Euthanasia

[greatnt249]

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I don't know about the procedure involved in physician assisted suicide but from what others have posted it involves prescription medications. I think a doctor would be the most qualified to determine the quantity of whatever medications(poisons?) are required and write the prescriptions.

I'm not buying the "doctors know how to best kill someone, so that means it's their obligation to do so" argument.

 

[greatnt249]

This is an interesting thread, thank you OP for bringing it up. I was not aware of PAS. Makes sense to me, if they know they are going to die painfully in x months, why not give them the option of having a little control over what's to come? Someone can kill themselves with anything with many horrible outcomes, if they are set on doing it why not give a means that will do the LEAST harm? I wonder what the numbers are of people who are provided the means and then actually go through with it? The bit about doing no harm above is interesting as well, even if you take away the cases above where harm is clearly done for whatever reason, don't physicians often inflict short term harm for long term good as well?

I've always said if it comes down to it I'm going skydiving, oops.

If someone is diagnosed with Alzheimer's, should they qualify? How about Parkinson's? Huntington's? ALS? MS? Most (if not all) of these are debilitating, terminal illnesses, yet it's difficult to predict when death will come naturally for them. Why should they be forced to wait until they're at death's door to commit suicide the "clean" way?

 

[softmed]

If someone is diagnosed with Alzheimer's, should they qualify? How about Parkinson's? Huntington's? ALS? MS? Most (if not all) of these are debilitating, terminal illnesses, yet it's difficult to predict when death will come naturally for them. Why should they be forced to wait until they're at death's door to commit suicide the "clean" way?

You should definitely research the Oregon Death with Dignity Law. It addresses many of the things you've said.

 

[sustentacular]

I'm not buying the "doctors know how to best kill someone, so that means it's their obligation to do so" argument.

But who else can prescribe that medication? And again, no one would be obliging you personally to assist in a patients suicide.

If someone is diagnosed with Alzheimer's, should they qualify? How about Parkinson's? Huntington's? ALS? MS? Most (if not all) of these are debilitating, terminal illnesses, yet it's difficult to predict when death will come naturally for them. Why should they be forced to wait until they're at death's door to commit suicide the "clean" way?

So because there are gray areas there should be no assisted suicide for anyone?

 

[FasterThanAll]

I know, overly dramatic. However, we would never let a depressed individual "off the hook" knowing that they had suicidal thoughts, and they may be suffering more unbearable pain (psychologically) than we can even comprehend. How is it "fair" to give the OK for someone to kill themselves when they are in physical pain, yet leave no "recourse" for those in psychological pain?

I think the majority of drug addicts that you'd find would fall into that "suffering" category (psychologically). They use the drugs to end the pain, sort of euthanizing themselves for half of the day, whenever they choose.

People have been committing suicide for a long time. So, while I don't understand why doctors now need to get involved in the 21st century, I do understand that if the drug addicts can numb their pain all day long then my grandparents dying from cancer (hypothetically) should be able to as well.

I'm undecided, as I am with abortion; it probably should be considered on a case-by-case basis with a conscious person having their family by their side.
I wouldn't want euthanasia departments to be started up at hospitals around the country.. imagine how long the lines would be. And, imagine how mindless the process could become for the physician.

 

[Spiker]

If some one is REALLY interested in this topic you can PM me I just wrote a short ethics report on this for my class (6 pages with citations). My teacher is going to help me in getting it published so it isnt horrible. It will give you an good idea of the most prominent arguments for each side of the debate

 

[softmed]

So here's the AMA's take:

"Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks."

http://www.ama-assn.org/ama/pub/phy...-ethics/code-medical-ethics/opinion2211.shtml

In an interview and in my career I'm forced to agree with them. In my personal life I disagree.

This is the only circumstance that I truly think it should be allowed: the patient is of sound mind and is going to die shortly. They cannot be depressed, insane, and there must be great care to ensure there is no financial motivation. I think that if someone is in great pain in the last months of their life they have every right to relieve their pain.

The idea that doctors must do no harm is extremely naive. In a cancer hospitals doctors often give treatments that will put their patients in the ICU and could even kill them. In Phase I trials, which are the only trial where the patient is informed there is no benefit to them, a patient will endure tremendous pain and suffering, and possibly death.

If relieving someone's suffering is incompatible with a healer, then how are Phase I trials compatible?

 

[greatnt249]

But who else can prescribe that medication? And again, no one would be obliging you personally to assist in a patients suicide.

1) Why does it have to be a medication?
2) It isn't about just me. Hypothetically, what if no physician in Oregon was willing to oblige a patient's request to die by euthanasia; what's the patient's recourse?

So because there are gray areas there should be no assisted suicide for anyone?

Yes, as a matter of fact, that's exactly what I'm saying. This isn't something to just write off as letting people decide for themselves what they want to do; this is a serious matter in which the medical community is being asked to determine whether someone qualifies to die by suicide, and then follow up that determination by carrying out said act. If even one person is given the okay to commit suicide at the hands of the medical community, and later on we find out that such measures could have been averted, how do we answer to that?

 

[greatnt249]

Current legislation requires a 2-physician consensus on terminal illness status of 6 months or less to live. Can this change? Absolutely. Often? Not really. I've heard many stories of 6 months to live lessened to weeks or days, but not the opposite. The process has the patient approach the physician. The physician has a right to say no. The patient takes the medication, of which the physician only provides a prescription for. Each year, in OR (and now WA), many more people die of the qualifying diseases naturally than by the barbiturates prescribed. The process isn't abused, the physician isn't playing God, the law is sound (and provides no legal recourse against a physician), and the patient makes the decision. Not letting people die the way they want is cruel.

As for your psycho- versus physiological question before. Depression is curable, although it can be tough, whereas a terminal disease is not. Common sense says the patient should exhaust all options available before granted the choice to die.

And lets not forget, we already have assisted-death. Removal of feeding tubes, removal of ventilators, administration of narcotics (which have a high indication of death at certain thresholds) just to name a few.


*All this is based on my views of PAS, not euthanasia.

I agree; however, it's a bit contradictory to ask medicine to provide death's "saving grace" when the overwhelming majority of us go into the profession to avert that outcome. By the way, there's a difference between removing life support on DNR request and providing a lethal prescription; you can't force someone to be treated, whereas you do have control over the medications you dispense.

What's the point in even going through medicine, anyway? If you really wanted to die that badly, surely there are easier (and painless) ways to go about doing it than forcing yourself through a panel that may wind up denying your request in the long run.

 

[minicow]

greatnt249, (to all posts in general?)

-shrug- might save the emergency room a few visits a year from the 10%(i think thats about right?) of gunshot wounds to the head that survive?(joke...kinda dark but im kidding)
i get that doctors are taught to heal...but once they sign off that a patient has 6 months or less to live its kind of like theyve given up the fight for that patient already(not in a negative way...though it might sound like it).
i get you questioning the logic and reasoning of those who sided with the euth or pas...but
there are plenty of ethical questions and moral standpoints...thus its not legal in many states.
i dont think doctors should have to provide it or that it be their responsibility(doctors dont have to perform abortions, why should they have to assist in ending a terminally ill persons life?). i think doctors should just be able to have it available(maybe a few precautions thrown in here and there to prevent abuse).
mmm thats enough thinking on death for now...

if you, yes you, are reading this you should go frolic in some flowers and thank your lucky stars for your health😀 (<-imagine the clover as a daisy)

frolic frolic frolic~~~~

 

[greatnt249]

What happens if the patient is so far gone that they can no longer take the dose themselves? Did they "miss the deadline," or is there a special exception for that?

 

[LizzyM]

The idea that doctors must do no harm is extremely naive. In a cancer hospitals doctors often give treatments that will put their patients in the ICU and could even kill them. In Phase I trials, which are the only trial where the patient is informed there is no benefit to them, a patient will endure tremendous pain and suffering, and possibly death.

If relieving someone's suffering is incompatible with a healer, then how are Phase I trials compatible?

The purpose of a Phase I Clinical Trial is not to kill the subject. Every subject death is reported to a research ethics board (called the IRB) and to the FDA. In a phase I trial a new compound is tested for safety and dosage. Many phase I trials are conducted on healthy, young people. In studies of drugs for cancer, the subjects are usually volunteers with cancer who have not responded, or who no longer respond, to the standard treatment for their disease. For these folks, the alternative is usually comfort care/hospice. It is important to note that these are volunteers who are fully informed of the possible side effects and who willingly participate (and who are free to stop at any time) with the hope that their efforts will help others with the disease. It is one of the most altruistic things that one can do at the end of life but most adults are not given the opportunity or they choose not to participate. Almost all children with cancer participate in phase I trials with their parents' permisison. Given the purpose of a phase I trial, there may be discomforts but the knowledge that one is helping others (and often the misguided notion that this might be a new wonder drug that will help the subject himself) does much to alleviate what might otherwise be "suffering".

On the topic of comfort care, we need to be much more aggressive with the management of symptoms at the end of life. The US has a weird attitude about the use of narcotics and many physicians are shy about prescribing adequate pain control and pharmacies are conservative when it comes to stocking narcotics so as not to bring down the wrath of the Drug Enforcement Agency (DEA).

 

[shiftingmirage]

I agree; however, it's a bit contradictory to ask medicine to provide death's "saving grace" when the overwhelming majority of us go into the profession to avert that outcome.

Granted, I'm not a practicing physician, so I may be wrong, but there is a saying that you are not really a doctor until you kill someone. While I don;t know how many physicians actually kill a pt, I think it is fair to say that almost all physicians at some time make an action that negatively affects their patients due to error. Throughout a medical career, you will screw up somewhere, sometime.

The cliche answer of 'why medicine' has always been I want to help people. It's not I want to save people's lives, it's I want to help people. To some people, dying helps them. They no longer are in pain. They don't feel they are a drain on their family. The other day I met an end stage Huntington's patient. Although he was alert, and seem to understand what we were saying, she was unable to form words despite her attempts. She has limited control of her movements. Her pants were wet because people had neglected to change her diaper. Imagine living without the ability to interact with the world. Lying in your own fecal matter. What kind of life is that?

You asked why docs should do it. Because the law requires <6 months to live. That's a doc's call. It requires a psych eval, another doc's call. In theory, the doc could call someone else and say, he meets the requirements, you hook him up with the meds, but that guy is just an intermediate. The doc is still making the decision saying the pt can have the meds. And Rx are controlled. They are put out by companies, not the guy on the corner. There are requirements for the program, so having Rx allows the gov to collect data about the program, and to regulate it. If a doc screws up, their rx can be revoked, their license can be revoked. They understand the seriousness of any abuse of the practice.

 

[greatnt249]

Granted, I'm not a practicing physician, so I may be wrong, but there is a saying that you are not really a doctor until you kill someone. While I don;t know how many physicians actually kill a pt, I think it is fair to say that almost all physicians at some time make an action that negatively affects their patients due to error. Throughout a medical career, you will screw up somewhere, sometime.

Say what? There's a huge difference between treating a patient and accidentally bringing about their death in the process and prescribing medication knowing they are going to kill themselves with it. How/why you conflated the above with the intention of my previous posts is beyond me.

The cliche answer of 'why medicine' has always been I want to help people. It's not I want to save people's lives, it's I want to help people. To some people, dying helps them. They no longer are in pain. They don't feel they are a drain on their family. The other day I met an end stage Huntington's patient. Although he was alert, and seem to understand what we were saying, she was unable to form words despite her attempts. She has limited control of her movements. Her pants were wet because people had neglected to change her diaper. Imagine living without the ability to interact with the world. Lying in your own fecal matter. What kind of life is that?

My sister has a genetic condition where one of the symptoms is mental ******ation. Granted, it's not as severe as what others experience, but she still carries that burden every day. The reason I bring this up is because I am well aware of what it means to go through life in less-than-ideal conditions, knowing that someone's condition will never improve and may never experience a quality of life comparable to what many others experience. That being said, I'm tired of being told to go and observe [insert patients who have dire outcomes] so that I might be more sympathetic to their rationale for ending their lives. I get it; I don't condemn them for wanting to end their existence, and I can certainly sympathize with someone with a very poor quality of life. However, it does not follow for me that assisted suicide should fall into the realm of medicine. We (as the medical community) should not be going around demarcating the point at which quality of life is so poor that we give the go-ahead for a patient to kill him/herself on our watch just because "that's what they want to do." I wholeheartedly support improvements in end-of-life care and providing as pain-free an existence as possible (which apparently is lacking in this country), but I simply cannot bring myself to approve allowing someone to purposefully die at the hands of the medical community. It's an abuse of the knowledge/power that we've been given in our training to purposefully/knowingly provide a patient with a means to death simply because "we know how to do it best."

I'm not condemning any of you who support PAS; I'm simply providing my opinion on the matter just so it's out there to (hopefully) stimulate discussion.

 

[DRMRL]

Thank you. I feel like it was wise to bring it up because these are tough decisions that doc's have to face. I also understand that doc's are not required to perform euthanasia (maybe in Oregon and Washington though??). But anyways, health care is slowly changing in this country and I saw it fit to speak about euthanasia. This is a very emotional and moral event in medicine, in my opinion.

 

[c5212]

And those that don't get that right to dictate how their lives end because they don't "qualify" according to established guidelines...who speaks for them?

They DO have a voice and a choice; they speak for themselves. This is more commonly known by the name of suicide. A quiet, somber overdose is the key to attaining peace and comfort for many people. If someone loses their financial securities in the stock market or has to suffer living with the death of their family on their mind, they have the right and means available to end their life on their own terms.

***Not saying that suicide is the right thing to do in ANY circumstance, but people are not helpless, they can dictate the terms of their death.

 

[LizzyM]

They DO have a voice and a choice; they speak for themselves. This is more commonly known by the name of suicide. A quiet, somber overdose is the key to attaining peace and comfort for many people. If someone loses their financial securities in the stock market or has to suffer living with the death of their family on their mind, they have the right and means available to end their life on their own terms.

***Not saying that suicide is the right thing to do in ANY circumstance, but people are not helpless, they can dictate the terms of their death.

Some people are helpless. They no longer have the use of their hands, they can not swallow liquids or pills, they are unable to speak or even to communicate in non-verbal ways. My aunt lived that way, but without the use of technological devices such as ventilator or feeding tube, for years.

Those who approve of Physician Assisted Suicide (PAS) believe it unjustly leaves out those who wait too long and who are no longer able to act independently. Those who disapprove of PAS are concerned that it may devolve into involuntary euthanasia for those who are no longer able to speak for themselves on the grounds that it is unjust to deny to them what is available to those who are independent.

 

[RogueUnicorn]

as a somewhat tangentially related note, i think the hyppocratic oath should be done away with or heavily modified.

 

[Spiker]

as a somewhat tangentially related note, i think the hyppocratic oath should be done away with or heavily modified.

There is the modern version if you are still referring to the classical version.

 

[RogueUnicorn]

There is the modern version if you are still referring to the classical version.

link? is it the standard everywhere or just some schools?

 

[LizzyM]

as a somewhat tangentially related note, i think the hyppocratic oath should be done away with or heavily modified.

Some schools use the Declaration of Geneva:

Physician's Oath

I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity; the health of my patient will be my first consideration;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honor.

 

[RogueUnicorn]

Some schools use the Declaration of Geneva:

Physician's Oath

I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity; the health of my patient will be my first consideration;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honor.

oo i like this one... the penultimate line gives me pause for thought though.

 

[circulus vitios]

as a somewhat tangentially related note, i think the hyppocratic oath should be done away with or heavily modified.

Uh I don't think it's like an actual law that's taken seriously anymore.

 

[LizzyM]

oo i like this one... the penultimate line gives me pause for thought though.

What should a physician do if the government mandates that a procedure be performed against a patient's will? What if that procedure were an abortion?

Keep in mind that this declaration is meant to apply worldwide.

 

[RogueUnicorn]

Uh I don't think it's like an actual law that's taken seriously anymore.

i don't know about you but i take rather seriously anything labelled "oath" that is required of me.

What should a physician do if the government mandates that a procedure be performed against a patient's will? What if that procedure were an abortion?

Keep in mind that this declaration is meant to apply worldwide.

i guess that's a great point.

 

[chman]

You are correct. It does take 2 MD's and a psychological evaluation. Good for Oregon and good for Washington. Let rational people make choices about how their life will end.

And go Ducks in 2 hours with the Rose Bowl on the line.

Quack Quack all the way to the rose-bowl. Congrats.

 

[greatnt249]

They DO have a voice and a choice; they speak for themselves. This is more commonly known by the name of suicide. A quiet, somber overdose is the key to attaining peace and comfort for many people. If someone loses their financial securities in the stock market or has to suffer living with the death of their family on their mind, they have the right and means available to end their life on their own terms.

***Not saying that suicide is the right thing to do in ANY circumstance, but people are not helpless, they can dictate the terms of their death.

You either just proved my point or missed it entirely.

 

[URHere]

As a medical student in Oregon, we spend a bit of time discussing PAS and what it means for us as providers. Most of the details have already been expounded upon (requirement of two physician and mental status/psych evaluations, low estimated life expectancy, and the eventual drugs being taken by patients independently). One thing I wanted to point out is that the number of patients who request PAS is still surprisingly low.

I think this happens for several reasons. Many patients do not want to go through the hassle of so many evaluations. Some are already past the point of being declared mentally competent for making such a decision, and others can still not accept their impending mortality. The last reason is why many patients also balk at hospice care - it can be like someone coming to them out of the blue and saying, "by the way, do you want us to support you while you die?" (side note: 100% of PAS cases I have heard about have been patient requested, not physician suggested). Unfortunately, physicians do not always do the best job when it comes to giving patients a straightforward assessment of their disease and several patients only realize that they have less than 6 months to live when someone brings up hospice care, and the patient heads to the internet.

But, I digress. I just wanted to point out that states allowing PAS are not prescribing life-terminating medications on a large-scale basis. At the same time, several patients who seek PAS do move to Oregon from out of state and then go through the evaluation procedure. So even if you state does not allow PAS, that doesn't necessarily mean that your states' native residents aren't out seeking it.

 

[randombetch]

you're thinking awfully narrow here. try getting more end of life/palliative care. like hospice. or try volunteering in a cancer treatment center. we allow people to be taken off life support, have their feeding tubes clamped off, stop giving them fluids, and allow them to have strict DNR preferences. it seems only reasonable to also offer euthanasia as an option. I agree that the guidelines would be harry.....but most things in medicine are anyway. everyone seems to be missing what I said earlier about people trying and failing on their own.

Wow, okay you volunteered a ton at some place - WE GET IT. Stop acting like you're better than everybody else and know more than medical students just because you had nothing better to do than spend a long portion of your life volunteering some place where you did b**** work.