/c this is so improtant to me-the way I die. Everyone close to me knows my wishes. I don't want to sit on a ventilator for months to years. I don't want to be a vegetable or even semi lucid, If I cannot be a full functioning human I want to go. If I was in an accident and had to be on a ventilator I have instructions to take me off in 6 months (I initially had 3 months but my friend talked me into 6-if they take me off before then I am ok with that). I have 2 very close friends that are vets and they are listed in my will as medical POA. They know my wishes and will help my family if the need shoudld arise. Having medical knowledge helps a great deal. And I am not talking about "someone"-I am talking about me and what I want.

On that note-my close friends (all vets) also have a pact. We all know each others wishes.
I don't understand why "death" is treated as such a dirty word/thing. It is a part of life. It is going to happen to all of us, why not make it quick, painless and peaceful?

Then commit suicide. Do not make someone else do it for you

Aggie, by "vets" are you talking about veterinarians(sp)? Do you think the life and death of an animal is comparable to that of a human? I do not believe the average "vet" who is accustomed to performing euthenasia for dogs and cats would be so mentally and physically willing and able to assist in the passing of a human.

Splash, that makes sense for people who are mentally and physically capable of committing suicide with no assistance. However, assisted suicide is often applied to people who are not able to do that.

I would not "make" someone else do it. I suspect there are physicians out there that are not opposed to helping people but b/c it is illegal they cannot. The law needs to change. If you are against it then that is your perogative but do not interfere with my wishes.

Yes, as veterinarians we deal with death on a daily basis. I obviously cannot speak for every vet but if the human was suffering and wanted me to help them along I would do it -if it were legal. I suspect there are physicians who help patients along but just can't document it as such. Suffering is suffering to me.

You all deal with the death of animals everyday. However, in a culture like that in North America where the "animals are divine spiritual beings" and "animals are people too" beliefs are the minority, I would question the mental health of a vet who TRULY believes that putting a bird "to sleep" is the same as putting a human "to sleep." That does not mean that some vets would not medically assist a suicide if need be. But, your post implied that the vet factor matters such that "a death is a death is a death" as though assisting with a person's death is automatically and always so easy and casual.

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Hmmm, I never said it was easy or casual. Even when I euthanize a cat or dog it is not easy for me. Obviously, you do not get what I am trying to say and so now I am crazy for what I believe-ok that is fine :). I believe in relieving suffering-whether it be a bird or a human. I can at least speak to what I want and I will do so (the bird not so much). This is obviously a touchy subject and I did not come here to change people's minds I just wanted to present another side. I truly hope that assisted suicide is someday legal and those who chose to die can do so legally and peacefully.

This is what I am responding to. If you were not implying what I was inferring, okay.

I said I would question the mental health (I did not use "crazy") of a vet, in the North American culture, who truly believes that animals and humans are the same and therefore euthenasia on a cat is mentally (and even physically, depending) comparable to assisting with the passing of a human. If you do not fit in that category, I do not question your mental health (I did not use "crazy").

Now that the vet thing is out of the way, you can stop being defensive with me. I am not opposed to assisted suicide and I am not bothered that your will specifies what should be done with you.

DrPhil-
It's all good, sorry to come off defensive-hard to do come off any other way sometimes with posts I suppose-think it would be different one on one. I am a pretty easy going gal UNTIL you tell me what to do with my body-that includes abortion or death. Hey, I rescue opossums for a living so... being called crazy (which I know you did not do but probably were thinking:)-maybe) is ok (having 10-12 opossums in your bathtub for most of spring probably qualifies me for being mentally abnormal:)) I have a pretty good medical knowledge base and can understand what is going on (be it animal or human, which we are technically animals and suffer from some of the same diseases).

well I tried to edit but it kicked me off-I suppose I don't rescue opossums for a living but it is my passion:), as is most wildlife. I pay for it by doing ER work.

You as a vet have the ability to end your own life should it come to that. You have to euthanize animals because they are unable to commit suicide. There is no comparison between veterinary and human medicine. The ethics are completely different.

But why should you have to be in the medical profession (vet or otherwise) in order to end your own life??? People are going to question this more and more-human Drs will need to face it sooner or later. People will want control over their own lives for many reasons. It is only a matter of time.

You don't. Humans have been ending their lives painlessly for millennia without involving physicians.