Euthanasia during Interviews

TheWildcat08 said:

Hey all,

I've heard from a lot of my friends that the topic of euthanasia comes up during their interview. Usually the question is, "how do you feel about physician assisted euthanasia? I have a case right below, if you have the time to read it, do so and give me some feedback. I'm having trouble answering the question at the end. How would you answer it?

Case:
A woman was diagnosed with motor neurone disease (the same disease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble breathing.

Question:
Does she have a right to make this choice, especially in view of the fact that she will be dead in a short while (say six hours)? Is this choice an extension of patient autonomy?

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IMHO, the right to die with dignity is also a patient right (whether or not it's recorded or legal).

"Euthanasia during Interviews"

I don't know, personally I would't kill myself during an interview...i mean then theres ABSOLUTELY NO WAY you're getting into medical school.

gopens67 said:

"Euthanasia during Interviews"

I don't know, personally I would't kill myself during an interview...i mean then theres ABSOLUTELY NO WAY you're getting into medical school.

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Agreed. And euthanizing your interviewer probably wouldn't go over well either...

I think it might fall under the same lines of Physician assisted suicide...so its illegal in most states...but personally I think its the more ethical thing to do, but if the law says no, dont go against it.

If she knows the different options and possible outcomes, she has the right to make an informed decision.

You do have to follow the laws of the state. Beyond that, there is no "right" answer for an interview. The objective isn't to find out whether you know the right answer, but whether you can think on your feet to answer questions in a logical, well thought manner, and justify your conclusion without getting flustered.

This is a loaded question. If you're wondering how to answer it get some background information on Oregon's Death With Dignity Act -- available on google .

You should read up on "end of life" care. What you describe is not euthanasia and is not illegal in 49 states if the administration of morphine is for the purpose of relieving pain/discomfort even if, as a side effect, it results in the patient dying sooner than they would have done so without the medication.

I didn't read that far into the post. This happens fairly "often" (its noticed) and its not illegal. You're relieving pain, plain and simple.

mdmdt said:

Agreed. And euthanizing your interviewer probably wouldn't go over well either...

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What about sedating them?

As for end of life, I think it's fine to be honest, but you should put your answer in the context of current laws. For example, if you feel strongly pro-assisted suicide I think it's ok to say that you find cases like the one mentioned to be powerful examples of cases that have shades of grey. Then add your argument (presumably you have one if you feel strongly one way or another). Personally I think there's a difference between palliative pain management that could possibly hasten an inevitable death in the last hours and assisted suicide per se.

If you could be sure the person is of sound mind when making the decision then it should be their right. The problem is, how can anyone be sure that someone else is sane?

engineeredout said:

If you could be sure the person is of sound mind when making the decision then it should be their right. The problem is, how can anyone be sure that someone else is sane?

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The patient's mental status does need to be considered when making a decision.

We make decisions everyday that shorten our lives. Based on the case it seems that this individual's life was being shortened by at most a month. People that get every meal from a fast food chain could die ten, twenty years earlier when they suffer a fatal MI because of the unhealthy diet. Studies have found that each cigarette takes 5-15 minutes off a person's life. I know I eat way more junk food than I should and less fruits and veggies that I should. My reason, I would rather my life be shorter and I enjoy it more, than long and funless. Everyday we make these decisions that shorten our lives. As long as the individual is the one who is making the decision, and they are of sound mind, I see no problem.

I was asked this question during one of my interviews last year, and my answer was that medicine is about improving a patient's quality of life, which is sometimes not the same as extending his/her life.

I think that as long as you can support what you are saying, you should be able to handle this question.

However, as a heads up, discussions like this can be fairly emotional and I have heard of people tearing up or actually crying in interviews during such discussions (personally, I teared up). Work on talking about this sort of thing ahead of time. It may not hurt you to cry in an interview, but it's better to not have to deal with that situation in the first place.

I know I'm not (yet) a physician, but I feel like the way I would handle this situation if it ever happens to me is to consult the family, and have them speak with the patient. If they all agree that dying with some dignity is worth losing some time, I would administer the drug... Er, maybe get it [the consultation] on video tape. America is pretty sue-happy nowadays...

Theres also the "slippery slope" argument to consider. What happens to people who are unable to give consent? What about the severly disabled? Should other people be able to decide that they're in too much pain to live?

What level of pain will qualify a patient to ask to die? An elderly woman with arthritis who is unable to easily get around? Someone who has lost both their legs due to diabetes? Someone who does not want to wait for an organ transplant any longer? Sever depression?

The problem with legal euthanasia is that it cannot be applied equally to everyone since there is an infinite amount of possibilites and circumstances that surround it, so law could never be written to address all situations.


What could you say?

A patient has the right to request to be euthanized from his doctor only if his/her pain is a 9 out of 10 on the pain scale, but only if the pain is physical and not mental, but only if the person has a resonable chance of dying anyway; If he'll live 10 more years in sever pain then that is where we'll draw the line

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It just won't work.

TheWildcat08 said:

diamorphine

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Heroin!

As far as euthanasia is concerned, this particular case is on the fringes. If taking the pain medicine or dying painfully are her ONLY options, she should just be able to take the pain killers. This isn't euthanasia: this is making a patient "as comfortable as possible."

The title thread led me to believe that some med schools were putting bad interviewees out of their misery...

Chemist0157 said:

As far as euthanasia is concerned, this particular case is on the fringes. If taking the pain medicine or dying painfully are her ONLY options, she should just be able to take the pain killers. This isn't euthanasia: this is making a patient "as comfortable as possible."

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Issues with this however:

• What if she'll live for 5 years even with the pain? For 10? For one? What is the life limit that you'll define as being necessary to be able to take ones life to avoid the pain? How are you as a doctor going to say "Hm this girl is only going to live 3 months so I'll give her the necessery pills to die, but this boy is going to live 3 months and a week so he has to live.
• Define painfully. What if you have a person who has a very low threshold of pain. How are you going to quantify what counts as a painful death? I could have a headache until I die, does that count? I'll have a stomach ache until the day I die, can I request to die now? What about this damn tingling in my hand? I don't want to live with it anymore.

Again, I'm not saying that I disagree with euthanasia if the person is truly of sound mind, I'm just saying that it is impossible for the law to make a determination for the purposes of legal euthanasia, and how can someone caring for the hypothetical dying person decide if they should be allowed to die while others may not?

A: It's called comfort care, not at all unusual. If you spare an octagenarian with a hip fx and asp. pneumo the horrible shotgun ABx regimen/turn up the drugs at their request, are you helping them end their life? Little ridiculous to argue, no?

B: The drugs aren't being administered TO end life, so I'm not quite sure how the case has to do with euth.

I guess I would argue against outright euthenasia, and take a more passive-aggressive stance.
Euthanasia is intended to bring an end to sufferring. Citing engineeredout's "slippery slope" argument, the 'active' euthanasia (CN pills, etc) position is clearly untenable.

However, death is a natural process, and despite our tech. advances, it's one condition we can't prevent. If a person's imminent demise can't be prevented via medical intervention, removing supportive measures at the patient's request is tantamount to an original refusal to accept treatment which entirely within a patient's rights.

Likewise, the administration of an objectively "harmful" substance, in which a shortened life expectancy is merely an externality, not the intended result, would represent an acceptable excersice of patient autonomy (see tobacco, EtOH).

The primary rubric for me would be a combination of medical benefit of alternative treatment/willingness to accept treatment. The greater goal of medicine is to aleviate suffering. If a patient is unwilling to accept the alternative, or if there is no alternative that can accomplish the goal (terminal illness) then DNR, comfort care, and even removal of treatment are all acceptable courses of action.

Of course, all of the above assumes a rational patient or rational family. Pretty big assumption, I know, but it's impossible to argue either way once you get into the case of Vegetable & Looney v. Loving family. That's one legal minefield I don't look forward to crossing...


( , I know, but I'm borred and need to practice this...)

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engineeredout said:

Issues with this however:

• What if she'll live for 5 years even with the pain? For 10? For one? What is the life limit that you'll define as being necessary to be able to take ones life to avoid the pain? How are you as a doctor going to say "Hm this girl is only going to live 3 months so I'll give her the necessery pills to die, but this boy is going to live 3 months and a week so he has to live.
• Define painfully. What if you have a person who has a very low threshold of pain. How are you going to quantify what counts as a painful death? I could have a headache until I die, does that count? I'll have a stomach ache until the day I die, can I request to die now? What about this damn tingling in my hand? I don't want to live with it anymore.

Again, I'm not saying that I disagree with euthanasia if the person is truly of sound mind, I'm just saying that it is impossible for the law to make a determination for the purposes of legal euthanasia, and how can someone caring for the hypothetical dying person decide if they should be allowed to die while others may not?

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That's right, and I agree. As described by the OP, this situation really isn't a model of euthanasia so I don't see anything wrong with it legally because, like many others have posted, pain-killing drugs like morphine can sometimes weaken the body. Euthanasia is such a complicated, controversial topic because it must be handled on a case-by-case basis. However, I have found myself against euthansia in stories that I have read/heard about.

The slippery slope argument is a frail argument for euthanasia and physician assisted suicide. There are two types of euthanasia, active and passive and this describes the physician's role of administering or only providing the means to end one's life. Passive euthanasia, aka physician assisted suicide is currently legal in Oregon. It has not been abused and has withstood the rigors of society. Reading the Oregonian law one will realize that it has many 'foolproof' directions in the law to prevent accidental prescription of the barbiturates administered: psych consult (if necessary), terminal diagnosis, physicians' opinions on diagnosis, proof of no outside coercion (family), etc. Comparing Oregon to euthanasia disasters is like comparing apples to oranges. Most notably, Oregon's law, and similar laws proposed in many states can in no way be compared to what has happened in foreign countries, especially the Netherlands.

Also, family must be free from the choice because they can put undue stress on the decision process. Inviting them in for the consultation is a horrible idea.

As stated above, this is about quality of life, not length of life.

TheWildcat08 said:

Hey all,

I've heard from a lot of my friends that the topic of euthanasia comes up during their interview. Usually the question is, "how do you feel about physician assisted euthanasia? I have a case right below, if you have the time to read it, do so and give me some feedback. I'm having trouble answering the question at the end. How would you answer it? And does anyone know of good resources to read up on this topic?

Case:
A woman was diagnosed with motor neurone disease (the same disease that Stephen Hawking has) 5 years ago. This is a condition that destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neurone disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month, and is worried about the pain that she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain, but it will also hasten her death. About a week later, she falls very ill, and is having trouble breathing.

Question:
Does she have a right to make this choice, especially in view of the fact that she will be dead in a short while (say six hours)? Is this choice an extension of patient autonomy?

Click to expand...

if you're trying to find the "right" answer on what you should do, you can generally find it in the law books whether or not you believe in it. after all, your employer is not going to allow you to break rules or drag them into liability issues just because you "felt" your action was right at the moment. however, since the question is asking how you might feel about euthanasia, not what you might do, whatever you say won't be wrong. obviously that's the reason the question could be reused at interviews over and over again. don't stress out about these types of questions too much. if you believe she has the right choice when the law says otherwise, say that you do and will write to congress about it. just don't threaten to destroy hospital beds or put whole hospital at risk of being sued when there's a disagreement and you'll be fine.

LizzyM said:

You should read up on "end of life" care. What you describe is not euthanasia and is not illegal in 49 states if the administration of morphine is for the purpose of relieving pain/discomfort even if, as a side effect, it results in the patient dying sooner than they would have done so without the medication.

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Exactly. My grandfather was in a similar situation when he passed away. They wouldn't give him morphine until they explained that it would hasten his respiratory arrest. He said, "Excellent. I'd rather die in 30 minutes than 2 hours. Does this look like fun to you?" He died comfortably, which was his desire.

gopens67 said:

"Euthanasia during Interviews"

I don't know, personally I would't kill myself during an interview...i mean then theres ABSOLUTELY NO WAY you're getting into medical school.

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True. But interviewing can be a very painful experience. It may be the most compassionate way to end a dehumanizing situation.

gopens67 said:

"euthanasia During Interviews"

I Don't Know, Personally I Would't Kill Myself During An Interview...i Mean Then Theres Absolutely No Way You're Getting Into Medical School.

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Haha

LizzyM said:

You should read up on "end of life" care. What you describe is not euthanasia and is not illegal in 49 states if the administration of morphine is for the purpose of relieving pain/discomfort even if, as a side effect, it results in the patient dying sooner than they would have done so without the medication.

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Agreed. First, euthanasia is illegal in all but Oregon, so if you are interviewing in any other state, offing your patient is always the wrong answer. Doesn't really matter how well thought you are, schools aren't looking for the next Kevorkian, and may get concerned if you come out on that side of the debate. Second, administering pain relief is not euthanasia, so long as the dosage is such to relieve pain, not off the patient. That the patient may not do as well is a calculated risk. So there is a gradient -- there will be an amount of morphine that is murderous and you can't administer, and an amount that makes a person comfortable. You have to stay far within the comfortable range, even if the person still has a little pain. Morphine can kill even a healthy person if the dose is too high, so you are always picking an appropriate balance when you use opiates on any patient, terminal or not.
A better example might be the ethics of putting in a feeding tube to a geriatric senile demented patient who cannot feed themselves anymore; statistically studies have shown when you do this their life shortens appreciably. So should you do this, given that although it makes things much easier and more manageable for the caregiver, statistically you know you are shortening their life in a big way? This kind of debate is more likely to come up without an easy answer as compared to euthanasia, which has an easy, law prescribed answer in 49 states.

In my one interview last cycle a similar question was the second question they asked. I refused to put a feeding tube in my grandma when she had a stroke b/c she was comatose and already had renal failure and I put it in my PS. I gave her roxanol (morphine) when she was moaning and did the whole hospice thing. I'm a nurse and have older patients on hospice care all the time. If you've got a terminal illness it's better to take meds to make it faster and less painful, imo. Would you rather be writhing in pain for 12 hours then die or be somewhat pain-free and die in 8 hours?

Look up the "principle of double effect."