The Right to die.
 

I was debating whether or not if I was going to start this thread. But I think I am interested in hearing what others have to say about this subject.

So..... things to think about

1. How do you feel about terminally ill or elderly patients requesting a medical facility to terminate their life?

2. What is your stance on euthanasia? Is it humane?

3. With considerations to what happened to Terri Schiavo, how do you feel about others making that decision to terminate that life?

4. Do you have a DNR in place? Would you consider it? Who do you best think would make the right decision?

5. Do you think any kind of legislation that broadens a person's right to take their own life due to terminal illness or age, would make things better or worse for US citizens?



folks you don't have to answer those questions in that order...these are just things to think about as you answer...thanks

Okay, I'll bite.

I think it is ethically acceptable to decline or avoid extraordinary means of sustaining life (feeding tubes, respirators, etc.) when it is clear that (1) absent such extraordinary means, nature would take its course and death would occur, and (2) there is no question that the patient would not want such extraordinary means taken. (Which is why DNRs are important. Yes, I need one; thanks for the reminder. ;))

I do not think it is ethically acceptible to take positive action to end a life. I would be opposed to physician assisted suicide/euthanasia.

I agree with MC regarding declining or avoiding extraordinary means of sustaining life. My husband and I both have DNRs in place, and our parents have been informed of our decisions (DNR, organ donation, creamation, etc...).

In addition, I also believe that, if an adult of sound mind is diagnosed with a terminal disease which causes great suffering, that adult should have the option of physician assisted suicide (PAS). I know if I were faced with a terminal condition that caused tremendous suffering, I would want all options, including PAS, available to me. (I realize I'm vague in precisely the areas I need to be clearest - "sound mind", "great suffering", an abundance of "ifs", etc... perhaps if this thread takes off I'll take the time to remedy all that. My opinion still remains: I believe it is morally acceptable to pursue PAS in certain circumstances.)

I agree here. If you want to kill yourself, you should have the right to do so.

Personally, I'd rather be dead. I'm not depressed by any means and I would not commit suicide, but I've lived enough life and I'm ready to go anytime the Lord wants to take me. :) I do not want to be resuscitated under any circumstances although I do not have a formal order out there. My family knows my feelings on it although they brought me back from the brink of death in 2002. I was not happy.

Maybe I'm straining at gnats here, but is there a difference between having a "right" to do something (at least legally) and it being ethical to do something? I think there probably is.

I think that's why I have a problem with it . . . physician-assisted suicide/euthanasia makes it my decision as to when, not the Lord's. Even if I might legally have the right to decide when I will die, ethically (or religiously, if you prefer), I do not think I have any such right at all.

thanks for bringing that up...I actually meant to put right in quotes when I posted this originally.

As a physician, I am completely opposed to physician assisted suicide but completely supportive of withholding any artificial measures to prolong life if requested by the patient or power of attorney. Having a physician assist in a suicide is asking him/her to disregard the first tenant of medicine "First do no harm."

This, in my opinion, is the best argument for the illegality of PAS.

And, as has already been mentioned, there's a difference between what is legal and what is ethical (and for good reason).

I can totally see both sides, and every time I think about it, I struggle with whether my argument holds water. But in the end, I still think the morality of the issue should be left to the patient. If all options are legally available, then each person should be left to make the moral decision for him/herself.

I'd say there certainly is.

I agree here as well. However, my beliefs should not dictate what another person does with his/her own body.

If assisted suicide were ever fully legalized, there could be an entirely separate category of medical professionals who would handle this sort of situation - ones that are not bound by the tenants of medicine.

but...would that be ethical?

I'm not sure I want there to be any medical professionals who are not bound by the tenets of medicine, and I certainly wouldn't want any such persons involved in life or death decisions or actions.

One could argue that you are doing harm, mental anguish type harm, to someone by forcing them to die a slow, painful and struggling death when a little bit of morphine could hasten the process and keep them peaceful simultaneously. The line between "keeping them comfortable" and killing them is very very fine. I think my mom was euthanized last year so that she didn't have to stay awake/alert while she was gasping for air in that last day. I think, without the morphine, she would have stayed alive another day but in a horribly anxious, desperate, gasping for air state instead of being sound asleep and not struggling. Hospice does this all the time, they simply do it quietly.

I truly hope I just fall over dead without any of the long drawn out suffering. It's torturous to the patient and the family to go through that. I felt like I was severely traumatized by watching my mom die a tiny bit more every day for a month. I hope that once my quality of life is gone, I go very quickly.

How are you defining ethical?

Yes they do. Actually, I was thinking about hospice when I made the comments about other types of medical professionals.

ME TOO!

This is always a really touchy situation. I completely agree that living in such conditions is unpleasant at the least. However, the physician is not causing the harm...the disease process is. We don't cause harm by making patients comfortable, but intentionally causing the death of a patient is completely against what the medical profession stands for. Hospice gives morphine to keep the patient comfortable...the consequences of which may cause death. If they are purposefully causing death, then they are breaking the law. They need to keep it quiet. What they are doing could jeopardize their nursing licenses.

FWIW, none of the friends I have who work or have worked for hospice would call themselves "medical professionals" . . . except, of course, for the ones who are doctors or nurses (and therefore bound by medical ethics).

It is, and maybe we're getting into areas of grey here. At least accoring to the Wiki (hey, why not), what you describe is called "passive euthanasia."

Euthanasia may be conducted passively, non-aggressively, and aggressively. Passive euthanasia entails the withholding of common treatments (such as antibiotics, pain medications, or surgery) or the distribution of a medication (such as morphine) to relieve pain, knowing that it may also result in death (principle of double effect). Passive euthanasia is the most accepted form, and it is a common practice in most hospitals. Non-aggressive euthanasia entails the withdrawing of life support and is more controversial. Aggressive euthanasia entails the use of lethal substances or forces to kill and is the most controversial means.

The Wiki on Physician Assisted Suicide.

I think that this is quite different from "aggressive euthanasia," which is what I, at least, think of when I hear "physician assisted suicide" -- a terminally ill patient, who by law usually must be of sound mind, makes a conscious decision to commit suicide before the illness puts them in what they consider an untenable quality of life situation and seeks out the help of a physician or medical professional to carry out the suicide painlessly and quickly. It's this later practice I have a problem with.

The Wiki also describes the Principle of double effect here; the description is quite in line with what AOII Angel said above.

Can it not be argued that by allowing a patient to live who suffers greatly every day and wishes to not live, the physician is assisting in the harm of that patient?

ETA: I see it was already answered - my bad!

I have it in my will that is binding that I will not be kept alive if there is no hope.

This releives the medical people of any recourse.

Why burden the family if any remaining with medical costs that they cannot afford or want?

I completely agree with you Tom. Our country goes soooo overboard on end of life care. No one knows how to say enough is enough, because so many decisions are made by people that feel too guilty for not doing enough for their parents and can't let go. Universal health care will never work here for this main reason...most medical costs are associated with the last two weeks of life.

Let me ask you all this question:

Have you EVER "euthanized" ANYTHING beyond a bug yourself? Particularly, a mammal?

If you have, then you should know with that comes responsibilities, that are sometimes difficult to swallow. You cannot do it with cruel intentions and malice and it must always be done with compassion...

Extending it to humans is difficult--especially if one has never seen another human die albeit slowly, painfully or quickly. Then, it is tough to imagine modern burial techniques--i.e. one must still prep the body even if it is to be cremated.

The best anyone can do is not only have a DNR, no code (because my grandmother's was ignored prolonging her painful existence), but also a Physician's Health Directive, POLST form and a living will and trust.

I personally do NOT want any healthcare worker injecting me with any lethal injections of anything even if I am from the Borg Collective... If I die naturally, with minimal pain because of the morphine drip, then hey, K.I.M.

But healthcare worker assisted suicide no matter what the cause--unrealistic in a "civilized society"... We know we can do better. There are some fine scientists working on the concepts of pain management, chronic diseases of the aging, and improvement of the quality of life. We MUST persuade people that we are better and we will improve health and wellness by all means necessary!

Dr. AKA_Monet
Ariafya LLC

Well said!

Tom, do you really mean your will, and did a lawyer draft the will? I ask only because in my experience (which I'll readily admit doesn't include Kansas), such a directive in your will, which by definition doesn't take effect until after your death, is meaningless. Most states provide for some version of an Advance Health Care Directive, Living Will or Health Care Proxy/Power of Attorney (or a combination of these) to cover these end of life issues.

Maybe I'm off base here, and sorry if I'm stirring things up unnecessarily; just don't want anyone to be relying on something if it won't be effective to carry out their intentions.

I know what you're saying, as I've sat by someone's side as they slipped away - and that's precisely why I really don't know how I feel on this topic anymore. I hate to say "you don't know it unless you've been through it," and I think people have been perfectly reasonable in this thread, but for me, the whole experience raised more personal questions that I haven't been able to answer.

Do you mind posting the journal to the bolded? Just asking? I had not heard that stat before. But it filters down to us minions over time... ;)

Not sure if it is in this article, but here's a NEJM article on physician-assisted suicide: http://content.nejm.org/cgi/content/full/339/3/167

I'm at work and won't have a chance to go through it right away, and it is kind of old (1998), but I figured it might be interesting reading for some of the posters.

:(

I know someone quite well who has to make "life and death decisions" about GMO rodents...

For aggressive euthanasia, by exsanguination, she says her limit is ~10 mice. For "passive aggressive" euthanasia, by asphyxiation, she says her limit ~50 mice.

For rats, after 2, she cannot work anymore.

And after a whole process of euthanizing rodents, she cannot work anymore for ~2 days because she says the whole process is too much for her. Sometimes, she has nightmares. Especially if blood was involved or a full necropsy (an autopsy for animals).

And publish literature on the subject, especially with veterinarian care, says folks limits differ from one animal to another. Like for rodents, not too bad, but for non-human primates, euthanasia is painful to do and watch...

She says sometime you can see in their beady little eyes. And euthanasia is different for neonates mice... She does not like having to do that.

I'll have to do some searching about that, but it's a commonly held opinion taught at med schools throughout the country. I guess I shouldn't pass on info that I haven't seen myself, but I have a feeling that this is true since the most expensive part of medical care is ICU care. Add in all of the daily radiologic examinations, specialists charges and long length of stay, and the bills get astronomical. I'll post if I find anything definitive.

I have heard it directly from the Chief of ER at a large LA hospital that folks use ER care as routine healthcare... I guess if the pain is too much, folks feel better at the ER... IDK? But the ER care only stabilizes the patient until the "next step"...

The other issue is chronic diseases that most folks who are older get--heart attacks, strokes, etc... I've seen someone in his late 50's who needed a liver transplant, but the dobutamine echo showed his heart could not take the transplant due to the ath plaques. Now, if I can tell on an echo and I am not a sonographer, then this patient was far off...

Was he in pain, probably so. He needed a new liver--I think his was cirrhotic, but the fact remains, we aren't there yet with advances in technology--which means, that we have to take very good care with what we've got...

Part of the illness causes depression and several other mental health issues. Some alzheimer patients sometimes become psychotic with the drug treatments. Given the mental disorders that can occur with several illnesses, it would be inherently inhumane to allow this kind of practice in this country.

In a perfect system, euthanasia in NEVER humane. But given our system and how it's done with animals is to minimize pain and suffering. That gauge is set very high and is not allowed by several laws in place to protect people's human and civil rights.

Others are not allowed to terminate anyone's life. If you review Ms. Schiavo's case, they essentially unplugged her and she "expired". A husband has the right to make that call. However, if she had survived on her own--i.e. breathing and heart beat, they would have done nothing beyond what was allowable.

A DNR order is not going to protect your wishes. ONLY a living will and trust and a health directive will in a court of law.

Think of it this way, you come in from a very bad car accident, you are mangled. Then you cough up blood and you go into cardiac arrest. Would you NOT want the team to put the AED on you because of a DNR order?

What about a routine simple outpatient surgery? For some reason you OD'ed on the Servoquel mix. Do you want them to NOT do all that is in their pharmacopoeia power to revive you--even if it is just enough smelling salts?

I think it will make things worse for some people. We have a problem with health disparities in this country. And childhood healthcare for ALL children is foul. Mothers are NOT allowed to be with their children 6 weeks after birth, whereas other advanced countries allow upto 2 years of PAID mother leave to care for infants.

Moreover, disabled people get jacked constantly. Let's not even go there with what happens to their insurance and job placement.

And if freedom to die is passed, do not be mentally retarded in this country. You can forget it.

I think our healthcare crises should be fixed first before we start culling our colonies down with people. Yes, there will be exorbitant costs, but I think that will be up front money that will pay off in the future. And to fix healthcare costs will be a dynamic process that will need constant review every 2,3,5,10+ years. I'd rather have a fair and equitable system that what we have now with a bunch of hypochondriacs.

If folks feel the need to kill themselves, then there are plenty of illegal actions that one can do to make that happen.

But, I would not allow any healthcare worker with that kind of power to do it. What would that person LOOK like? The "Angel of Death"?

I think is how one lives his or her life that makes all the difference...

Wasn't Terri Shchiavo basically denied nutrition and hydration? I believe she was still breathing on her own - she was essentially starved to death.
The husband argued that she was brain dead.That is totally different than not being able to function at all without machines. I think it is barbaric to allow someone to die that way.

I would find it more harmful to allow that person to remain in pain and further deteriorate.

And yes, I have euthanized many animals from rodents to dogs and cats to horses. While it is sad, watching the peace come over their face as they're released from their pain is more powerful than the grief.

I would still support any human to have the right to die. No one should be able to tell you that you can't end your suffering.

In many ways, I find our treatment of animals more humane than our treatment of other humans.

The question was should licensed healthcare workers be allowed to assist in a human's right to die... If someone wanted to kill himself, guess what! He will find a way to do that by his own hand. It doesn't make it "ethical" or "sound", but the finality of dying is so permanent.

Sure, one suffers and has pain, but life is suffering and painful and for some people it is everyday...

What makes humans different from animals--which is not saying that much--is that animals cannot directly communicate their feelings to humans--we just do not understand them to that point. Animals that cannot live upto expectations will be gleaned from the gene pool by predation.

At this time, humans do not have active predators that hunt us...

ETA: Even if one worked for a slaughterhouse, there are still rules that govern euthanasia of animals and what to do with the carcass afterward...

I think that the fact that humans can communicate their feelings makes more of a case for allowing human euthanasia.

And not all humans that want to die, can actively participate in killing themselves. There are certain situations and conditions that trap a sane mind in a body that is not capable of ending themselves.

I'm really not sure of what the edit to your post is supposed to mean? I've worked in labs mass euthanizing rodents for medical testing, and in a vet hospital (mixed practice) as an RVT, but I have no clue what you're getting at about slaughterhouses.

If you have inspected slaughterhouses for foodstuff meats, they have animal carcasses and blood and organs all of over the place. Yet, no matter how much "gore" is in that area, there is still rules that are followed when killing these animals... One cannot just slam conscious animals bodies against walls.

And even in research laboratories, you still have to be approved to use animals, take classes to handle the animals and you cannot do some euthanasia techniques because it is against OLAW regulations--such as killing mice by slamming their heads against the counter... Hayle it's getting to the point that you cannot toe tag mice that much...

As far as being trapped in a immobilized body unable to communicate. The disabled cannot speak for themselves and require others to speak to them--and I am talking about paraplegics with the unicorn or laser guided writing on a computer. That is illegal to euthanize someone in prison who committed heinous crimes... Why would it be legal on the outside?

But folks who grow old or get into a severe accident or know they have a severe genetic disorder--like Huntington's Disease--then arrangements can be made with appropriate forms. But I do not think they should ask healthcare workers to ASSIST them in dying because of too much pain/suffering...

We will just have to agree to disagree...

Believe me I know about the endless hoopla dealing with both medical testing and euthanasia, it is part of the schooling to become an RVT. I'm still not getting what, if anything, that has to do with human euthanasia.

It is illegal to put someone to death who is in prison who is disabled because of the 8th amendment.

However, I'm not speaking people that are simply disabled, I'm talking of people who are in constant pain and are losing their quality of life. Dying with the little dignity they have left should be afforded to them. And if they are to the point where they are not physically able to do it themselves but are mentally sane, then I see no point in disallowing a humane, caring physician to ease their suffering and let them pass.

Note: I am not saying that healthcare workers should be made to help them die, just that there should be no penalties for the ones that do, provided the patient's intentions are known and communicated.

How will human euthanasia be done? Like lethal injection as a capital crime punishment? Is that the "Humane way" to kill a human being? Will drug overdose be enough?

Killing a steer or pig for its meat is done humanely, yet provides decent cuts of meat. But we are NOT euthanizing humans for meat--we are basically putting a person out of their misery or cost to the healthcare system.

Maybe I just don't trust people enough to do the right thing by people without violating "humane euthanasia guidelines and actions" with agreed procedures... Maybe I have more belief in the research scientists and workers trying to cure human ailments.


No matter what happens, there will be a personal penalty for any person who does participate in this process that is not worth it. Even "death rows" are having problems doing lethal injections because some death row inmates have other physical issues that prolongs the difficult process.

Also the United States signed the Geneva Conventions which state that we just cannot euthanize people who are deemed not needed.

To me, dying is hardly EVER dignified, and mental sanity during a chronic illness inherently does not allow for a caring from a physician who actually meant their oaths. Some people would say: "NEVER AGAIN"... We, humans think we can justify killing all kinds of people, but that still does not make it right, ethical or moral for that matter.

And yes, I have seen the slow debilitation of 2 loved ones and the pain they suffered. But the finality killing someone because of ANY reason, it is just not me. That just means hospices will become slaughterhouses and I do not want my country to get involved with that fascism...

For setting up standards for human euthanasia, we should look to Belgium and the Netherlands, where they have legalized human euthanasia (including physician assisted), or even Oregon's Death with Dignity Act (which is death by overdose.) There were no cases found with a cursory search that indicated that there are major problems with these policies.

When it comes to the Geneva Conventions:
1) The Geneva Conventions are speaking of people that are euthanized against their will, but the people we are talking about are asking for the right to die.
2) The US didn't have a problem breaking the Geneva Convention when it comes to the rights of the "detainees" (really prisoners of war) in Gitmo.
3) Other Geneva Convention signers have legalized euthanasia, Belgium and the Netherlands.

My grandmother survived the Holocaust at Dachau, then Bikenau, she survived fascism. It still didn't stop her from asking to die with dignity. There is a huge difference between murder and euthanasia. It seems that you can't separate the two.

You also can't seem to see that while you don't want it for yourself, that doesn't mean that it shouldn't be available to others. Hospices would NOT become slaughterhouses because those that choose to deteriorate and lose what little dignity they have will be allowed to do so, and those that want to retain their dignity and die would also be allowed as they wish. No, dying isn't dignified, but to allow people to die with what dignity they have left is the ultimate in humane, "do no harm" treatment. People shouldn't have to live in pain.

Maybe you do have faith in medical research, but until that research is in action and people DON'T suffer, then human euthanasia should be an option.

But given my ancestors who were brought over here in slave ships, I am sorry, but I just do not trust this government system enough to enact any kind of law fairly and equitably.

People can be coerced to agree to anything and make it sound like it is what they want given the circumstances. A free people who are informed to make those choices would choose differently. A wise people would know that it is in their living that makes all the difference in the world.

Beloved,

I am asking you to walk along a path of serenity when you seek these ideas. My life has been fraught already with indignation. Institutionalized racism did that to me.

I have also done unsavory acts against my own life and I know what feels like when one is helpless, alienated, and forsaken. And I am here today to tell anyone willing to listen, to request dying with dignity--assisted or otherwise--is still suicide, which makes it a mental health issue at its core.

And because it is well known in the scientific literature that most chronic illnesses and some treatment actually do cause major clinical depression which is seen in rodents--meaning the molecular pathways have evolved similarly--that allowing someone to come to the conclusion that death is their only option, then I would say, wait something new and better, because one's death is not going to solve these ailments of humanity.

In the very near future, it is already predicted that those people who have HIV and full course of treatment will reach drug failure. The cocktails will not work anymore. And the disease will progress. Some people, those who are ignorant, would say that is the moral price one pays for contracting HIV. However, we as humans have to get beyond that level of thinking.

Beloved,

We will not get a second chance at this--our humanity. If we do not solve these major health care issues with humanity, is death with dignity an evolved option--given the breadth and depth of all our human knowledge?

I am sorry, but I have to do an invocation, because I believe in a higher power and spirit that I call my God in The Universe, I cannot agree to those terms... I would not want to be a part of a government that condones it. To me, that is not a freedom but a curse and trying to buy a way to get out of the costs of using Carbon--especially, when there is so much poverty in this world, so much hunger and strife--folks who have a very good life here in the States would think it is okay to die?

Also, we, in the US will have to pay a price for the infractions at Gitmo. It has already started in the courts.

The problem is that healthcare and researchers are still TRYING to find ways to manage pain, diseases, etc. I don't see why my bf's mom, with cancer nearly everywhere in her body, who was going to die no matter what, had to suffer through the pain of that cancer. She couldn't walk, sit up by herself or control her bodily functions. I think that is a pretty inhumane way of "living."

If you KNOW you are going to die from a diesease and there is no way to prevent it, why not allow that person to make their own decision about it?

Why not allow a person to make their own decision on how long they want to live with a disease like alzheimers? My gpa is 90 and has been dealing with it for several years. His older brother died about 8 years ago and had the disease as well (death not related to disease). My gpa said he never wanted to be like his brother and guess what, he's 10 times worse.

If HE doesn't want to live like that (little clue of what is going on around the world or even in his head-ie he thinks he's a teenager) and HE doesn't want to burden his wife and family with caring for him (if you haven't cared for a family member in this state, you just can't understand), then why can't HE make that decision early on his life, before the disease takes away his ability to make that kind of decision?

It's hard for me to understand why people can't make their own decision to end their life when there are valid medical reasons involved AND not have it be illegal, which denies the family the benefits of life insurance to cover their medical costs. I'm not saying minor things, but big problems that will cause pain and suffering down the road. I'm not saying suicide just b/c someone is depressed or going through a tough time should be OK, either.

What part did you not understand about what I said? It is in my will which is a binding contract that any judge will abide by. He has to because it is The Law!

This is my last will and testiment no matter what.

It is written in stone, notorized, period.:D

Yes, it is done by a Lawyer who is a Brother of mine.

It was my decission and he abided by the Law of the area.


Sorry mot to be snide as there is a difference than snarky!