Doctor/Medical Assisted Suicide

[DrPhil]

This spans beyond Dr. Jack Kevorkian.

Originally Posted by article

Dr. Richard Wesley has amyotrophic lateral sclerosis, the incurable disease that lays waste to muscles while leaving the mind intact. He lives with the knowledge that an untimely death is chasing him down, but takes solace in knowing that he can decide exactly when, where and how he will die.

Under Washington State's Death With Dignity Act, his physician has given him a prescription for a lethal dose of barbiturates. He would prefer to die naturally, but if dying becomes protracted and difficult, he plans to take the drugs and die peacefully within minutes.

“It’s like the definition of pornography,” Dr. Wesley, 67, said at his home here in Seattle, with Mount Rainier in the distance. “I’ll know it’s time to go when I see it.”

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


********

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.

[Kevin]

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.

[DrPhil]

State laws on assisted suicide.

Originally Posted by AXOmom

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.

1994. Oregon was ahead of their time.

Originally Posted by Kevin

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 agree, especially with the bolded.

[AOII Angel]

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.

[Kevin]

Originally Posted by AOII Angel

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.

[AOII Angel]

Originally Posted by Kevin

"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? No. They can commit suicide without the help of a physician. It's been done for millennia.

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.

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

[DrPhil]

Originally Posted by AOII Angel

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.

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

Thanks for providing one medical doctor's perspective.

[AXOmom]

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.

[AGDee]

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.

[AOII Angel]

Originally Posted by Blondie93

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

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.

Originally Posted by AGDee

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.

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.

[aggieAXO]

Originally Posted by AGDee

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.

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.

[DrPhil]

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.

[Mevara]

Originally Posted by DrPhil

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.

[DrPhil]

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.

[Splash]

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