Question for Anesthesiologists

[Technology]

Hi. So I know the obvious: anesthesiologists deliver anesthesia to patients before operations. However, do they have any other functions, such as working with euthanasia (assisted suicide)? This is a field that particularly interests me (physician assisted suicide). I was curious if they perform this as well.

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[ZzzPlz]

You're a real sick son of a bitch

 

[Technology]

You're a real sick son of a bitch

Lol? You may think negatively of this field, but it solely depends on someone's life circumstances. Please do not post irrelevant criticism. This is a legal procedure in a few states in America.

 

[Aether2000]

In some states that have the death penalty, it is illegal for physicians to administer any drug to hasten death. So docs in those states can neither assist in executions nor in assisted suicide. Furthermore, I am not aware of any anesthesia euthanasia fellowships in the works. It would be detrimental to the profession if anesthesiologists were to become known to patients as part-time executioners.

 

[Technology]

In some states that have the death penalty, it is illegal for physicians to administer any drug to hasten death. So docs in those states can neither assist in executions nor in assisted suicide. Furthermore, I am not aware of any anesthesia euthanasia fellowships in the works. It would be detrimental to the profession if anesthesiologists were to become known to patients as part-time executioners.

Thanks for your comment. I was just curious, so I specifically asked this in the Anesthesiology section because it seemed like the only possibility.

 

[YayPudding]

I can't speak to euthanasia, but anesthesiologists maintain patients' anesthesia and monitoring before, during and after procedures, in critical care units, pain management, research and other fields.

 

[vector2]

You're a real sick son of a bitch

As opposed to the hospital day 63 lined up 85yo demented vent trach peg with diffuse mets who heme onc thinks they should enroll in their latest trial

 

[Mman]

physician assisted suicide is generally practiced by internists or palliative care docs AFAIK and is with prescribed oral medicines that a patient takes on their own. While anesthesiologists have a boat load of IV meds that could finish someone off quickly, that's not really what physician assisted suicide is. I mean it's not like I could start an IV on a patient and then put 400 of propofol in line and 20 of vecuronium and tell them to push the 2 big white syringes and then the clear syringe. I mean you'd be unconscious before you got the vec and someone else would have to push it or in other words, someone would have to kill them.

The beauty of the oral meds is they are given to a patient that they just goes off and does it whenever/wherever they want with nobody else helping.

 

[Planktonmd]

This is actually an interesting subject and the debate on it is ongoing.
The AMA's position on it stops a little short from recommending euthanasia. It discourages actions or interventions aimed at ending the patient's life, but encourages all forms of palliative measures to improve the quality of the dying process, even if these measures ultimately shorten the patient's life.
https://ama.com.au/system/tdf/docum...ed Suicide 2016.pdf?file=1&type=node&id=45402

I think the AMA's position is reasonable and could be adopted as a guideline for those physicians involved in the care of terminally ill patients.
As for anesthesiologists, We are rarely involved in palliative care in the U.S. except as consultants for pain management. So it is extremely unlikely for an anesthesiologist to be faced by the difficult decision of helping a patient wishing to end his/her suffering.

 

[GravelRider]

physician assisted suicide is generally practiced by internists or palliative care docs AFAIK and is with prescribed oral medicines that a patient takes on their own. While anesthesiologists have a boat load of IV meds that could finish someone off quickly, that's not really what physician assisted suicide is. I mean it's not like I could start an IV on a patient and then put 400 of propofol in line and 20 of vecuronium and tell them to push the 2 big white syringes and then the clear syringe. I mean you'd be unconscious before you got the vec and someone else would have to push it or in other words, someone would have to kill them.

The beauty of the oral meds is they are given to a patient that they just goes off and does it whenever/wherever they want with nobody else helping.

And this is a big distinction because with IV anesthetic medications, the actual act of killing is performed by the physician rather than by the patients themselves. So, is this really suicide? Although, Dr. Kevorkian had an apparatus that allowed patients to self administer drugs.

Most medical societies and specialty boards (including the ABA) have statements against physicians participating in lawful executions in capital punishment cases. I'm not sure what their overriding sentiment is regarding physician assisted suicide, but I think it has softened a bit from being totally against it. My understanding is that the AMA has taken a sort of "neutral" stance on the issue.

Physician-assisted suicide is also a completely distinct issue from the futile
ICU care that was mentioned in a previous post. There is a big difference between not escalating interventions and actually assisting a patient's death. This is a complicated issue with many areas of gray. I think being a "specialist" in assisting suicide would be bizarre and the exact wrong thing we need. I think a decision such as ending one's life should be made over a long period of time, with many discussions with a physician who knows you and your disease state well....such as a primary care doc or oncologist.

 

[Gern Blansten]

I have not heard that the ABA has softened their stance on this issue. The last I heard was that the ABA reserved the right to withdraw your certification status if you were found to be participating in assisted suicide or lethal injections for convicted criminals. I don't agree with their stance as I think the two are completely separate and that it is overstepping by the ABA (they do not have the same policy for those who participate in abortions). I think the ABA should have no policy on the issue and that it should be left to state medical boards to ensure that the physician is complying with local laws.
With regards to the futile care of the critically ill patient, I believe that compassionate withdrawal of care is the way to go and that we will see a sharp rise in this as we try to deal with rising costs of medical care and how we can better utilize our limited resources. In my opinion, we treat our pets better than we do our family members. We would never allow our pet to suffer for days, weeks, months, or years like we do family members. The problem comes in when people have other motives to hasten death or prolong life (many times driven by monetary gains-they may get a large life insurance settlement if they die or they may continue to get substantial government benefits if they are kept alive). Often times, the financial security of the rest of the family members hinges upon the outcome of the critically ill or slowly dying loved one, and that needs to be reconciled. Another issue is unrealistic expectations of what recovery will look like for their loved one. Many think they will recover and go on to lead a normal productive life like they did previously. The reality, many times, is that they will require 24 hour care, have no idea who they are or where they are, and will live out a miserable existence in a nursing home. The lines are almost always blurred by confounding motives or misconceptions. Each case has its own unique circumstances and it will be a challenge to apply a one size fits all policy. In addition, it is likely that the way we do things today, from an ethical standpoint, will be viewed through a vastly different lense 10, 20, or 50 years from now as cultural norms change.

 

[deleted162650]

I mean it's not like I could start an IV on a patient and then put 400 of propofol in line and 20 of vecuronium and tell them to push the 2 big white syringes and then the clear syringe. I mean you'd be unconscious before you got the vec and someone else would have to push it or in other words, someone would have to kill them.

Dude, just mix 'em both in the same syringe - problem solved.

 

[sigrhoillusion]

Dude, just mix 'em both in the same syringe - problem solved.

One of the attendings I worked with as a resident told us a story on call one night that when he was a resident they used to have a competition of who could give the best anesthetic in the lowest volume. They would just mix a bunch of **** into a 5 cc syringe and see how it worked.

 

[psychbender]

One of the attendings I worked with as a resident told us a story on call one night that when he was a resident they used to have a competition of who could give the best anesthetic in the lowest volume. They would just mix a bunch of **** into a 5 cc syringe and see how it worked.

Versuvecular

1mL of 5mg/mL versed, 1mL 50mcg/mL sufenta, 1mL 100mg/mL ketalar, use the volume to reconstitute 10mg of vecuronium. You're welcome.

 

[aneftp]

I have not heard that the ABA has softened their stance on this issue. The last I heard was that the ABA reserved the right to withdraw your certification status if you were found to be participating in assisted suicide or lethal injections for convicted criminals. I don't agree with their stance as I think the two are completely separate and that it is overstepping by the ABA (they do not have the same policy for those who participate in abortions). I think the ABA should have no policy on the issue and that it should be left to state medical boards to ensure that the physician is complying with local laws.
With regards to the futile care of the critically ill patient, I believe that compassionate withdrawal of care is the way to go and that we will see a sharp rise in this as we try to deal with rising costs of medical care and how we can better utilize our limited resources. In my opinion, we treat our pets better than we do our family members. We would never allow our pet to suffer for days, weeks, months, or years like we do family members. The problem comes in when people have other motives to hasten death or prolong life (many times driven by monetary gains-they may get a large life insurance settlement if they die or they may continue to get substantial government benefits if they are kept alive). Often times, the financial security of the rest of the family members hinges upon the outcome of the critically ill or slowly dying loved one, and that needs to be reconciled. Another issue is unrealistic expectations of what recovery will look like for their loved one. Many think they will recover and go on to lead a normal productive life like they did previously. The reality, many times, is that they will require 24 hour care, have no idea who they are or where they are, and will live out a miserable existence in a nursing home. The lines are almost always blurred by confounding motives or misconceptions. Each case has its own unique circumstances and it will be a challenge to apply a one size fits all policy. In addition, it is likely that the way we do things today, from an ethical standpoint, will be viewed through a vastly different lense 10, 20, or 50 years from now as cultural norms change.

What about life insurance policies and quickly ending life to give family members that 1-2 million tax free policy pay out?

How will insurers handle life insurance with assisted suicide

 

[Wiscoblue]

Life insurance does not pay in cases of suicide.

 

[deleted126335]

Actually many do. Group term life often pays. My personal policy wouldn't pay for suicide for the first three years of initiating the policy, but after that it would pay out.


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[Wiscoblue]

Wow that's quite interesting. I've always been under the impression that they don't pay for suicide.

 

[deleted162650]

Versuvecular

1mL of 5mg/mL versed, 1mL 50mcg/mL sufenta, 1mL 100mg/mL ketalar, use the volume to reconstitute 10mg of vecuronium. You're welcome.

I'm not convinced the anesthesia is gonna outlast the paralysis.

 

[psychbender]

It's just the induction syringe.

 

[deleted162650]

It's just the induction syringe.

Well that's not overly impressive then. Somebody give me a recipe for a single syringe that'll get me through a lap appy start to finish.

 

[epidural man]

Versuvecular

1mL of 5mg/mL versed, 1mL 50mcg/mL sufenta, 1mL 100mg/mL ketalar, use the volume to reconstitute 10mg of vecuronium. You're welcome.

3cc induction!

My good friend and co-resident taught me this recipe.

 

[chocomorsel]

I'm not convinced the anesthesia is gonna outlast the paralysis.

Really? That's a lot of ****. Enough for even a cow I would think. 100 of Ketamine is in there for crying out loud!! And that's a bunch of Sufenta as well.

 

[pgg]

Wow that's quite interesting. I've always been under the impression that they don't pay for suicide.

I think my term policies have a 2 year exclusion period. I suspect every policy that does cover it has a similar clause.

 

[epidural man]

Hi. So I know the obvious: anesthesiologists deliver anesthesia to patients before operations. However, do they have any other functions, such as working with euthanasia (assisted suicide)? This is a field that particularly interests me (physician assisted suicide). I was curious if they perform this as well.

It's been answered plenty - but wanted to add my take.

Anesthesiologists keep you alive. There is no role of an anesthesiologist to help to facilitate death and are completely un -needed in this realm. The reason anesthesiologists are so talented - is they walk that very fine line between the drugs that will kill you and the physiological state that keeps you alive. Once that line is gone, an anesthesiologist is not needed (or even a physician really...)

 

[chocomorsel]

OP, anesthesiologists can do palliative care fellowships. This can open doors to physician assisted suicide if that's what you want.

I don't know why people are picking on the OP. He has his own interests and who are we to judge? How many gomers do we take care of who really need to pass peacefully to the other side instead of sitting there eating, breathing, peeing, and pooping out of tubes? With absolutely no quality of life?

 

[dhb]

Epidural man, you sound very dogmatic for a dogm fighting guy

 

[IlDestriero]

Life insurance does not pay in cases of suicide.

Not necessarily true. You have to consult your policy. Mine for example paid after 12 or 24 months. They pointed that out as we were reviewing the specifics.


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Il Destriero

 

[aneftp]

Wow that's quite interesting. I've always been under the impression that they don't pay for suicide.

Many have 1-2 year exclusion periods for suicide. Prevents people from buying and killing themselves to make money for their loved ones.

Some say you cannot fly an airplane even with instructors. Read the fine print

 

[urge]

Hi. So I know the obvious: anesthesiologists deliver anesthesia to patients before operations. However, do they have any other functions, such as working with euthanasia (assisted suicide)? This is a field that particularly interests me (physician assisted suicide). I was curious if they perform this as well.

The ASA/ABA do not allow its constituency to participate in euthanasia. They will strip you off of your board certification and kick you out of the society. So the answer is no.

 

[SansaStarkMD]

People OD all of the time without fellowship training, imagine that.

 

[MD Financial Services Scott]

Life insurance does not pay in cases of suicide.

All normal Life policies regardless of term or cash value contract will pay for suicide do to a law that states they can't have that as a limitation for longer than 2 years. What that means is from the day the policy goes into effect if you decide suicide is the right thing then the policy does not pay out the benefit but the premiums paid would be returned to your beneficiaries. 2 years and 1 day you are good to go on whatever path you choose.

 

[MD Financial Services Scott]

Many have 1-2 year exclusion periods for suicide. Prevents people from buying and killing themselves to make money for their loved ones.

Some say you cannot fly an airplane even with instructors. Read the fine print

If you have a policy with a flight exclusion then that is correct, you would be excluded from benefit if you die while flying the plane. If however you don't have an exclusion on a current policy but later decide to start flying then die doing so that would be a Non-excluded event so the policy would pay.

 

[MD Financial Services Scott]

What about life insurance policies and quickly ending life to give family members that 1-2 million tax free policy pay out?

How will insurers handle life insurance with assisted suicide

Most policies actually have accelerated death benefits which allow you to get paid part of the death benefit prior to death, usually it is for anyone diagnosed with 24 months or less to live.

 

[Gern Blansten]

The ASA/ABA do not allow its constituency to participate in euthanasia. They will strip you off of your board certification and kick you out of the society. So the answer is no.

I think only the ABA cares. I think the ASA will continue to take your money.

 

[IlDestriero]

I think only the ABA cares. I think the ASA will continue to take your money.

The ASA will make you switch to perioperative medicine.


--
Il Destriero

 

[pgg]

The ASA will make you switch to perioperative medicine.

Can I choose euthanasia instead?

 

[sigrhoillusion]

Can I choose euthanasia instead?

No but you can still practice anesthesia on the youth in Asia...

 

[Technology]

Thanks for the comments everyone! Sorry if anyone was disturbed by this post . I was just curious about the use of euthanasia because I do not know much about it. I would never wish for anyone to pass away in a painful manner. I am sure most terminally ill people would rather pass away peacefully than have an abrupt, painful death.

 

[Hamhock]

I was just curious about the use of euthanasia because I do not know much about it. I would never wish for anyone to pass away in a painful manner. I am sure most terminally ill people would rather pass away peacefully than have an abrupt, painful death.

Patients with terminal illness should not, ever, pass away with severe pain (unless they request such a death). Aggressive pain management that completely removes all pain -- and may also lead to an earlier death as a secondary outcome -- is completely within the current ethical and legal norms of the United States medical community. The principle of double effect is well-established.

This is a completely different topic than physician-assisted suicide; which itself, is a completely different topic than euthanasia.

This confusion is part of the reason we (the public -- and even the medical community) so struggle with end of life issues in this country...this and of course the incestuous cousins: religion and politics.

HH

 

[Gern Blansten]

Thanks for the comments everyone! Sorry if anyone was disturbed by this post . I was just curious about the use of euthanasia because I do not know much about it. I would never wish for anyone to pass away in a painful manner. I am sure most terminally ill people would rather pass away peacefully than have an abrupt, painful death.

I feel like you mean a long, drawn out, painful death.
Not much chance to intervene in an abrupt painful death.