fancymylotus

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DermViser

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When I was a young kid, I used to wonder how anyone would dare contemplate such a thing and thought of how selfish they could be. I used to think people like Dr. Kevorkian were pure evil. After having completed M-3 clerkships, I am 100% ok with her choosing to die with dignity and to not live every moment in pain - esp. morphine-resistant pain. People who are usually against this type of thing, have usually not had the clinical experiences that med students and physicians have had in seeing patients who have terminal diseases many of which have unending suffering and pain. Patients such as these should be allowed to die on their own terms.
 
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When I was a young kid, I used to wonder how anyone would dare contemplate such a thing and thought of how selfish they could be. I used to think people like Dr. Kevorkian were pure evil. After having completed M-3 clerkships, I am 100% ok with her choosing to die with dignity and to not live every moment in pain - esp. morphine-resistant pain. People who are usually against this type of thing, have usually not had the clinical experiences that med students and physicians have had in seeing patients who have terminal diseases many of which have unending suffering and pain. Patients such as these should be allowed to die on their own terms.
I was talking about this with a (non-medical) friend of mine who has never stepped foot in a hospital. He didn't understand why old people don't just eat ice cream all day and watch TV in the hospital-- it sounded like a great way to spend time to him.
 

kami333

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Death with dignity is a great thing. Much better than hospice.

I am somewhat ambivalent about whether physicians should really be involved in it though.
They aren't mutually exclusive, 90% of PAS patients in Washington and Oregon used hospice. link
 
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DermViser

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I was talking about this with a (non-medical) friend of mine who has never stepped foot in a hospital. He didn't understand why old people don't just eat ice cream all day and watch TV in the hospital-- it sounded like a great way to spend time to him.
Yes, it's really hard to explain what we see on a day to day basis in the hospital to people who don't have those experiences. A lot of glamorization of medicine I believe both by forces inside medicine (med schools, etc.) and outside medicine (the general public).
 

DermViser

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4 or 5 seconds on any vent-floor is all it would take to convince most people this isn't a terrible idea.
No, bc they all think they'll wake up eventually.
 

DermViser

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I was talking about this with a (non-medical) friend of mine who has never stepped foot in a hospital. He didn't understand why old people don't just eat ice cream all day and watch TV in the hospital-- it sounded like a great way to spend time to him.
On a completely different side note, I think it would be awesome to be a doctor on a ward of happy old patients eating and enjoying their ice cream.
 

colbgw02

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I am somewhat ambivalent about whether physicians should really be involved in it though.
I'm with you. I think it's important that physicians are seen as healers, and only healers, but I don't think this sort of thing should be illegal either.
 
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DermViser

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I believe that allowing a competent adult to determine how they receive treatment and/or choose to die is the ultimate in caring. I may not support those decisions in all cases but in this one I do.
The problem is as a society we are so scared of death esp. if it's of a family member and esp. if it's going to be painful. Go to any ICU, where families will hang on as long as you allow them to, no matter what. For some reason in this country, we've equated people plugged to machines as actually being alive. It's sick.
 

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The problem is as a society we are scared of death esp. if it's of a family member and esp. if it's going to be painful. Go to any ICU in the country, where families will hang on as long as you allow them to, no matter what. For some reason in this country, we've equated people plugged to machines as actually being alive. It's sick.
Part of the reason I've developed my views on this is because my family (no medical professionals except me and my aunt's current husband) is incredibly ignorant when it comes to health. They refuse to talk about illness and death when it involves someone they care about and believe that people just "wake up" all the time when in vegetative states. These are graduate degree educated people so they're not stupid.

There's a reason that none of my family members are my "Emergency Contact" nor will they be making decisions about my health if I can help it.
 
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fancymylotus

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I think a lot of my fears come from just being scared in general that something catastrophically horrible is going to happen to someone I love and although its a selfish thing to want to have them "live"....I get that they would probably not want to continue on that way and really what kind of life is that anyway. Hrm
 

DermViser

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Part of the reason I've developed my views on this is because my family (no medical professionals except me and my aunt's current husband) is incredibly ignorant when it comes to health. They refuse to talk about illness and death when it involves someone they care about and believe that people just "wake up" all the time when in vegetative states. These are graduate degree educated people so they're not stupid.

There's a reason that none of my family members are my "Emergency Contact" nor will they be making decisions about my health if I can help it.
With my family, the tears start flowing when I start talking about advanced directives. Oh, and I also love - about DNR/DNI, they say to only do resuscitation and intubation if it will bring them back - as if people can predict in advance before doing it that it will 100% work. I guess it could be worse - they could say I'm trying to purposefully unplug them. Sigh.

It's not surprising at all that the govt. has now gotten involved bc we live in a society that wants EVERYTHING done, including EVERY procedure, no matter what the cost, and no matter what the quality of life.
 

Winged Scapula

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I think a lot of my fears come from just being scared in general that something catastrophically horrible is going to happen to someone I love and although its a selfish thing to want to have them "live"....I get that they would probably not want to continue on that way and really what kind of life is that anyway. Hrm
Those are common fears.

But the ultimate expression of love is to put aside what *you* need and want and give them what *they* need and would want.
 

DermViser

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I think a lot of my fears come from just being scared in general that something catastrophically horrible is going to happen to someone I love and although its a selfish thing to want to have them "live"....I get that they would probably not want to continue on that way and really what kind of life is that anyway. Hrm
I think being a physician makes that conversation a little easier to have with family, bc you realize it's not about you and what you want, but what the patient wants for his/her life and you have MUCH MUCH more realistic expectations on outcomes of common interventions like CPR, etc. The general public has such a skewed reality as to how successful these things are in real life.
 

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I would hope that if I or anyone I loved were ever in that situation that the state would kindly shove off.

Drinking to this young woman tonight.
 

jakeislove

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I'm with you. I think it's important that physicians are seen as healers, and only healers, but I don't think this sort of thing should be illegal either.
It's just a very late term abortion.

I keed, I keed!

Not something I'd personally want to be involved in but it would be better (and more humanely) done by a trained physician.
 

sinombre

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On a completely different side note, I think it would be awesome to be a doctor on a ward of happy old patients eating and enjoying their ice cream.
There seems to be a decent amount of happiness in outpatient geriatrics...
 

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GUH

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It's not the physician's job to administer drugs with the express purpose of ending a patient's life before she dies naturally. Get some other profession to do it.
 
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dpmd

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It's not the physician's job to administer drugs with the express purpose of ending a patient's life before she dies naturally. Get some other profession to do it.
Some physicians take their job of minimizing suffering so seriously that they have no qualms facilitating a humane death when necessary. It is something we do all the time when give meds to a patient who has been terminally extubated (although in that case the medication is given to relieve suffering even though we know it will hasten death). This is just taking things a step forward and managing the suffering that comes along with knowing you have an illness that is going to rob you of your ability to talk, eat, and think as it kills you.
 

GUH

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Some physicians take their job of minimizing suffering so seriously that they have no qualms facilitating a humane death when necessary. It is something we do all the time when give meds to a patient who has been terminally extubated (although in that case the medication is given to relieve suffering even though we know it will hasten death). This is just taking things a step forward and managing the suffering that comes along with knowing you have an illness that is going to rob you of your ability to talk, eat, and think as it kills you.
Administering poison with the express purpose of killing your patient is against both the Hippocratic Oath and AMA guidelines.
http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?

Whether another profession should participate in assisted suicide is up to them and whatever laws they are required to abide by.
 

colbgw02

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Not something I'd personally want to be involved in but it would be better (and more humanely) done by a trained physician.
Maybe. Physicians are in charge of state-sponsored executions, and those get botched all the time.

My point is that the system should be set up so that there can never be a doubt about whether or not a patient's physician will continue to treat them as long as the patient is willing to keep fighting. Maybe it's as simple as having a second physician, who previously has not had a relationship with the patient, be responsible for prescribing/administering the drugs.
 

dpmd

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Administering poison with the express purpose of killing your patient is against both the Hippocratic Oath and AMA guidelines.
http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.page?

Whether another profession should participate in assisted suicide is up to them and whatever laws they are required to abide by.
Surgery is also against the hippocratic oath but things adapt over time. The ama guidelines are just that-guidelines. And not many docs are actually members of the ama so there is that too.
 
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withdrawing medical support is wise in some situations, nobody can deny that.
 

dpmd

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Maybe. Physicians are in charge of state-sponsored executions, and those get botched all the time.

My point is that the system should be set up so that there can never be a doubt about whether or not a patient's physician will continue to treat them as long as the patient is willing to keep fighting. Maybe it's as simple as having a second physician, who previously has not had a relationship with the patient, be responsible for prescribing/administering the drugs.
I thought the main issue with screwed up executions is that there is no doctor involved.
 

GUH

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withdrawing medical support is wise in some situations, nobody can deny that.
There is a difference between withdrawing care for the patient's well-being and deliberately prescribing poison to a patient with the sole purpose of killing her.
Surgery is also against the hippocratic oath but things adapt over time. The ama guidelines are just that-guidelines. And not many docs are actually members of the ama so there is that too.
Comparing surgery to deliberately killing a patient is quite a stretch.
 
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ACSurgeon

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With my family, the tears start flowing when I start talking about advanced directives. Oh, and I also love - about DNR/DNI, they say to only do resuscitation and intubation if it will bring them back - as if people can predict in advance before doing it that it will 100% work. I guess it could be worse - they could say I'm trying to purposefully unplug them. Sigh.

It's not surprising at all that the govt. has now gotten involved bc we live in a society that wants EVERYTHING done, including EVERY procedure, no matter what the cost, and no matter what the quality of life.
For anyone who has worked in an ICU, you know that there are worse things than death.

While we can never predict with 100% certainty we can predict trends fairly well. Roughly speaking, we can say a disease process or injury will most likely have a good outcome or bad outcome. While a severe TBI has a small chance of making a good recovery if everything is done, there is a very high chance that instead they will have a terrible outcome (ie disability).

So, if you don't do everything possible there is a small chance that the patient who is allowed to die could have survived and led a normal life. If you do everything in that same scenario there is a high chance this person will live in a nursing home for the rest of time. I'll take my chances with the first option. Most non-medical people chose the latter. All we can do is present the options and let them chose guilt free.
 

sinombre

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There is a difference between withdrawing care for the patient's well-being and deliberately prescribing poison to a patient with the sole purpose of killing her.
Comparing surgery to deliberately killing a patient is quite a stretch.
"Deliberately killing" in these cases means deliberately doing something that is inevitable in order to mitigate suffering. I take it you've never had to watch someone slowly suffer as they die. It is a truly horrible thing, and I hope I have some say over the way I go if I am ever in this situation.
 

colbgw02

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I thought the main issue with screwed up executions is that there is no doctor involved.
The articles from this years controversial injections are a little scarce on details, and maybe it varies by state, but this article mentions the doctor in the Oklahoma case:

After administering the first drug, "We began pushing the second and third drugs in the protocol," said Oklahoma Department of Corrections Director Robert Patton. "There was some concern at that time that the drugs were not having the effect. So the doctor observed the line and determined that the line had blown." He said that Lockett's vein had "exploded."

Oklahoma's botched lethal injection...



ETA: Besides, in these instances, the "main" issue has nothing to do with presence/absence of a physician, but rather the change in the drugs used.
 
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GUH

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"Deliberately killing" in these cases means deliberately doing something that is inevitable in order to mitigate suffering. I take it you've never had to watch someone slowly suffer as they die. It is a truly horrible thing, and I hope I have some say over the way I go if I am ever in this situation.
Your assumption about my experience is quite wrong.

I would not personally condemn someone who did kill a dying person who asked to die, but as physicians (or physicians in training) there are certain things we can do that others can't and certain things we can't do that others can. Even if you think that it's inevitable.

Let another profession do the killing. That's not our job.
 

ACSurgeon

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Your assumption about my experience is very, very wrong. One of the last things a person close to me asked as he was slowly dying was for me to kill him.

I would not personally condemn someone who did, but as physicians (or physicians in training) there are certain things we can do that others can't and certain things we can't do that others can. Even if you think that it's inevitable.

Let another profession do the killing. That's not our job.
Our job is not to give life or take it away. It's to manage or treat medical illness in the way that best fits the patient's needs. Palliative care is one of the most valuable aspects of medicine.
 

sinombre

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Your assumption about my experience is very, very wrong. One of the last things a person close to me asked as he was slowly dying was for me to kill him.

I would not personally condemn someone who did, but as physicians (or physicians in training) there are certain things we can do that others can't and certain things we can't do that others can. Even if you think that it's inevitable.

Let another profession do the killing. That's not our job.
I apologize for making that assumption. I think we have both reached very different conclusions from similar experiences, which is okay. I think my post was emotionally charged because of how strongly I feel about the topic. So again, I'm sorry for responding that way. I don't think we're going to agree on the topic and I don't think I can contribute much more than pointing out that in my mind "deliberately doing something that is inevitable in order to mitigate suffering" is a good thing.
 

GUH

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Our job is not to give life or take it away. It's to manage or treat medical illness in the way that best fits the patient's needs. Palliative care is one of the most valuable aspects of medicine.
I apologize for making that assumption. I think we have both reached very different conclusions from similar experiences, which is okay. I think my post was emotionally charged because of how strongly I feel about the topic. So again, I'm sorry for responding that way. I don't think we're going to agree on the topic and I don't think I can contribute much more than pointing out that in my mind "deliberately doing something that is inevitable in order to mitigate suffering" is a good thing.
Hopefully one day our profession will decisively find the right balance between quality of life and the role of a physician in ending life in a way that we'll all agree upon.
 
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dpmd

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The articles from this years controversial injections are a little scarce on details, and maybe it varies by state, but this article mentions the doctor in the Oklahoma case:

After administering the first drug, "We began pushing the second and third drugs in the protocol," said Oklahoma Department of Corrections Director Robert Patton. "There was some concern at that time that the drugs were not having the effect. So the doctor observed the line and determined that the line had blown." He said that Lockett's vein had "exploded."

Oklahoma's botched lethal injection...



ETA: Besides, in these instances, the "main" issue has nothing to do with presence/absence of a physician, but rather the change in the drugs used.
I thought all the doc did was certify death. I would argue that a good anesthesiologist and several other kinds of specialists should be able to provide a humane and quick death if their conscience allows (I have no problem with a doctor not wishing to take part but since we are best skilled to minimize suffering I think letting others do it is inhumane-I will leave the argument of whether or not there should be death penalty to a different thread)
 
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GUH

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I thought all the doc did was certify death. I would argue that a good anesthesiologist and several other kinds of specialists should be able to provide a humane and quick death if their conscience allows (I have no problem with a doctor not wishing to take part but since we are best skilled to minimize suffering I think letting others do it is inhumane-I will leave the argument of whether or not there should be death penalty to a different thread)
Now you're talking about a doctor deliberately killing a healthy person. That's not what the article in the OP was about.
 

evilbooyaa

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Totally OK in my books. While I, if I was in her position, would want to wait until my symptoms became unbearable before going to hospice to live the end of my days relatively pain free, I can understand that she wants to end her life before her symptoms become unbearable.

Given that the best treatments for GBM give people in general about a median 6 month OS, it's not something that should be illegal.
 

Doctor Bob

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Let another profession do the killing. That's not our job.
If we give this responsibility over to another profession, the first question is which one?
Veterinarians? They do this on a daily basis. But what would we be telling our patients by sending them here? "I'm done with you; now you're cattle"
Pharmacists? Sure they know the drugs and have the access, but many of the same emotional conflicts occur. If we want people to feel safe getting meds from their pharmacists, then they shouldn't also be the deciding person to dispense end-of-life bottles.

We could make a new field... euthanists? What would their training be? Licensing? How would a patient be certified as eligible for their services?

Even if we identify another profession, then how do patients get their services? Do we allow patients (anyone) to go to the euthanist and say "I want to die, give me meds"? Perhaps having a sanctioned route for self-referral would be beneficial, but that's another discussion. So at some point the patient's doctor would have to certify them as eligible for a euthanist's services. So then the person taking care of them is also the one signing the form saying they can end their life.

I'm not sure how this is functionally any different than the doctor being the one to write the script.
 

colbgw02

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I thought all the doc did was certify death. I would argue that a good anesthesiologist and several other kinds of specialists should be able to provide a humane and quick death if their conscience allows (I have no problem with a doctor not wishing to take part but since we are best skilled to minimize suffering I think letting others do it is inhumane-I will leave the argument of whether or not there should be death penalty to a different thread)
I have no idea what their exact role is, but earlier you contended they weren't present. At least in some cases, they are.

Regarding your other point, sure, taken in isolation, many physicians could come up with a painless, humane way to kill someone. The problem with executions is that the state mandates it be done in a certain manner. Do we really believe that legal physician-assisted suicide would be any different vis-a-vis interference from the state?
 
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Anyone working in the health profession will respect this decision. Families with dying relative need to read this. 85 y/o pt with stage 4 lung cancer with pneumonia and a broken hip, and they want to do everything to keep them alive, we see cases like this ALL THE TIME. Its inhumane and sickening. I know its hard. But i wouldn't even put my own family members though that.
 

wildzodiac

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I though I would chime in here. Although I do not see nearly the same degree of suffering as you guys may be exposed to, I can completely relate. For those who are interested in reading more, look up the situation in Switzerland regarding this issue. Over there, its pretty much 100% legal. In fact, there are entire companies such as Dignitas for example, built around the field of euthanasia. In Switzerland, euthanasia was only an option for those who were terminally ill, which I understand. However, this gradually changed. Many people felt that they too, had the right to end their life regardless of their present health. Even recently, there have been cases of completely healthy people who chose to end their life because they feared the eventual but not imminent decline of their health. I saw a video about an 80 year old woman who really wanted to end her life because she the suffering that her husband with dementia went through some years prior and feared that her eventual demise would be close to her husbands. There was also a middle-aged woman who suffered from a non-lethal bone disease who decided to end her life through Dignitas in 2010. If something like this were to be legalized on a national level here in the United States, it must be extremely regulated so it does not gradually evolve into the situation in Switzerland. One more thing, assisted suicide companies such as Dignitas and Exit are for-profit companies. Is it ethical for companies to profit on someone's choice to die?
 

GUH

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...However, this gradually changed. Many people felt that they too, had the right to end their life regardless of their present health. Even recently, there have been cases of completely healthy people who chose to end their life because they feared the eventual but not imminent decline of their health. I saw a video about an 80 year old woman who really wanted to end her life because she the suffering that her husband with dementia went through some years prior and feared that her eventual demise would be close to her husbands. There was also a middle-aged woman who suffered from a non-lethal bone disease who decided to end her life through Dignitas in 2010...
That's horrible. Hopefully we can all agree that this is waaaaaay over the line... right?
 
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I though I would chime in here. Although I do not see nearly the same degree of suffering as you guys may be exposed to, I can completely relate. For those who are interested in reading more, look up the situation in Switzerland regarding this issue. Over there, its pretty much 100% legal. In fact, there are entire companies such as Dignitas for example, built around the field of euthanasia. In Switzerland, euthanasia was only an option for those who were terminally ill, which I understand. However, this gradually changed. Many people felt that they too, had the right to end their life regardless of their present health. Even recently, there have been cases of completely healthy people who chose to end their life because they feared the eventual but not imminent decline of their health. I saw a video about an 80 year old woman who really wanted to end her life because she the suffering that her husband with dementia went through some years prior and feared that her eventual demise would be close to her husbands. There was also a middle-aged woman who suffered from a non-lethal bone disease who decided to end her life through Dignitas in 2010. If something like this were to be legalized on a national level here in the United States, it must be extremely regulated so it does not gradually evolve into the situation in Switzerland. One more thing, assisted suicide companies such as Dignitas and Exit are for-profit companies. Is it ethical for companies to profit on someone's choice to die?

This is a massive topic to discuss.

I think my fingers will fall off if I had to type everything I want to say about this.
 

dpmd

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Now you're talking about a doctor deliberately killing a healthy person. That's not what the article in the OP was about.
I am basing my thoughts on a very simple idea. Doctors help patients minimize suffering. Most of the time that is by prescribing treatment or offering surgery that can have ill effects and can sometimes kill the patient. Sometimes this is by not administering treatments or performing operations that are unlikely to help a patient. Sometimes that decision means the patient dies. I don't make the decision to kill those patients any more than I would be making the decision to kill the pt referenced in the op. What I would be doing is ensuring that a patient who has already chosen to die (or a prisoner that has been ordered to die) doesn't suffer needlessly during the process. I could instead tell her she is on her own and she could try one of the many forms of suicide that each have their failure rates and associated pain (or in the case of prisoners we could let a poorly trained person start am iv and another insufficiently trained person press a button to deliver the drugs the state has selected which from what I read is typically what happens, I don't consider a doctor present to verify death but has no role in the decision making process or the actual action one who is "involved"). To me that is more unethical than voluntarily choosing to help her.
 
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