Should Doctors Practice Euthanasia?

[WilcoWorld]

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Starting a new thread to discuss an issue that I think could promote enlightening discussion.

Should doctors practice euthanasia?

Are "passive euthanasia" and "active euthanasia" the same things?

 

[RustedFox]

Yes

 

[deleted941485]

I was firmly in the No column for many years…after dealing with enough patients I’m in full support to putting these people out of their and my misery.

 

[bravotwozero]

In my mind, passive euthanasia is withdrawal of care, whereas active is actually giving medications/treatments to hasten or cause someone’s death. Not a subject matter expert, could easily be way off.

Have zero problems with the former, the latter represents a red line I’m not willing to cross.

 

[WilcoWorld]

Some object to passive euthanasia as a term, saying it undermines the meaning of euthanasia. If you allow "passive euthanasia" to be a real thing, where does it end? Is declining to take a patient to the OR for a devastating head bleed or a ruptured aorta euthanasia?

Some will reply that those don't count, because nothing is being withdrawn. But what about calling a code - is that passive euthanasia? What about not exchanging clotted ECMO catheters in a patient who's bleeding out their total blood volume every 8 hours?

Another problem with calling things like discontinuation of pressors "passive euthanasia" is that it doesn't reliably lead to death. Yes, outcomes are better in sepsis if we keep the MAP>65, but not everyone who doesn't meet that goal dies, and many who do meet that goal go on to die. Dobutamine is a good example (yes, I know it's an inotrope), patients with advanced heart failure who receive dobutamine do not live longer than those who don't get it.

For these reasons, I think it's most productive to discuss euthanasia in the cases where the doctor is actively taking an action with the intention of bringing about death (i.e.: "Active" euthanasia).

 

[Birdstrike]

Should doctors practice euthanasia?

Euthanasia is illegal in all 50 U.S. states, so, to answer your question, no, doctors should not practice euthanasia.

 

[WilcoWorld]

Euthanasia is illegal in all 50 U.S. states, so, to answer your question, no, doctors should not practice euthanasia

Do you think the law is correct on this issue?

 

[Mount Asclepius]

Physician assisted death is legal though in 11 U.S. jurisdictions.

Could someone more knowledgeable on the subject please elaborate on if there is a substantial difference between euthanasia and physician assisted suicide? I understand there is a distinction upon who is ‘directly in control’ of the dying process. The end outcome seems similar.

 

[WilcoWorld]

Physician assisted death is legal though in 11 U.S. jurisdictions.

Could someone more knowledgeable on the subject please elaborate on if there is a substantial difference between euthanasia and physician assisted suicide? I understand there is a distinction upon who is ‘directly in control’ of the dying process. The end outcome seems similar.

You've identified the practical difference correctly:
Euthanasia - the doctor or nurse administers the lethal drugs
Physician assisted suicide - the doctor advises, but the patient administers the lethal drugs

If you ascribe to consequentialism (the outcome of an action determines the ethics of the action), then there is no difference.
If you ascribe to virtue-based (Aristotelean) or rule-based (deontology) ethics, then there is a significant difference.

 

[thegenius]

Without question there are select people for whom death is a better alternative than life.
Is it sacrosanct to suggest this is true for select patients as well as select criminals / murderers?

One problem I have reconciling a statistic (if I recall correctly) where a very large percentage of people who attempt suicide and fail subsequently are grateful for a second chance at life.

 

[thegenius]

Canada will soon offer doctor-assisted death to the mentally ill. Who should be eligible?

 

[emergentmd]

I assume passive means not doing everything humanly possible to keep someone alive. Absolutely we should allow this but the water is too murky, the line is too gray for any universal agreement.

If someone is on a ventilator and essentially a veggie, who gets dialyzed 3 times a week then I see no issues with stopping dialysis.
if someone is on a ventilator, gets dialyzed but still have a decent quality of life, then no you can not stop dialysis/pull the tube.


Active is a no go.

 

[Angry Birds]

I am opposed to active euthanasia. As for passive euthanasia, it would depend on what is meant (as this term is often used imprecisely).
I am, of course, wholly opposed to physician assisted suicide.

 

[3rdJob]

Folks,

I am a hard 'No' on this one (active euthanasia), because I am not the Almighty and that job is taken. Withdrawal of (in my medical judgement) futile care? Administering medications (sedatives, opiates, etc.) with the primary aim of reducing suffering in such circumstances? Yes. Just my $0.02.

 

[alpinism]

So here’s a real world situation that occurs commonly in many places of the world.

Let’s say there’s a natural disaster that completely overwhelms your hospital.

Let’s say you’ve got limited supplies and have few options for pain medications.

Let’s say you’ve got a critically injured patient with horrible burns that are not compatible with life.

You have two choices:

A. They have a slow and painful death which happens over a few hours.

B. They have a fast and painless death which happens over a few minutes.

Which one are you choosing?

 

[RustedFox]

If we have a right to life, why do we not have a right to death?

 

[Angry Birds]

If we have a right to life, why do we not have a right to death?

Because the exceptional and untrammeled right to human life is rooted in its sanctity, which is what precludes the curtailment thereof.

 

[Angry Birds]

So here’s a real world situation that occurs commonly in many places of the world.

Let’s say there’s a natural disaster that completely overwhelms your hospital.

Let’s say you’ve got limited supplies and have few options for pain medications.

Let’s say you’ve got a critically injured patient with horrible burns that are not compatible with life.

You have two choices:

A. They have a slow and painful death which happens over a few hours.

B. They have a fast and painless death which happens over a few minutes.

Which one are you choosing?

This is a false, unreal, and imaginary choice -- a pure thought experiment with no applicability to the reality. Aggressive pain control and palliative sedation is always an option.

 

[Angry Birds]

Canada will soon offer doctor-assisted death to the mentally ill. Who should be eligible?

The march towards permissiveness in killing is even faster than I imagined. This is nuts. I find my psych patients annoying. Now instead of giving them a Turkey sandwich and an Ativan, I can just kill them. Cool.

 

[dadaddadaBATMAN]

You've identified the practical difference correctly:
Euthanasia - the doctor or nurse administers the lethal drugs
Physician assisted suicide - the doctor advises, but the patient administers the lethal drugs

If you ascribe to consequentialism (the outcome of an action determines the ethics of the action), then there is no difference.
If you ascribe to virtue-based (Aristotelean) or rule-based (deontology) ethics, then there is a significant difference.

To me it is a distinction without a difference. I suppose that puts me in the consequentialism camp.

To those preaching about the sanctity of life, I question whether you are also respecting its dignity or autonomy.

An 85yo aaox0 patient living covered in stool with bed sores in our-mother-of-daily- neglect nursing home is not the same as an 85 yo who is ambulatory and attending her grandaughters wedding.

If the former has a terminal dementia diagnosis anticipated years in advance and makes the choice long before she loses capacity, I don’t understand why you have the right to torture them with the slow descent into madness. I don’t understand why you have the right to inflict that on their children or loved ones.

This isn’t an unrealistic hypothetical, it’s a daily reality we all watch play out. Some would choose to live, some would not. I do think they should have that choice.

 

[To Infinity and Beyond]

If the former has a terminal dementia diagnosis anticipated years in advance and makes the choice long before she loses capacity, I don’t understand why you have the right to torture them with the slow descent into madness. I don’t understand why you have the right to inflict that on their children or loved ones.

The catch here is that at least in those states where assisted suicide is legal, you need to be diagnosed with having no more than six months to live. By the time you reach stage 2 dementia, you're considered to be no longer capable of making decisions. With 7 stages of dementia you'll never be able to legally make that decision for yourself because you're more likely than not to live beyond the six month requirement.

 

[WilcoWorld]

To me it is a distinction without a difference. I suppose that puts me in the consequentialism camp.

To those preaching about the sanctity of life, I question whether you are also respecting its dignity or autonomy.

An 85yo aaox0 patient living covered in stool with bed sores in our-mother-of-daily- neglect nursing home is not the same as an 85 yo who is ambulatory and attending her grandaughters wedding.

If the former has a terminal dementia diagnosis anticipated years in advance and makes the choice long before she loses capacity, I don’t understand why you have the right to torture them with the slow descent into madness. I don’t understand why you have the right to inflict that on their children or loved ones.

This isn’t an unrealistic hypothetical, it’s a daily reality we all watch play out. Some would choose to live, some would not. I do think they should have that choice.

And I don't object to your holding that view. I use "consequentialist" to describe, not to criticize.

As for your hypothetical - there is a third option between "torture" and euthanasia: comfort care and natural death. If her wishes are honored she can be enrolled in hospice and she can be kept comfortable as she dies naturally. The patient you describe is probably not taking PO and will typically die in about 2 weeks if she's not getting artificial nutrition/hydration.

 

[Vandalia]

What happened to the good ol' "slippery slope"?

Every political discussion when I was in high school and college eventually ended up with "the slippery slope."

That is also the reason why my answer to this is "no."

Look at our own profession: "This is a great idea! Let's have these people more trained than nurses and EMT's, but with nowhere near the training of physicians, who can handle the simple stuff like ordering routine lab tests and renewing blood pressure medications. What can go wrong?"

 

[Birdstrike]

Do you think the law is correct on this issue?

Yes

 

[VA Hopeful Dr]

What happened to the good ol' "slippery slope"?

Every political discussion when I was in high school and college eventually ended up with "the slippery slope."

That is also the reason why my answer to this is "no."

Look at our own profession: "This is a great idea! Let's have these people more trained than nurses and EMT's, but with nowhere near the training of physicians, who can handle the simple stuff like ordering routine lab tests and renewing blood pressure medications. What can go wrong?"

Slippery Slope

www.txstate.edu

 

[dadaddadaBATMAN]

And I don't object to your holding that view. I use "consequentialist" to describe, not to criticize.

As for your hypothetical - there is a third option between "torture" and euthanasia: comfort care and natural death. If her wishes are honored she can be enrolled in hospice and she can be kept comfortable as she dies naturally. The patient you describe is probably not taking PO and will typically die in about 2 weeks if she's not getting artificial nutrition/hydration.

I didn’t feel criticized, I was noting that thought process seems like a reasonable approximation of my own.

I appreciate the introduction to several new terms.

And there is a third option. But not everyone wants to reach that stage of existence, even if they do not personally suffer the consequences.

I am not commenting on what I would want for me personally, just observing what others have said even within my own family.

Part of the question of whether or not euthanasia is reasonable is whether a “natural death” is something that has intrinsic value.

Mostly my response was meant to balance what I view as an equally extreme view. As I have said previously, I find this topic a source of personal conflict.

 

[RustedFox]

Because the exceptional and untrammeled right to human life is rooted in its sanctity, which is what precludes the curtailment thereof.

So, the answer is "sanctity".

It's sacred. Because it's sacred.

I think a lot of posters here are forgetting that the person in question in this discussion does not consider their life to be sacred, and prefers death, given whatever their circumstances are.

 

[TrailRun]

This is a false, unreal, and imaginary choice -- a pure thought experiment with no applicability to the reality. Aggressive pain control and palliative sedation is always an option.

Perhaps not entirely, remember this case relating to Hurricane Katrina?

The Case of Dr. Anna Pou: Physician Liability in Emergency Situations

A year after Hurricane Katrina, Dr. Pou was arrested and charged with one count of second-degree murder and nine counts of conspiracy to commit second-degree murder for administering drugs to patients who subsequently died.

journalofethics.ama-assn.org

 

[Nephro critical care]

So, the answer is "sanctity".

It's sacred. Because it's sacred.

I think a lot of posters here are forgetting that the person in question in this discussion does not consider their life to be sacred, and prefers death, given whatever their circumstances are.

I would ask the posters here would they want more fentanyl more benzos for themselves if they knew they were in an end of life situation.

 

[RustedFox]

I would ask the posters here would they want more fentanyl more benzos for themselves if they knew they were in an end of life situation.

I'll take it one step further.

Patient develops ALS.
Patient is of sound mind.
Patient doesn't want to live like this.
Patient has right to life , so they can't seek assistance in death?
Confusedpikachu.gif

 

[Apollyon]

I don't know how many of y'all are familiar with "Johnny Got His Gun". That was a book by Dalton Trumbo, but was based on a real case. In the book, the protagonist has been blown up in war, so he has no face, is blind, deaf, has no arms or legs, can't talk - but is alive. It deals with euthanasia. If you've seen the video for "One", by Metallica, they used footage from the 1971 movie version in it.

Alternately, there are the people "locked in", after basilar artery thrombosis. They blink out, in Morse code, "kill me".

 

[WilcoWorld]

I don't know how many of y'all are familiar with "Johnny Got His Gun". That was a book by Dalton Trumbo, but was based on a real case. In the book, the protagonist has been blown up in war, so he has no face, is blind, deaf, has no arms or legs, can't talk - but is alive. It deals with euthanasia. If you've seen the video for "One", by Metallica, they used footage from the 1971 movie version in it.

Alternately, there are the people "locked in", after basilar artery thrombosis. They blink out, in Morse code, "kill me".

darkness, imprisoning me, all that I see, absolute horror...trapped in myself

 

[WilcoWorld]

I

I'll take it one step further.

Patient develops ALS.
Patient is of sound mind.
Patient doesn't want to live like this.
Patient has right to life , so they can't seek assistance in death?
Confusedpikachu.gif

The case that touches me the most was a friend of my parents. She was a very proper woman - a socialite who was always perfectly put together - and she talked to me like an adult from as early as I can remember, which led to my having a great affection for her.

She developed gradually progressive MS and lost her abilities slowly over decades, eventually losing her sense of dignity. After multiple failed suicide attempts in the US, her husband took her abroad for euthanasia and she died in peace.

Still, I'm not sure if I would want to practice euthanasia. I don't think I want it to be illegal, but I'm not sure I want to practice it. Not because I'm afraid of a slippery slope, but because I worry that if I practiced euthanasia it might undermine the confidence patients and families put in me when they submit to my care.

For me, it's complicated.

 

[Birdstrike]

I don't know how many of y'all are familiar with "Johnny Got His Gun". That was a book by Dalton Trumbo, but was based on a real case. In the book, the protagonist has been blown up in war, so he has no face, is blind, deaf, has no arms or legs, can't talk - but is alive. It deals with euthanasia. If you've seen the video for "One", by Metallica, they used footage from the 1971 movie version in it.

Alternately, there are the people "locked in", after basilar artery thrombosis. They blink out, in Morse code, "kill me".

I saw Metallica live circa ’89/‘90. One, was their first video. When the video came out, of course I had to go out and rent the movie. The movie wasn’t very good, but the song and video, were great.

Never in a million years did I imagine I’d be discussing it 30 years later on a medical discussion website. In fact, back then, no “website” even existed, yet.

Dr. Kevorkian existed though, and was already assisting in the suicides of his eventual 130 patients with his homemade “euthanasia” contraptions. He eventually was convicted of murder, although it took almost a decade for any of the charges to stick.

 

[Angry Birds]

If the former has a terminal dementia diagnosis anticipated years in advance and makes the choice long before she loses capacity, I don’t understand why you have the right to torture them with the slow descent into madness. I don’t understand why you have the right to inflict that on their children or loved ones.

I think this is very telling and explains the real impetus for the descent into this dystopian future complete with suicide pods.
The emphasis in the modern world is on consent and one's own rights as opposed to sanctity and duty.
Your parents changed your diapers for at least two years; best to kill them when you have to do the same.

 

[CajunMedic]

This is a false, unreal, and imaginary choice -- a pure thought experiment with no applicability to the reality. Aggressive pain control and palliative sedation is always an option.

Perhaps not entirely, remember this case relating to Hurricane Katrina?

The Case of Dr. Anna Pou: Physician Liability in Emergency Situations

A year after Hurricane Katrina, Dr. Pou was arrested and charged with one count of second-degree murder and nine counts of conspiracy to commit second-degree murder for administering drugs to patients who subsequently died.

journalofethics.ama-assn.org

This was actually my first thought when I read the original post. The book "Five Days at Memorial" talks about it in great detail. I know I struggled with the decisions I had to make as a medic triaging people at I-10/Causeway Blvd in Metairie for many years afterwards. I can't imagine the decisions Dr. Pou and others had to make.

To answer the original question: Yes. It may be a terrible comparison, but why do we not let our pets suffer at end of life? But 94 y/o demented, bed-bound papaw getting ex-lapped for dead gut and dying miserably in the ICU is OK? I have absolutely no qualms about terminal extubation, futile care, comfort care, etc. I've had at least 2 patients make themselves comfort care and die several hours later on my ICU rotations.

When it comes to patients choice, in cases like ALS, Alzheimer's, etc. I think there would have to be some kind of special training or licensing to have the ability to perform or prescribe the medications, as well as some kind of cross-checking to ensure it's appropriateness. i.e Belgium or Japan.

 

[Angry Birds]

What happened to the good ol' "slippery slope"

I think you are right. The slippery slope is not pure hypothetical. Not only do we see the slip already -- who would have thought that it would get to killing mentally ill people and schizophrenics?? -- but the slip is actually inbuilt in the very logic of the arguments raised to justify the practice to begin with. In other words, the very reason that people here are quoting Hurricane Katrina, third world village, etc. -- i.e. extreme outliers -- is precisely in order to then slide and justify the same in the less extreme situation.

This is what people used to justify torture: create an extremely unlikely or rare situation (a bomber being interrogated and there is 1 hour left before the bomb goes off) in order to then justify torture so that it can then be used in a much wider context.

That is the very purpose of the justification. People here justifying it through Hurricane Katrina aren't actually using the argument to justify its use in a natural disaster like this, but rather, to use it on demented ole' grandma who is annoying family with her diaper changes ... which is why that is the case we should actually be discussing.

So, the answer is "sanctity".

It's sacred. Because it's sacred.

I think a lot of posters here are forgetting that the person in question in this discussion does not consider their life to be sacred, and prefers death, given whatever their circumstances are.

The sanctity of the person's life is not rooted in their personal consideration thereof (otherwise, what do we say about someone with no mental capacity at all, i.e. the mentally challenged*?); the sanctity is rooted in a very long tradition of human civilization and history, even transcendental in/above the moral/social fabric of society or the universe, if not even above that. It's the very basis of our tradition of medicine, which we took an oath to uphold. But, yes, let's jettison all that for expediency, materialism, and capitalism. We need the bed.

* Of course, the slip will very soon include them as well and already does in at least one way.

 

[Angry Birds]

To answer the original question: Yes. It may be a terrible comparison, but why do we not let our pets suffer at end of life? But 94 y/o demented, bed-bound papaw getting ex-lapped for dead gut and dying miserably in the ICU is OK? I have absolutely no qualms about terminal extubation, futile care, comfort care, etc. I've had at least 2 patients make themselves comfort care and die several hours later on my ICU rotations.

The reason we jump to euthanasia so quickly for pets is precisely because their lives are not considered equally sacrosanct-- rather, they are expendable. Most often it is the case that a financial calculus is being made, whereby the cost of treatment is considered too onerous so that it's just better to euthanize the animal. I'd probably pay $5,000 to save my dog's life... but definitely not $50,000.

This comparison is actually what should reinforce in our minds the need to protect the exceptionality of human existence, which, unfortunately, is quickly being eroded.

 

[Vandalia]

Slippery Slope

www.txstate.edu

The problem is that once we remove all the formal logical fallacies from medicine, there is not much left.

 

[Birdstrike]

Just think of all the shady, unethical, abusive behavior and malfeasance you’ve seen as a physician, by other physicians. It’s staggering when I look back through my career and training. Now imagine those same egotists licensed to kill, with a profit motive, to boot. Add in corporate driven medicine and way too much could go wrong.

I think physicians should have to power to safe a life and ease suffering. What patients do with their own lives, is their choice. But the goal of a physician should never be to kill.

 

[Angry Birds]

The problem is that once we remove all the formal logical fallacies from medicine, there is not much left.

"Slippery slope. A slippery slope argument is not always a fallacy...There are a variety of ways to turn a slippery slope fallacy into a valid (or at least plausible) argument. All you need to do is provide some reason why the adoption of one policy will lead to the adoption of another..."
Logical Fallacies and the Art of Debate

 

[Tenk]

If you’ve ever extubated someone to die and pushed morphine and/or benzos then you’ve euthanized someone.

You can do whatever mental gymnastics you need to help you sleep better at night but you definitely “put a living being to death humanely” which is the definition of euthanasia. Nothing wrong with it, we should probably do a lot more of it in the right situation.

 

[thegenius]

The sanctity of the person's life is not rooted in their personal consideration thereof (otherwise, what do we say about someone with no mental capacity at all, i.e. the mentally challenged*?); (1) the sanctity is rooted in a very long tradition of human civilization and history, (2) even transcendental in/above the moral/social fabric of society or the universe, if not even above that. It's the very basis of our tradition of medicine, which we took an oath to uphold. (3) But, yes, let's jettison all that for expediency, materialism, and capitalism. We need the bed.

1) that's pretty hard to verify...maybe we could go back hundreds of years, but certainly not thousands of years, to prove your point. Your viewpoint to me seems basically purely rooted in religious beliefs.\
2) Uhhh....this seems out beyond left field for me. It's just not the case.
3) I think you are a better person than this. First you write that a concept might be transcendental above the fabric of our universe, and then you write about others who want to jettison it to save some money. I mean c'mon. You don't have to belittle others who don't believe the way you do like this (and I'm not hatin' on ya I think you are an outstanding member of this forum.)

 

[WilcoWorld]

Your parents changed your diapers for at least two years; best to kill them when you have to do the same.

I also want to respect my elders. For me it is an enriching part of life.

If my parents ask that I stop doing invasive things to their bodies, and to instead take very good care of them in their home - including giving pain meds if they are in pain, but not forcing nutrition on them with a G tube. Hopefully driving them to IHOP, but maybe turning them in bed while giving liquid morphine drops if they seem to be struggling for breath...

That is different from euthanasia - no?

 

[dadaddadaBATMAN]

I think this is very telling and explains the real impetus for the descent into this dystopian future complete with suicide pods.
The emphasis in the modern world is on consent and one's own rights as opposed to sanctity and duty.
Your parents changed your diapers for at least two years; best to kill them when you have to do the same.

Fascinating misinterpretation. The “themself” I mentioned was meant to refer to the patient. I don’t think you have the right to make decisions for the patient if they feel dying slowly of dementia, als, etc over ten years is not how they want to die.

When I change my child’s diaper I’m not doing it as a quid pro quo. Are you? That’s pretty messed up. I chose to bring my children into this world. They don’t owe me a thing, it is the greatest joy of my life to care for them.

I don’t plan to take care of my parents because it’s a duty, but because I love them. I will happily keep them in my home till their dying breaths. And if they tell me they would rather die than continue living as they are, I will respect that too.

Are you capable of making an argument without a circular base (life is sacred, because it’s always sacred, because it was sacred) or a baseless attack on someone’s character?

Just think of all the shady, unethical, abusive behavior and malfeasance you’ve seen as a physician, by other physicians. It’s staggering when I look back through my career and training. Now imagine those same egotists licensed to kill, with a profit motive, to boot. Add in corporate driven medicine and way too much could go wrong.

I think physicians should have to power to safe a life and ease suffering. What patients do with their own lives, is their choice. But the goal of a physician should never be to kill.

I think of the patients I saw at the va who lived in an unchanging dementia ward while the families lived off their benefits and never so much as visited.

Regardless, the person I would want this to be available to would be the one with capacity to make their own decisions.

It absolutely comes with logistical and other hazards. A few years ago I remember reading on a European country (Denmark? Can’t remember) who passed “right to die” legislation. They naturally found families who had coerced loved ones for an inheritance, or got the demented relative to sign papers etc.

whether it can be practically implemented is a separate question from whether it can be justified.

 

[WilcoWorld]

"Slippery slope. A slippery slope argument is not always a fallacy...There are a variety of ways to turn a slippery slope fallacy into a valid (or at least plausible) argument. All you need to do is provide some reason why the adoption of one policy will lead to the adoption of another..."
Logical Fallacies and the Art of Debate

Agreed. @Vandalia was right to point out that The Slippery Slope argument is most often a fallacy while/and @Angry Birds is right to point out that it is not invalid IF and WHEN the the sequence of causes is explicitly explained.

 

[deleted1114045]

My opinion, based on sanctity of life and the Hippocratic oath that I took as a medical student, is that it is unethical for doctors to participate in euthanasia.

It is cowardly for patients to demand that physicians kill them when they themselves have the ability and the means, but refuse to chance pain or suffering in the effort.

The fact that assisted suicide is legal in many states I think is logically and ethically inconsistent.

The repercussions are vast regarding our current psychiatric practice.

As was pointed out above, if physical suffering is a reasonable reason to kill oneself, then why not emotional or psychiatric pain? We have prioritized suicidality above the triage level of many medical complaints.

I was in a patient’s room when he pulled a knife and held it to his arm. I stupidly grabbed his arm. I knew he was just intent on causing a scene rather than actually having a real intent to hurt himself or me. But, what are my legal/moral obligations as I’m sitting at that idiot’s bedside? Am I legally/ethically obligated to stop him from hurting himself? Am I ethically obligated to tell security to restrain him, putting their lives at risk? Are we obligated to stun-gun him? Why? Is it better for us to assault him, than for him to assault himself? Is the life of a security guard less important than his? Does his status as a patient make him protected and thus, more valuable than a security guards?

We have gone overboard in physically restraining/assaulting /chemically restraining people in an effort to keep them from hurting themselves. We show up to people’s house because they post suicidalish statements on social media, and haul them to the ER. How is that compatible with a world where they could call a suicide service the next day and get themselves legally murdered?

Maybe that would be a silver lining to this cloud. We could revert to a situation where we are legally obligated to help those who want help, rather than be held hostage by people who have no humility or drive to change anything about themselves. Rather than let patients stare at the wall indefinitely until they stop saying the “S” word, we could start SSRIs on those not on meds, and offer some words of advice on life changes that would make them happier. We could send them on their way with a referral to a psychiatrist and a therapist and say “good luck.”

Perhaps this trend would allow society to accept the truth they refuse to acknowledge so often: YOU CAN’T HELP THOSE WHO DON’T WANT TO HELP THEMSELVES!

 

[thegenius]

I think physicians should have to power to safe a life and ease suffering. What patients do with their own lives, is their choice. But the goal of a physician should never be to kill.

I think if Hippocrates were alive now and witnessed how medicine has changed his Hippocratic Oath would have modifications.

Imagine he saw a typical ICU patient today:

Hippocrates: "What is this tube in the patients mouth?"
Birdstrike: "Oh father of medicine...that is a breathing tube. The patient's lungs do not work so we use a machine to do his breathing."

Hippocrates: "A machine? What is a machine? Uh.....and what is this hard device in his chest wall?"
Birdstrike: "Oh great father of medicine....you once espoused do no harm. When this patient had a fluttering, non-functional heart due to daily illicit drug use for 6 years, all the great minds of this hospital convened and decided that there would be more harm if we let this guy die...so we put a metallic machine in his chest that will fix his fluttering heart."

Hippocrates: "Another machine? What is a MACHINE? And...Uh...what are these bulging veins in his arm for? And why are there more tubes coming out of them?"
Birdstrike: "Oh grand father of medicine...and you just might be a superlative father. We adore you and have memorized your speeches too. When this patients heart stopped working...his kidneys stopped working as well. But we have this great machine that can replace his kidneys! All he has to do is hook up to his machine 3 times a week for 3 hours and detoxify. He can't live without it, but as long as he complies with treatment he can live a few more years."

Hippocrates: "HEY! WHAT IS A F*&ING MACHINE? Hey! Wait a minute....why does this guy have another machine on the side of his back and a tube coming out above his bellybutton?"
Birdstrike: "Oh you will love this my beloved Doctor. We literally implemented your oath and found a way to feed this patient! You see...with a dysfunctional, gastroparetic stomach he couldn't eat that well. And now he has a tube in his mouth to breath. So we hook him up to a machine and feed him twice a day directly into his stomach! And that other machine on the side of his body stimulates his stomach to contract. You see...his stomach is dead and needs a little coaxing to live."

Hippocrates: "ARE YOU F*&CKING with me? This guy is hooked up to 5 machines and you won't even tell me what a machine is. So his lungs, heart, stomach, esophagus, and kidneys don't work. Interesting this guy doesn't have any toes either. Was he born that way? Or were they chopped off?"
Birdstrike: "Dr. Hippocrates. We decided to prolong his life by amputating his fetid, ghoulish, pus-ridden toes."

Hippocrates: "Dear Zeus that sounds horrible and probably smelled disgusting. Well surely you are giving him medicine to help ease his suffering, right?"
Birdstrike: "My dearest of dear beloved Doctor, you are my hero. I have provided him with 24 medicines to help prolong his life. He just might make it. Have you heard of fentanyl, midazolam, norepinephrine, vasopressin, vancomycin, meropenem, sodium chloride 0.9%, heparin gtt, pantoprazole, albuterol, ipratropium, carvedilol, digoxin, insulin gtt, colac....."

Hippocrates: "STOP! You lost me at phantomol. I never heard of any of these herbs. Surely he can at least pop a stiffy on his own?"
Birdstrike: "Oh....there is one more machine for that...."






I can't imagine Hippocrates 100% endorsing everything we do in today's world as a means to help people. If he had to write the oath today I think it would be different.

 

[Angry Birds]

I think if Hippocrates were alive now and witnessed how medicine has changed his Hippocratic Oath would have modifications.

Imagine he saw a typical ICU patient today:

Hippocrates: "What is this tube in the patients mouth?"
Birdstrike: "Oh father of medicine...that is a breathing tube. The patient's lungs do not work so we use a machine to do his breathing."

Hippocrates: "A machine? What is a machine? Uh.....and what is this hard device in his chest wall?"
Birdstrike: "Of great father of medicine....you once espoused do no harm. When this patient had a fluttering, non-functional heart due to daily illicit drug use for 6 years, all the great minds of this hospital convened and decided that there would be more harm if we let this guy die...so we put a metallic machine in his chest that will fix his fluttering heart."

Hippocrates: "Another machine? What is a MACHINE? And...Uh...what are these bulging veins in his arm for? And why are there more tubes coming out of them?"
Birdstrike: "Oh grand father of medicine...and you just might be a superlative father. We adore you and have memorized your speeches too. When this patients heart stopped working...his kidneys stopped working as well. But we have this great machine that can replace his kidneys! All he has to do is hook up to his machine 3 times a week for 3 hours and detoxify. He can't live without it, but as long as he complies with treatment he can live a few more years."

Hippocrates: "HEY! WHAT IS A F*&ING MACHINE? Hey! Wait a minute....why does this guy have another machine on the side of his back and a tube coming out above his bellybutton?"
Birdstrike: "Oh you will love this my beloved Doctor. We literally implemented your oath and found a way to feed this patient! You see...with a dysfunctional, gastroparetic stomach he couldn't eat that well. And now he has a tube in his mouth to breath. So we hook him up to a machine and feed him twice a day directly into his stomach! And that other machine on the side of his body stimulates his stomach to contract. You see...his stomach is dead and needs a little coaxing to live."

Hippocrates: "ARE YOU F*&CKING with me? This guy is hooked up to 5 machines and you won't even tell me what a machine is. So his lungs, heart, stomach, esophagus, and kidneys don't work. Interesting this guy doesn't have any toes either. Was he born that way? Or were they chopped off?"
Birdstrike: "Dr. Hippocrates. We decided to prolong his life by amputating his fetid, ghoulish, pus-ridden toes."

Hippocrates: "Dear Zeus that sounds horrible and probably smelled disgusting. "Well surely you are giving him medicine to help ease his suffering, right?"
Birdstrike: "My dearest of dear beloved Doctor, you are my hero. I have provided him with 24 medicines to help prolong his life. He just might make it. Have you heard of fentanyl, midazolam, norepinephrine, vasopressin, vancomycin, meropenem, sodium chloride 0.9%, heparin gtt, pantoprazole, albuterol, ipratropium, carvedilol, digoxin, insulin gtt, colac....."

Hippocrates: "STOP! You lose me at phantomol. I never heard of any of these herbs. Surely he can at least pop a stiffy on his own?"
Birdstrike: "Oh....there is one more machine in his body for that...."






I can't imagine Hippocrates 100% endorsing everything we do in today's world as a means to help people. If he had to write the oath today I think it would be different.

What Hippocrates thought or did is largely irrelevant.

 

[Angry Birds]

If you’ve ever extubated someone to die and pushed morphine and/or benzos then you’ve euthanized someone.

You can do whatever mental gymnastics you need to help you sleep better at night but you definitely “put a living being to death humanely” which is the definition of euthanasia. Nothing wrong with it, we should probably do a lot more of it in the right situation.

The question is not what is being done but rather what ought to be done. The current cavalier practice is rooted in the very trend that is being criticized.

1) that's pretty hard to verify...maybe we could go back hundreds of years, but certainly not thousands of years, to prove your point. Your viewpoint to me seems basically purely rooted in religious beliefs.\
2) Uhhh....this seems out beyond left field for me. It's just not the case.
3) I think you are a better person than this. First you write that a concept might be transcendental above the fabric of our universe, and then you write about others who want to jettison it to save some money. I mean c'mon. You don't have to belittle others who don't believe the way you do like this (and I'm not hatin' on ya I think you are an outstanding member of this forum.)

1) The sanctity of human life -- and the concern for maintaining human exceptionality -- was indeed historically rooted in theological premises. So too is the entire idea of human rights in the modern period. This is the basis upon which John Locke, the father of liberalism, justified basic human equality, upon which our entire Western system is based. One does not need to be religious in order to uphold this starting premise, although it certainly helps. Jeremy Waldron has attempted to build a secular bridge to attain the same result: See One Another’s Equals: The Basis of Human Equality.

3) I am not at all trying to insult anyone on this esteemed board. I am simply saying that the recent push and march towards embracing physician assisted suicide is not unconnected to a materialist and capitalistic worldview: these gomers lose their utility and therefore ought to be taken behind the barn and shot. Or, rather, they should be convinced to shoot themselves.

I also want to respect my elders. For me it is an enriching part of life.

If my parents ask that I stop doing invasive things to their bodies, and to instead take very good care of them in their home - including giving pain meds if they are in pain, but not forcing nutrition on them with a G tube. Hopefully driving them to IHOP, but maybe turning them in bed while giving liquid morphine drops if they seem to be struggling for breath...

That is different from euthanasia - no?

Yes, I agree with you. However, I think we need to also need to create and foster a culture of life and duty instead of one that prioritizes the young and virile, abandoning the old, weak, and decrepit. We literally call them GOMERs. They waste a bed in our ER... better if they just die or go back to the nursing home that they've been dumped in by their ungrateful children.

There is great honor and nobility in caring for one's elderly parents. Filial piety is a virtue that ought to be restored. Nursing homes and euthanasia are not the solution.

I should state clearly that there are indeed times in which nursing homes need to be used. One cannot generalize across the board... But yeah, one of the things that has shocked me as an ER doctor is how many old people rot away in nursing homes or all alone, with nary a responsible child in sight.