Hey just was wondering what everybody thought about the supreme court's ruling in Oregon regarding doctor assisted suicide? Also I have asked several MDs about the difference between euthenasia and doctor assisted suicide and none of them knew. Does anybody out there know the answer??

NUKID

Euthanasia is generally thought of as mercy killing. It is basically killing someone without their consent when they are not in a position to give consent such as coma. Obviously the thought behind it being that you are relieving the person of terrible suffering or suffering soon to be experienced.

Assisted suicide is just that. Assisting someone take their own life after they themselves have decided it is what they want. Usually done to avoid prolonged suffering when the patient is in a terminal state. Eg: terminal bone cancer. Physician assistance is done for the sole purpose of doing the suicide right and not botching it AND to make it pain-free and peaceful.

No, euthanasia and doctor assisted suicide are differentiated by who delivers the fatal medications- in the former it's a medical professional, in the latter the patient does it themselves. "Mercy killings" are totally seperate and usually the act of depraved sociopaths such as Orville Lynn Majors and others.

Personally I don't see a problem with a reasonable person ending their live when they have no hope of recovery from a serious illness, and I would have no problem administering or prescribing such medications for this purpose if it were legal where I practiced.

No, euthanasia and doctor assisted suicide are differentiated by who delivers the fatal medications- in the former it's a medical professional, in the latter the patient does it themselves. "Mercy killings" are totally seperate and usually the act of depraved sociopaths such as Orville Lynn Majors and others.

Personally I don't see a problem with a reasonable person ending their live when they have no hope of recovery from a serious illness, and I would have no problem administering or prescribing such medications for this purpose if it were legal where I practiced.

I was under the impression that euthenasia was ending someone's life without the consent of the patient. If the patient does it themselves it is just called plain "suicide" or "unassisted suicide". If the patient consents to a doctor's assistance it is "doctor assisted suicide".

I was under the impression that euthenasia was ending someone's life without the consent of the patient. If the patient does it themselves it is just called plain "suicide" or "unassisted suicide". If the patient consents to a doctor's assistance it is "doctor assisted suicide".

Euthanasia is often divided into direct vs. indirect, and direct may be futher subdivided into voluntary, non-voluntary and unvoluntary.

Wikipedia (http://en.wikipedia.org/wiki/Euthanasia) has an informative entry on the subject.

"For the Megadeth album, see Youthanasia."

I was under the impression that euthenasia was ending someone's life without the consent of the patient. If the patient does it themselves it is just called plain "suicide" or "unassisted suicide". If the patient consents to a doctor's assistance it is "doctor assisted suicide".
Doctor assisted is prescribing a fatal dose of medication for the person to take.

I was under the impression that euthenasia was ending someone's life without the consent of the patient. If the patient does it themselves it is just called plain "suicide" or "unassisted suicide". If the patient consents to a doctor's assistance it is "doctor assisted suicide". No, think of it as what what vets do with animals (and humans are animals after all): They have to have consent of an owner to euthanize an animal. There is nothing illicit about it, just as there should be nothing illicit or immoral about helping a person end their suffering.

No, think of it as what what vets do with animals (and humans are animals after all): They have to have consent of an owner to euthanize an animal. There is nothing illicit about it, just as there should be nothing illicit or immoral about helping a person end their suffering.
This is the logical reply. Unfortunately we have the fundamentalists out there who think that all human life is sacred.

ALL life is sacred, well perhaps not sacred, but important and deserving of preservation so long as the living being is not subjectan intolerable amount of irreversible suffering, regardless of whether that life belongs to a person, a dog, a cat, a bird, a fish or a lizard. All living things have a right to live without pain and to die in a manner in keeping with this.

Of course there are things that some people do which makes them deserving of punishment, but this is a topic for another thread.

What has happened to the option of having a terminal patient enter hospice care? Palliative care personnel are trained to ease the suffering and pain of individuals in the end stages of their life. If one chooses to end their life according to their own plan because they are not strong enough to deal with pain and sufferring, then in my book that is self-murder. How can we as a society lawfully hold one accountable for killing another human being by calling it murder then not hold others accountable for doing it under the umbrella of "suffering"? If people did not die on account of suicide (weird statement, I know), then our law declares we much then charge them with self-"murder". My husband, in law school, told me of a case where an individual who had a failed suicide attempt was charged for murder because we must protect and uphold our rights as humans, and allowing one to murder, even in suicide, defeats those human rights. As Praetorian said, all life is sacred. To get back to hospice, all treatments to prolong life are ceased and pain meds can be given to put you in a nice deep slumber every single day, if you wish, until you pass.

It is selfish to kill yourself if you are weak in the face of adversity.

Palliative care has its limits as do all manner of medical care- in more than a few cases there is intractable pain (pain so severe that it responds to nothing short of general anesthesia); and it should not be a mandate that people be forced to endure what is tantamount to biological induced torture. I'm guessing that as an OT you never dealt with large numbers of terminal cancer, HIV or similar patients. Also, judging by the book of Isiah quote on your blog (which is very well written by the way), I'm guess the fundamentalists that CHEF_NU brought up have arrived. :rolleyes:

There is nothing speaking of weakness and selfishness to end your suffering in cases such as this, as it is not adversity- it's a death sentence.

It is selfish to kill yourself if you are weak in the face of adversity.


It depends.

What if the person is in the battlefield and has just been wounded badly to the point of death and in the enemy camp. No hope for rescue only possible capture by the enemy or lay there to rot. He/she has only enough life left to kill themself. Should they not take their own life? WHat if one of his/her comrads cannot take the wounded to get treatment. Do they just leave them there barely alive?

Personally I don't think any one should die a painful death. If it has been determined that death is inevitable then for me lets make the transition quick.
WHile a doctors main objective is to foster and preserve all human life as much as possible, death is very much an ugly reality that we must face. Furthermore perhaps, we should qualify the phrase "human life". If we talking about someone who is in limbo or persistive vegetative state and absolutely no chance of recovery then whats the purpose of remaining on earth.

The same groups raising eyebrows because of an issue like this are also rejecting stem cell research. Maybe if we advance to a state where stems cells help cure the incurable diseases, then we wouldnt have things like PVS or terminal cancer anymore.

I really havent decided what I would do when I become a doctor in terms of assisted suicide because its not as simple as yes or no. But I do know I will abide by whatever law prevailing at the time regarding the issue.

Well said Orth2006, well said.

Alot of people who are against Doctor assisted suicide are religious zelots who quote the Hippocratic Oath assuming that makes it unethical.

Since "Do No more Harm" is the standard short version of the Hippocratic Oath the question that should be posed is this:

Is it doing more harm giving a person with terminal cancer a prescriptive OD to hasten their inevidible demise but, in the process, take away the weeks of horrible pain?

OR

Is it doing more harm allowing a person with terminal cancer who is in such pain that the MS drip dosen't blunt it and they ASK for death, linger for 3 more weeks of hell?

As an RN in the hospital I have had the distinct privilage to be there when life begins and when it ends. I have seen all subsets of religions, cultures and races BEG for death when their terminal pain was unbareable. Instead of getting the compassionate and humane treatment we would afford to a dog, they are allowed to die a horrible slow death begging for release. Not only is this refusal of care unethical, but the decision not to do it is based on religious views/values that do not represent the majority of Americans; Moreover, they never take into account the needs of the patient. It is wrong to do this.

Alot of people who are against Doctor assisted suicide are religious zelots who quote the Hippocratic Oath assuming that makes it unethical.

Since "Do No more Harm" is the standard short version of the Hippocratic Oath the question that should be posed is this:

Is it doing more harm giving a person with terminal cancer a prescriptive OD to hasten their inevidible demise but, in the process, take away the weeks of horrible pain?

OR

Is it doing more harm allowing a person with terminal cancer who is in such pain that the MS drip dosen't blunt it and they ASK for death, linger for 3 more weeks of hell?

As an RN in the hospital I have had the distinct privilage to be there when life begins and when it ends. I have seen all subsets of religions, cultures and races BEG for death when their terminal pain was unbareable. Instead of getting the compassionate and humane treatment we would afford to a dog, they are allowed to die a horrible slow death begging for release. Not only is this refusal of care unethical, but the decision not to do it is based on religious views/values that do not represent the majority of Americans; Moreover, they never take into account the needs of the patient. It is wrong to do this.
:thumbup:

Hey just was wondering what everybody thought about the supreme court's ruling in Oregon regarding doctor assisted suicide? Also I have asked several MDs about the difference between euthenasia and doctor assisted suicide and none of them knew. Does anybody out there know the answer??

NUKID

I know two things that I would do:

1. If I were the suicidee's health insurance company, I would NOT cover it.
2. If the suicidee had any life insurance policies, then the life insurance companies should have the right to refuse to pay out for a doctor assisted suicide. what do y'all think??

I'm guessing that as an OT you never dealt with large numbers of terminal cancer, HIV or similar patients. Also, judging by the book of Isiah quote on your blog (which is very well written by the way), I'm guess the fundamentalists that CHEF_NU brought up have arrived. :rolleyes:

There is nothing speaking of weakness and selfishness to end your suffering in cases such as this, as it is not adversity- it's a death sentence.

Oooo, Prae, you are going below the belt but I'll respond to you and leave this thread because I responded with my opinion and do not expect such disrespect that you demonstrated.

I am an OT that has been working in a long term acute care hospital for the past 2 years. My caseload includes almost entirely of terminally ill patients, ventilator dependent patients, HIV cases, and multiple systems failure. 30% of our patients that come to our hospital are expected to pass away in our hospital. It is a success if even 30% of our patients even go home to live again in the community. The rest go into a SNF or home with palliative care. I, too, have seen many of my patients suffer needlessly. I feel that the problem is within our health care system driven by excessive procedures and dollars spent on trying to keep the quantity of life high without thinking about the quality that one may have post disease/surgery/chemo and radiation/unfortunate circumstance. The problem I have seen oh-too-often is a person being diagnosed with terminal cancer, have tons of chemo and radiation and then when it's too much, a person wants to give up right then and die?? That's an oxymoron to me. I have personal convictions about suicide because my father committed suicide after a very long lifetime battle of depression. I do not change my position that suicide is a selfish decision; however, I do know that my father is probaby more at peace now than he was while he was living. I understand and sympathize with individuals who are in terminal pain and if there are physicians out there who choose to help that individual end their life, I'm not at all opposed to Oregon having a law that upholds physician assisted suicide. I just will not be a physician that personally practices this option. I just feel that in this "I want here and now" society the US has become, people want to run away from pain and not face the reality of their situation. We all have a death sentence--it just depends on when we find out. I just offerred the idea that maybe hospice could be a secondary option.

Sadly, you are misjudging me. Just because I am a believer in Jesus does not make me a "fundamentalist". When one is a fundamentalist then one does not tolerate or accept other views by others. I have my own beliefs and stand firm on what I believe but will never demonstrate shame, doubt, or intolerant behavior to other individuals based solely on their religious/spritual/atheistic beliefs. That is against the true teachings of the Christian religion. It is unfortunate that you become so quick to label me and probably due to some zealous religious individuals that you have come in contact with previously in your life. I hope that as you work towards becoming a physician that you become more understanding towards others and their religious beliefs, even if you do not agree, because in medicine, you will encounter this quite often when dealing with patients.

That sounds reasonable.

I would also agree that physicians should be able to choose if they would offer that option.

Hmm

Now that is an excellent question. I would not disagree with the first part, but the second is not fair. This put excessive pressure on the terminally ill individual to stay alive just so their relitives get the benefits. I suggest if they were eligible for the benefit in the first place they should still get it if they die slightly sooner.

I know two things that I would do:

1. If I were the suicidee's health insurance company, I would NOT cover it.
2. If the suicidee had any life insurance policies, then the life insurance companies should have the right to refuse to pay out for a doctor assisted suicide. what do y'all think??

I choose not to chime in with my opinion on this point, but I will on another which has been touch upon by Mike and Praetoran. That is - the pain some terminally ill patients suffer, which as a pharmacist in 2006 I feel
, is needless. We have soooo many options now to provide comfort to these folks and honestly, when the health care system works well - there should be no terrible suffering. IMO - the breakdown of the system involves lots of reasons - some physicians (justified & otherwise...) are fearful of prescribing narcotics in large doses, some hospice providers do not have well written protocols in place to escalate dosages when needed, initiate a call to the prescriber when a medication change needs to be made or educate families to call promptly when the family member's comfort is declining, pharmacists who balk (justified & otherwise....) at dispensing large doses of narcotics, and finally, restrictive insurance formularies which limit quantities &/or types of pain medication. Unfortunately, good pain management is not an issue just for the terminally ill, but, I feel the pain and fear of pain is certainly a factor (IMO - unnecessary) in why some folks choose other ways to ease their or their family member's suffering. Sorry to digress.....

If it meant the patient were not suffering any longer, I'd pay for the medication myself and not bill for my services if I were able to legally aid a patient in this way.

By the way Disgruntled. I apologize for being such a jerk.....I'm so used to dealing with wide-eyed premeds who haven't seen the ugly side of medicine that I tend to get a bit testy at times.

No, no, don't feel bad for interjecting...it's nice to get the take of a pharmacist. Even given the broad nature of pain control options and even when docs aren't afraid to use them aggressively (which many are, as you said), there are just some cases where the pain is intractable. But part of the issue is self-determination, the ability to go "No, I don't even want to go through that. There's no hope, and the psychological torment in addition to physical suffering is just too much." There is nothing wrong with saying "OK, I'm done. I'm going out under my own terms."

I know two things that I would do:

1. If I were the suicidee's health insurance company, I would NOT cover it.
2. If the suicidee had any life insurance policies, then the life insurance companies should have the right to refuse to pay out for a doctor assisted suicide. what do y'all think??
1. The cost of the dose of fatal meds is minute compared to palliative care. The bottom line says that they should cover it.
2. I'm not sure I agree here. If the life insurance policy covers death from cancer, terminal illness, etc. then I think it should be covered as doctor assisted suicide is only ending it more rapidly. I am not too familiar with life insurance, but I'm pretty sure they are hedging that you won't get a terminal illness rather than hedging that you won't die from it so I don't think it would hurt their $$$.

1. The cost of the dose of fatal meds is minute compared to palliative care. The bottom line says that they should cover it.
2. I'm not sure I agree here. If the life insurance policy covers death from cancer, terminal illness, etc. then I think it should be covered as doctor assisted suicide is only ending it more rapidly. I am not too familiar with life insurance, but I'm pretty sure they are hedging that you won't get a terminal illness rather than hedging that you won't die from it so I don't think it would hurt their $$$.


Seriously, I wasn't going to post but I have an addiction but that is another thing to add to my shrink list...

Most life insurance policies will pay out, even with suicide, if you have had the policy 2+ (depending on policy) years. Life insurance cannot deny you the money, even with suicide. The 2 year policy prevents individuals with suicidal ideation from getting a large insurance policy only to commit suicide 3 months down the road. The insurers believe that if you have to wait 2 years then maybe you will have time to think about killing yourself for a big payout.

By the way Disgruntled. I apologize for being such a jerk.....I'm so used to dealing with wide-eyed premeds who haven't seen the ugly side of medicine that I tend to get a bit testy at times.

Thanks for the apology.

Thanks for the apology.
Not a problem. When I overstep my bounds or say something that is wrong, then I make it a point to apologize.

I swear, a controversial issue and everyone is all of a sudden an expert.
No offense to anyone. But, lets drop the urban legend crap.

Someone said their husband went to law school and told about a case where an attempted suicde was prosecuted. Urban legend. Maybe happened once back in 1847 somewhere but generally speaking public policy is against prosecuting those who attempt suicide. Just like drug users aren't usually prosecuted for use. Maybe for possession but NOT use.


Next the whole suicide life insurance issue. Read the fine print on your insurance policy. Generally speaking ALL whole life or term life insurance policies cover for suicide after a waiting period that is usually 2 years from date the policy commenced. Most states, including mine, force the insurance companies to cover for it. It, once again comes down to public policy. Don't pay the insurance money then you are only hurting the widow(er) and kids.
Also, when this thread began, we were specifically addressing the Oregon law which only allows for assisted suicide in terminal cases. Besides, they have 6 months or less to live and you are going to punish the family of the deceased by not giving them insurance proceeds when the deceased was going to die anyway? Where's the logic? You want to subtract a few bucks for the time value of money then fine, I can understand your argument there. But that's not what you said.


Next, insurance coverage of hospice care vs. Dr. prescribed barbiturate overdose. Hospice care is EXPENSIVE especially when the patient is on a morphine drip. Your insurance can spend $1000/day or more on morphine alone. That doesn't include coverage for hospice facilities or visiting nurses AND everything else that is involved. Like an earlier poster said, it is bottom line for insurance companies and they would LOVE to pay $50 for some pills and call it good.

To the person who said suicide is selfish--wake up!!! I can understand your point of view when a person does it because they are depressed or angry or just lost their life's fortune in Vegas but how in hell is it selfish if the person is going to die ANYWAY in a few weeks???? They should just be expected to linger in a bed to make YOU feel better??? Seems YOU are the one being selfish.

To the person who discussed intractable pain--at least SOMEONE knows what they are talking about. Fact is there is some cancer bone pain that cannot be diminished by drugs other than to put the person in a medical coma. And if you are on hospice and are put into a medical coma we all know what comes next. You aren't hydrated and you die of dehydration. We KNOW that is going to happen so for all intents and purposes that medical coma is killing the person ANYWAY. Just more slowly. Let's not split hairs.

To the pharmacist---I'm sure you are a good pharmacist but fact is not everybody reacts to pain meds the same way. And on top of that pain meds can't alleviate intractable pain for everyone unless they are put into a medicine coma. See the paragraph above.

To the person who discussed the hippocratic oath--Thank you, you took the words out of my mouth. Some people act like the oath is the be-all and end-all of practicing medicine. Bottom line is you are HELPING someone.

And to everyone who always falls back to the "we can drug them up and let them die peacefully in a coma" argument--Maybe that is a peaceful death to YOU but many many people don't want to go that way so don't impose your idea of a good death on everyone.

Lastly, I am uniquely qualified to discuss the topic for many reasons I'm not getting into because they are too personal. However, some I will.--My wife died in October of breast cancer. I was in the trenches providing her with home hospice care for about 2.5 months before she died. I have seen it ALL. I have seen pain so bad that I would have traded my life just to take that away from her. I am an attorney and we lived comfortably. We were able to consult with the best doctors in the country. We flew to M.D. Anderson in Houston to consult. She also was cared for by local doctors who were associated with our local university. We also went to U Mich. Cancer Center to consult. She had the absolute BEST care available which included pain management specialists. Her local oncologist was even willing to have my wife admitted to the hospital for no other reason than to give me a "break" from caring for her. I declined the offer. My point is we spared NO expense and left no avenue untraveled. But STILL, in the end, the pain was unbearable. We tried every drug out there from fentanyl patches, fentanyl lollipops, oxycodone, oxycontin, msir, ms contin, demerol, dilaudid, a morphine pump. You name it and we probably tried it. It emotionally pained my wife SO much to know that she was going to have to go under and be put in a medicine coma that first of all she knew she would never come out of, and secondly that she knew would cause her death by dehydration in probably less than 2 weeks. She didn't want to go like that and she didn't.

I submit to you that there is no difference between switching on the IV that you know will put you under for good until you die from dehydration and, alternatively, switching on an IV that you know will cause your death swiftly and painlessly. All some people want is a GOOD death. That is the ULTIMATE in health care.

It's time we got our asses out of the dark ages.

Well said Caveat.....it's a shame such knowledge and maturity came out of something so horrible. :(

CaveatLector,

I just wanted to thank you for sharing your story. That must have been difficult for you, but I'm glad that you gave us an insight into what end-of-life care can truly be like.

Thank you so much.

CaveatLector,

I'm so sorry for your loss. My deepest condolences to you and your family!

Well said Orth2006, well said.

It was not well said at all. It was an incredibly dull and stupid post.

Well said.

Caveat, i am sorry for your loss, i went through a similar experience with my grandparents and it was horrible. Luckily I was in Canada then and assisted suicide was not uncommon nor frowned upon.

As an RN I have had the distinct privilage to be there when life has arrived and departed from this world. I have taken care of patients from every subset of religion, culture and race. I can tell you that in my 10 years I have yet to meet anyone who didnt wish for death when the terminal pain became unbearable. I have had patients beg for us to end it.

To address the person who said it was selfish, your a fool. The only selfish act i have seen at the end of life are those of the realitives who want to keep that person alive as long as possible, for their own benefit. This is ALWAYS driven by guilt at the fact that they havent bothered to come see their realitive as they progressed in their illness, and now feel guilty and want to keep them alive until they are ready to let go. It is pathetic, cruel and above all, Selfish.

It is all I can do not to strangle them as their mother is dying with a DNR (clearly stated she wants nothing done) and the daughter says "Do Everything!!!! I cant Let her go!!" and we, as liability fearful healthcare professionals, intubate and brutalize her for the benefit of the daughter and the avoidance of a lawsuit. There is nothing more Un-Ethical or wrong than bypassing the end of life wishes of someone for the selfishness of another, I have often refused to take part in these resus. attempts.

It was not well said at all. It was an incredibly dull and stupid post.
Hmmm.....the same could well be said for many of your posts. Eh?

CaveatLector that was a very deep and thoughtful post. It was one
of those really long post that I could agree all the way down from head to
toe.

I do not buy that it is "chickening out" to choose to take one's life instead of dying slowly from a terminal illness. From watching my dad die solwly over the course of a few weeks, I appreciate that there is a point past which quality of life is so diminished that it becomes a burden for them. Also, many people see themselves as a burden on their families during periods of extreme need. If someone would prefer to die in a controlled manner once they are ready, why should we as a society force them to live? It really makes no sense to me.

Hospice is a good thing for some, but it does not ensure that the end of a patient's life will be free of pain or emotional distress. Patients aren't going to be numb, as inferred above. The goal is to make pain tolerable rather than nonexistent. There will probably be breakthrough episodes. They aren't all going to avoid dypsnea, which has to be hell on earth. And, it gets really old really fast when you just wish death would come and end the whole ordeal. Having that thought in your mind is pretty miserable in and of itself.

They aren't all going to avoid dypsnea, which has to be hell on earth.

Personally I wouldn't wish a death by respiratory failure on someone I hated. It ranks right up there with death by burning or drowning as one of the most horrible ways to die.