Should Doctors Practice Euthanasia?

[Southpaw]

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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.

They changed my diapers knowing I would grow and mature into an adult with a future. The exact opposite is occuring if you change your parents diaper. It won't improve. It'll get worse with time. And there's a decent likelihood your parent never wanted that to begin with. If however, a discussion was had and both you and your parent knew what was coming and welcome it, then fine. However, most often what happens is the parents goes to rot in a nursing home until they finally succumb to illness.

 

[Southpaw]

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.

I agree it's wonderful to care for an elderly parent, IF they are of sound mind and body and can still enjoy life. To make it personal, I have no interest in being a burden to my children. I want them to live happy lives and my spouse and I want to be part of those lives. However, if and when I get to the point where I can no longer enjoy life, and I require the help of others for the basic functions of life, and there is no hope of that ever reversing course, then please respect MY WISHES and let me die.

My guess is there are millions who agree with my thought process. And my guess is there are countless millions who've wasted away in ICUs and nursing homes with their life prolonged only by machines and modern medicine, who never wanted that.

I think when it comes to death, we have lost our way.

 

[Southpaw]

my belief is that if you respect life you must respect death (which is a natural part of life - we will all die). if a person has a terminal illness and wishes death for themself then societally speaking, we need to be okay with that. euthanasia is legal is many countries and as far as I can tell the zombies haven't taken over because of some slippery slope.

 

[dadaddadaBATMAN]

My man, you wrote, "I don’t understand why you have the right to inflict that on their children or loved ones."


Certainly I agree with you here, which is why virtually no religious, moralistic, or cultural text on earth has ever needed to stress the duty to children, since this is innate (although even this is being tested nowadays). Instead, it is filial piety that needs to be stressed since this is where there is often dereliction.

My statement was rhetorical and not meant as an actual quid pro quo. It was meant to say that we need a cultural change instead of thinking it's normal to have parents just dumped in nursing homes or dying alone.


I have zero doubt about your own sense of honor and love towards your parents. My statements were never meant to be a personal attack on you.


Where exactly is the circular argument that you see?
Do you really think I have made an argument anywhere that "life is sacred because it is sacred"?
Rather, I have simply presented the long-held belief that human life is equal, sacred, and exceptional. The way one reaches this view is another debate altogether. I've already referred above to a good philosophical book on the topic if you're interested.


I think we can agree here that this sort of abuse of elderly parents is indeed deeply disturbing.


There are two counter-arguments here. But the second one is indeed that such safeguards will fail and that the march will continue, i.e. slippery slope. That is exactly what we are witnessing. And it's not a surprise, coincidence, or mystery why. The underlying logic cannot sustain the obvious corollary. That is to say, it is very difficult to restrict this option to the subset you may want to limit it to without someone coming along and arguing that you have no solid legal, moral, or philosophical reason to exclude the categories you have excluded.

I was including their children and loved ones because I do not think thats an irrelevant consideration, though the greatest harm is perpetrated against the patient. The misinterpretation was regarding the bolded themselves, but I can see where you’re coming from, it was not the clearest bit of writing.

If you’re drawing on philosophy as a support I would reference you to the stoics, like Marcus Aurelius. He repeatedly references how shameful it is to cling to life long after one is capable of fulfilling ones duty towards society and other people. He would have cited this as “unnatural” because all natural processes moved towards harmony and order of society, and ones contribution towards them.

My point is that the value of the sanctity of life above all other things is not a long standing thing. Artificially sustaining life after people’s minds have decayed is absolutely wrong in my book. I respect others right to do so, but disagree with the decision.

As for the last, there are plenty of justifications for not allowing blanket access to killing those without capacity. They are obviously uniquely vulnerable. It’s why we call aps for geriatric abuse or abuse of a patient with mrdd but not domestic violence.

I agree the implementation would have a lot of problems. I don’t think that our current solution is much better.

Edit: some interesting auto corrects and fat thumb changes on re-read

 

[WilcoWorld]

There is great honor and nobility in caring for one's elderly parents. Filial piety is a virtue that ought to be restored.

Agreed - filial honor is not just good for the aged. It also benefits the young. I see it routinely: those who care for their elders lead more fulfilling lives (though often more challenging) themselves.

I also think that there's not one single best way to honor our elders. Rather, there are as many ways to honor our elders as there are elders.

 

[WilcoWorld]

I think that if one wants to appeal to the sanctity of life, one should start by defining life. In my opinion, a beating heart is not a sufficient condition for life. Heck, with ECMO it's not even a necessary condition!

In my opinion "life" requires some interpersonal component. One who is completely isolated from all others, be it by disease or other means, is not alive in my book.

 

[Angry Birds]

(1) They changed my diapers knowing I would grow and mature into an adult with a future. The exact opposite is occuring if you change your parents diaper. It won't improve. It'll get worse with time.

(2) And there's a decent likelihood your parent never wanted that to begin with. If however, a discussion was had and both you and your parent knew what was coming and welcome it, then fine.

(3) However, most often what happens is the parents goes to rot in a nursing home until they finally succumb to illness.

(1) No, parents change diapers of a sickly, dying, handicapped, mentally challenged, etc. child... no questions asked. Parents will give their kidneys to their kids, their beating heart if they needed to. I agree with you if you say that this is changing a bit in the modern West, but it is still an innate part of our nature.

(2) I disagree. Most people say one thing before calamity strikes them, but we know that they most often say another when it actually does. The will to live is strong and cannot be gauged by what someone says years before such an event... especially when someone says this in a society that does not value elderly parents and the aged, considering them disposable. It is this very culture that I am challenging. Law/policy drives public opinion as much as the other way around. Our values are embedded in the laws just as the laws help dictate them. It's a dialectic.

(3) Yes, we agree here. 🙂

 

[Angry Birds]

I think that if one wants to appeal to the sanctity of life, one should start by defining life. In my opinion, a beating heart is not a sufficient condition for life. Heck, with ECMO it's not even a necessary condition!

In my opinion "life" requires some interpersonal component. One who is completely isolated from all others, be it by disease or other means, is not alive in my book.

This is morally and philosophically problematic but I don't want to divert the conversation.

 

[Birdstrike]

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.

You win the thread.

 

[WilcoWorld]

This is morally and philosophically problematic but I don't want to divert the conversation.

It most certainly is problematic - if you're interested in exploring an analysis of the view this is a good book.

How do you define life?

 

[Apollyon]

One who is completely isolated from all others, be it by disease or other means, is not alive in my book.

What about a hermit? Or avoidant PD?

 

[battie]

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.

I'm an ER veterinarian that cruises this sub-forum occasionally to see what human ER docs handle since your medicine can be drastically different in some ways to mine.

Someone mentioned how we allow animals a peaceful death with euthanasia, and I find it to be *the most important part of my job*. Whether it's due to a chronic illness that the animal *and* the owner can't handle any longer, or an acute crisis with a poor to grave prognosis, the way I handle death makes a huge impact for the dying animal and the humans left behind. All the gifts I've ever received from clients have been because of how I handled the euthanasia of their beloved pet. And I am in an affluent area of a metro suburb; approximately 80%+ of my euthanasias ate based solely on quality of life/welfare concerns as my clientele can easily devote approximately 5-8k on treatment in the short term (up to a week), and 10k+ if given a few days to move money around.

As someone who performs an average of 5-7 euthanasias per 10 hour shift, and someone whose younger sister committed suicide at the age of 23, it is absolutely not cowardly to ask for a peaceful death. I would much rather have any individual be sedated with propofol and then an overdose of pentobarbitol (my euthanasia protocol), and basically experience falling asleep, then attempt to kill themselves (or in my profession, kill their pet). My worst nightmares are of my sister's last hours being filled with mental, emotional, and physical suffering as she prepared for and experienced her death. She was thorough in her description of her emotions in the build up to the final moment. Likewise, I *always* tell owners what level of suffering to expect in whatever pathology is occurring. If suffering cannot be mitigated by treatment, then euthanasia is absolutely a viable option. This applies not just to the critical individual, but also to the individuals left behind. I don't think people outside of medicine realize how much some clients struggle to euthanize their pets; one client this week described her 20.5 year old cat as her "purpose in life" and we initiated a welfare check on her in the days following the death of her cat. Pets are becoming child-like to a lot of people with deep emotional attachments. The more clients I meet, the more I'm convinced that people care about their pets more than they care about some family members (myself included).

I will also say that which individuals should go through euthanasia is a difficult and personal decision for the individual and the doctor. I've denied euthanasia on a few cases, and have performed behavioral euthanasia (dog with human attack history, including an attack on me). Most euthanasias are easy to emotionally detach from because it is the appropriate decision for that individual; there have been several (6 week old puppy in septic shock and a 12 year old dog with severe dementia come to mind immediately) where I cried with the family, despite the appropriateness of the decision. With human sentience, I'm all for road blocks to prevent "convenience euthanasias" as we call them in vet med. And I absolutely do not think any doctor (human or vet med) should be forced to perform/facilitate a euthanasia by any means. But if there's ever a point where I have a terminal illness and am lucid, I hope I can be given the dignity I have given animals and die peacefully.

It's easy to have a black and white opinion about the nuances of the decision when one has never had the experience of purposely killing another living being. There's lots of grey when one is holding the pentobarbitol and you get to sleep with that decision at night.

 

[Franzd'Epinay]

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.

Aren't you doing the exact same thing, just in reverse? i.e., in an attempt to discourage the common event, you dismiss the rare--though still real--event.

If I ever am the victim in one of those extreme-outlier cases you mention, I sure do hope my pleas for relief aren't trumped by "well, lazy millennials don't want to change grandma's diapers, so you better suffer for the greater good."

 

[WilcoWorld]

What about a hermit? Or avoidant PD?

Or a meditating ascetic?

The thing is these folks still have some connection to the outside world, albeit much less than you or I.

The avoidant PD still gets groceries delivered. The off-the-grid hermit uses survival techniques learned from Christopher McCandless (or hopefully someone more successful). The ascetic in the cave still contemplates the words of the Buddha. In these ways, they remain connected to humanity.

To be truly isolated is a very difficult (perhaps impossible?) thing.

 

[Apollyon]

Or a meditating ascetic?

The thing is these folks still have some connection to the outside world, albeit much less than you or I.

The avoidant PD still gets groceries delivered. The off-the-grid hermit uses survival techniques learned from Christopher McCandless (or hopefully someone more successful). The ascetic in the cave still contemplates the words of the Buddha. In these ways, they remain connected to humanity.

To be truly isolated is a very difficult (perhaps impossible?) thing.

"The mind is it's own place
And in itself
Can make a heaven of hell
A hell of heaven"

 

[emergentmd]

I waver back and forth alot on this. What I hold steadfast is always do what you would want others to do to you.

If I were bedbound with a low quality of life, and being kept alive by a feeding tube vs dialysis machine vs ventilator then pull it ASAP. That is what I want and to keep me alive to live a demeaning existent is abusing me.

If a patient clearly of sound mind states that they do not want to be attached to a machine to live, then it is their right.

If a patient is not clear about his/her intentions, then this is the Gray area that I do not have the answer to.

 

[To Infinity and Beyond]

Even if you explicitly discuss your wishes ahead of time, you're at the mercy of your POA.

 

[WilcoWorld]

Even if you explicitly discuss your wishes ahead of time, you're at the mercy of your POA.

Not if you have a valid POLST.

 

[WilcoWorld]

I waver back and forth alot on this. What I hold steadfast is always do what you would want others to do to you.

If I were bedbound with a low quality of life, and being kept alive by a feeding tube vs dialysis machine vs ventilator then pull it ASAP. That is what I want and to keep me alive to live a demeaning existent is abusing me.

If a patient clearly of sound mind states that they do not want to be attached to a machine to live, then it is their right.

If a patient is not clear about his/her intentions, then this is the Gray area that I do not have the answer to.

I agree with you. That said, I do not consider discontinuing dialysis and artificial nutrition as euthanasia. I recognize that some disagree with me on this point, but the fact is that discontinuing dialysis and artificial nutrition is legal in all 50 US states (as of April 12, 2022, anyway).

 

[battie]

People whose existence in life is devoted to their cat’s should be placed on Zyprexa. Cats are only useful as dog food or as a useful addition to a barn for rodent control. One thing is for sure, that cat didn’t give a crap about that animal owner. It would’ve feasted on her corpse, crapped on her head and never thought twice about it. My good friend is a vet. He says his favorite activity at work is to put cats to sleep as he hates them so much.

To each their own. There's lots of background information you don't know about this client, of which you're making assumptions. There a many people out there with significant mental health concerns where their pet is the reason they're alive. They know the pet needs them, and so they do not commit suicide for the sake of their pet. Substitute a dog for the cat and the anecdote still stands.

The human-animal bond is quite powerful; humans as a species would not be where we are without our domestic (and frankly non-domestic species). They all deserve our respect as we have used them to advanced ourselves both to their benefit and their detriment.

As for if the cat cared about the owner, the cat had significantly advanced disease and dementia. The cat didn't know who he was to be honest. Likewise, your assertion shows your lacking knowledge in animal behavior. Your friend should ideally take a step back and assess their mental health. There are plenty of species I strongly dislike; I still would not take joy in ending an individual's life simply because they are off those species.

Moreover, you commented on one specific anecdote within my overall point, rather than making a substantive argument for/against euthanasia in humans. When we say, "do no harm", does that not include not wishing harm upon our patients? You claim human patients are cowardly for asking for medical assistance in death and that they need to risk failure and suffering of an attempted suicide. Why is it noble of me to be able to euthanize an animal to avoid suffering, but cowardly of a human to ask the same?

 

[Angry Birds]

I'm an ER veterinarian that cruises this sub-forum occasionally to see what human ER docs handle since your medicine can be drastically different in some ways to mine.

Someone mentioned how we allow animals a peaceful death with euthanasia, and I find it to be *the most important part of my job*. Whether it's due to a chronic illness that the animal *and* the owner can't handle any longer, or an acute crisis with a poor to grave prognosis, the way I handle death makes a huge impact for the dying animal and the humans left behind. All the gifts I've ever received from clients have been because of how I handled the euthanasia of their beloved pet. And I am in an affluent area of a metro suburb; approximately 80%+ of my euthanasias ate based solely on quality of life/welfare concerns as my clientele can easily devote approximately 5-8k on treatment in the short term (up to a week), and 10k+ if given a few days to move money around.

As someone who performs an average of 5-7 euthanasias per 10 hour shift, and someone whose younger sister committed suicide at the age of 23, it is absolutely not cowardly to ask for a peaceful death. I would much rather have any individual be sedated with propofol and then an overdose of pentobarbitol (my euthanasia protocol), and basically experience falling asleep, then attempt to kill themselves (or in my profession, kill their pet). My worst nightmares are of my sister's last hours being filled with mental, emotional, and physical suffering as she prepared for and experienced her death. She was thorough in her description of her emotions in the build up to the final moment. Likewise, I *always* tell owners what level of suffering to expect in whatever pathology is occurring. If suffering cannot be mitigated by treatment, then euthanasia is absolutely a viable option. This applies not just to the critical individual, but also to the individuals left behind. I don't think people outside of medicine realize how much some clients struggle to euthanize their pets; one client this week described her 20.5 year old cat as her "purpose in life" and we initiated a welfare check on her in the days following the death of her cat. Pets are becoming child-like to a lot of people with deep emotional attachments. The more clients I meet, the more I'm convinced that people care about their pets more than they care about some family members (myself included).

I will also say that which individuals should go through euthanasia is a difficult and personal decision for the individual and the doctor. I've denied euthanasia on a few cases, and have performed behavioral euthanasia (dog with human attack history, including an attack on me). Most euthanasias are easy to emotionally detach from because it is the appropriate decision for that individual; there have been several (6 week old puppy in septic shock and a 12 year old dog with severe dementia come to mind immediately) where I cried with the family, despite the appropriateness of the decision. With human sentience, I'm all for road blocks to prevent "convenience euthanasias" as we call them in vet med. And I absolutely do not think any doctor (human or vet med) should be forced to perform/facilitate a euthanasia by any means. But if there's ever a point where I have a terminal illness and am lucid, I hope I can be given the dignity I have given animals and die peacefully.

It's easy to have a black and white opinion about the nuances of the decision when one has never had the experience of purposely killing another living being. There's lots of grey when one is holding the pentobarbitol and you get to sleep with that decision at night.

Sorry, not buying any of this.
Pets are often euthanized because the cost of sustaining their life further is financially onerous, to give peace of mind to the pet owners, and, mostly, so that the pet owners don't have to watch the process of death/dying.

In the case of human beings, we are willing to exhaust more resources, including -- and I cannot stress this enough -- aggressive pain control and palliative sedation. This is so not only due to our belief in the exceptionality of human life but also the strong will to live (unknowable until at that moment, not before) and the desire to spend as much time as possible with our loved ones before they go.

It is because animals do not possess human dignity that they are so often euthanized, but, of course, we live in a topsy-turvy world.

dig·ni·ty
/ˈdiɡnədē/
noun
the state or quality of being worthy of honor or respect.

If I could get a dollar for every time someone said, "If I were demented and sick, pull the plug," I'd be able to quit clinical medicine already. The reality is that this is our projection of our discomfort with them, the undesirables. We think their lives are unworthy, and they are unworthy; so we are not really speaking about own selves, but rather, our disdain for them. The reality is that most people -- certainly not all -- who have devastating life circumstances (e.g. paralysis) -- learn to live with their condition and want to go on living, even if before their injury they said otherwise in a purely hypothetical situation.

 

[Birdstrike]

The majority of people, when healthy say, "When I'm terminally ill, pull the plug. Off me! Just like my dog."

The first thing those people say, when they or their loved ones are in that situation:

"DO. EVERYTHING! ____[insert name]_____ CANNOT DIE!"

 

[battie]

Sorry, not buying any of this.

That's your prerogative. I'm simply sharing my experience as someone who euthanizes living creatures for a living in a conversation about expanding euthanasia to other living things where the option is pretty limited in the US. Your prerogative of believing me or not doesn't change my experience.

If you're also a veterinarian and your experience is different, would definitely be important to share your daily euthanasia experience.

Pets are often euthanized because the cost of sustaining their life further is financially onerous, to give peace of mind to the pet owners, and, mostly, so that the pet owners don't have to watch the process of death/dying

I didn't say that pets aren't euthanized due to finances. Definitely are and I have euthanized due to clients being unable to afford care. However, as I said, *my* clientele are affluent and have the privilege of considering welfare/QOL instead of finances. And this is certainly becoming more common as more clients get pet insurance and purposely save for emergency care. I've had clients take out personal loans for emergency stays/surgeries.

You'd be remarkably surprised at how many clients *refuse* euthanasia because "natural death is important" or "what God intended" or is "sacred". Or that $250 is worth it to euthanize a pet when they'll just die anyways. I've sent home my fair share of bleeding splenic/liver masses so the pet could bleed out at home because "he'll be more comfortable at home." It's wild how many people are willing to pay 3k for 24-36 hours of hospitalization, but not the 250 for euthanasia because a natural death is "important".

It is because animals do not possess human dignity that they are so often euthanized, but, of course, we live in a topsy-turvy world.

dig·ni·ty
/ˈdiɡnədē/
noun
the state or quality of being worthy of honor or respect.

Dignity is completely subjective. The homeless certainly aren't afforded dignity. My Golden retriever is certainly granted far more dignity by random human strangers on the street than those same strangers general deliver to homeless people at the corner.

Most, if not the vast majority, veterinary professionals would argue all animals are worthy of the same level of dignity as humans due to the benefits they give society. That dignity expands beyond our pets to livestock, research animals, working animals, zoo/aquarium, etc. I definitely feel a steer going through a slaughterhouse has a more dignified death than many people do.

If I could get a dollar for every time someone said, "If I were demented and sick, pull the plug," I'd be able to quit clinical medicine already. The reality is that this is our projection of our discomfort with them, the undesirables. We think their lives are unworthy, and they are unworthy; so we are not really speaking about own selves, but rather, our disdain for them. The reality is that most people -- certainly not all -- who have devastating life circumstances (e.g. paralysis) -- learn to live with their condition and want to go on living, even if before their injury they said otherwise in a purely hypothetical situation.

I honestly would believe this, but thats not the philosophical argument here (at least as far as I've read this thread). The argument I'm interpretting here is *should* euthanasia be an option in human medicine; I would argue the option should be available for those who desire it as long as there are road blocks to prevent "convenience euthanasias" and the human doctor consents to providing that service.

 

[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*?); 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.

What Hippocrates thought or did is largely irrelevant.

 

[Angelo84]

Pets are often euthanized because the cost of sustaining their life further is financially onerous, to give peace of mind to the pet owners, and, mostly, so that the pet owners don't have to watch the process of death/dying.

In the case of human beings, we are willing to exhaust more resources, including -- and I cannot stress this enough -- aggressive pain control and palliative sedation.

I was intrigued by this thread as a fellow ECC veterinarian. I work in a busy referral practice and it is extremely uncommon for me to not have at least one euthanasia a shift and more commonly multiple. I agree that often times euthanasia is a course chosen based on finances however more often then not it is based on prognosis, response to treatment and owner’s and sometimes patient’s willingness to be treated. In reading through this thread it seems that human clinicians are comfortable withdrawing care but I am confused by human medicine insistence on a natural death seemingly at all costs.

Short of states that allow physician assisted suicide for example a person that has end stage heart failure and is actively dying from their disease is given pain control and sedation—while this may make the process of dying slightly less distressing to experience/observe I personally do not understand why this individual would not be allowed to chose euthanasia with propofol and pentobarbital as opposed to slowly struggling over hours on morphine.

If all parties involved patient and clinician agree that the end result is death it pains me that human medicine does not allow that process to be hastened.

I agree that there are many conditions that are not as clearly terminal where electing euthanasia would clearly negate any remote chance at improving however if the patient does not choose to go forward with treatment why is that person not allowed to judge their quality of life and choose to die quickly rather then slowly?

I totally understand the scary grey zone of people that are no longer of sound mind etc and how that could potentially be abused but believe the laws could be formulated to primarily avoid such situations.

If a individual practitioner does not agree that euthanasia is appropriate they can decline to perform the euthanasia. This happens in our practices as well as different doctors may have different lines in the sand —for example an animal presented for euthanasia due to aggression— one clinician may be comfortable euthanizing that animal another may not be.

I hope that human medicine can come around to a more nuanced view towards euthanasia as I believe in the right circumstances it truely is a gift.

 

[Southpaw]

Sorry, not buying any of this.
Pets are often euthanized because the cost of sustaining their life further is financially onerous, to give peace of mind to the pet owners, and, mostly, so that the pet owners don't have to watch the process of death/dying.

In the case of human beings, we are willing to exhaust more resources, including -- and I cannot stress this enough -- aggressive pain control and palliative sedation. This is so not only due to our belief in the exceptionality of human life but also the strong will to live (unknowable until at that moment, not before) and the desire to spend as much time as possible with our loved ones before they go.

It is because animals do not possess human dignity that they are so often euthanized, but, of course, we live in a topsy-turvy world.

dig·ni·ty
/ˈdiɡnədē/
noun
the state or quality of being worthy of honor or respect.

If I could get a dollar for every time someone said, "If I were demented and sick, pull the plug," I'd be able to quit clinical medicine already. The reality is that this is our projection of our discomfort with them, the undesirables. We think their lives are unworthy, and they are unworthy; so we are not really speaking about own selves, but rather, our disdain for them. The reality is that most people -- certainly not all -- who have devastating life circumstances (e.g. paralysis) -- learn to live with their condition and want to go on living, even if before their injury they said otherwise in a purely hypothetical situation.

I don't buy the large majority of this. It's certainly not what I believe. Many humans make end of life decisions and their loved ones honor them - those wishes are generally simple and involve being at home and with loved ones. Many would have far more humane deaths if euthansia were an option. Dying in a hospital, especially an ICU, with its never ending blaring lights, few windows to the outside world, smells, constant beeps from medication pumps, and nurses cackling at the nursing station over some facebook or instagram post is not the way the very large majority of humans would die if they had the choice. It is not the way most physicians want to die. And yet, every year, millions die in the hospital. Millions more have their lives needlessly prolonged, well beyond any quality of life, because of modern medicine. Millions go to facilities because their needs have outstripped their, and their loved ones, capabilities (both physical and financial). Dying in America is an absolute mess.

My guess is everyone here with an animal (dog especially, cat also) loves that animal. That becomes especially true when children are involved and that dog becomes part of a child's life. The loss of the animal is a big deal. Huge. Families have real emotional grief over it. But most know when the time is right, and often so does the animal, and they're given a humane death with euthanasia. It's the right thing to do. It's far better for the animal than being unable to walk, or losing complete bowel/bladder control, or losing mental capability.

It strikes me as absurd that we give our animals a more humane death than many give to their loved ones. There is nothing exceptional, or superior, about losing mental capabilities, lying in your own urine or stool, having multiple rounds of CPR and ribs cracked, being kept alive only by IV medications and PVC down your trachea pumping your lungs full of oxygen because your own lungs are too weak. I do not believe any life unworthy - however I do believe that millions don't discuss end of life options with family or what they actually want with end of life care.

 

[Angry Birds]

@thegenius - I can't seem to quote you since all you did was quote me. I assure you, however, there is no "gotchya" moment here.
I have hearkened to a cumulative tradition, not to an individual who is in any case merely the eponymous "founder" of this oath/tradition, such that it is not restricted to his views nor even to his strict historicity-- unless we are taking Hippocrates as some sort of divine prophet. Does any medical ethicist in the world really think we are beholden to Hippocrates the individual? No. We are rather beholden to the oath/tradition that is merely named after him, which has a long and continuing history. It is the weight of tradition that I am falling behind here, not a mere individual that may or may not have existed -- and may or may not even have actually written the oath that was named after him.

I am here talking about tradition in the Burkean and Macintyrean sense, as discursive in nature.

 

[Angry Birds]

I don't buy the large majority of this. It's certainly not what I believe. Many humans make end of life decisions and their loved ones honor them - those wishes are generally simple and involve being at home and with loved ones. Many would have far more humane deaths if euthansia were an option. Dying in a hospital, especially an ICU, with its never ending blaring lights, few windows to the outside world, smells, constant beeps from medication pumps, and nurses cackling at the nursing station over some facebook or instagram post is not the way the very large majority of humans would die if they had the choice. It is not the way most physicians want to die. And yet, every year, millions die in the hospital. Millions more have their lives needlessly prolonged, well beyond any quality of life, because of modern medicine. Millions go to facilities because their needs have outstripped their, and their loved ones, capabilities (both physical and financial). Dying in America is an absolute mess.

My guess is everyone here with an animal (dog especially, cat also) loves that animal. That becomes especially true when children are involved and that dog becomes part of a child's life. The loss of the animal is a big deal. Huge. Families have real emotional grief over it. But most know when the time is right, and often so does the animal, and they're given a humane death with euthanasia. It's the right thing to do. It's far better for the animal than being unable to walk, or losing complete bowel/bladder control, or losing mental capability.

It strikes me as absurd that we give our animals a more humane death than many give to their loved ones. There is nothing exceptional, or superior, about losing mental capabilities, lying in your own urine or stool, having multiple rounds of CPR and ribs cracked, being kept alive only by IV medications and PVC down your trachea pumping your lungs full of oxygen because your own lungs are too weak. I do not believe any life unworthy - however I do believe that millions don't discuss end of life options with family or what they actually want with end of life care.

Just to clarify, nowhere did I oppose DNR/DNI, which is different than euthanasia.

 

[Angry Birds]

The majority of people, when healthy say, "When I'm terminally ill, pull the plug. Off me! Just like my dog."

The first thing those people say, when they or their loved ones are in that situation:

"DO. EVERYTHING! ____[insert name]_____ CANNOT DIE!"

This is correct. This is also my experience with the patient themselves. Human beings are resilient and the will to live is strong.

 

[Angry Birds]

Most, if not the vast majority, veterinary professionals would argue all animals are worthy of the same level of dignity as humans due to the benefits they give society. That dignity expands beyond our pets to livestock, research animals, working animals, zoo/aquarium, etc. I definitely feel a steer going through a slaughterhouse has a more dignified death than many people do.

This is precisely what I am so wholeheartedly opposing... despite how much I "love" my own dog. I am seeking to affirm human exceptionality (against Singerian so-called "speciesism"). The affirmation of human dignity and exceptionality is the basis of our entire Western philosophical, legal, and moral tradition... Fido can be a loved part of the family, but this is only a relative or even rhetorical statement meant to convey a likeness, the likeness never reaching the real thing.

 

[Franzd'Epinay]

This is precisely what I am so wholeheartedly opposing... despite how much I "love" my own dog. I am seeking to affirm human exceptionality (against Singerian so-called "speciesism"). The affirmation of human dignity and exceptionality is the basis of our entire Western philosophical, legal, and moral tradition... Fido can be a loved part of the family, but this is only a relative or even rhetorical statement meant to convey a likeness, the likeness never reaching the real thing.

She's not arguing about the worth of a human life vs. an animal life. I think her point can be summarized as "in your quest to designate human life as exceptional, you are actually treating humans less humanely than animals."

 

[VA Hopeful Dr]

My Golden retriever

That's all I needed to hear. Everything you say is correct going forward.

 

[battie]

This is precisely what I am so wholeheartedly opposing... despite how much I "love" my own dog. I am seeking to affirm human exceptionality (against Singerian so-called "speciesism"). The affirmation of human dignity and exceptionality is the basis of our entire Western philosophical, legal, and moral tradition... Fido can be a loved part of the family, but this is only a relative or even rhetorical statement meant to convey a likeness, the likeness never reaching the real thing.

She's not arguing about the worth of a human life vs. an animal life. I think her point can be summarized as "in your quest to designate human life as exceptional, you are actually treating humans less humanely than animals."

Yes. The majority of animals in our society have an appropriately humane death compared to a lot of humans because we actively prioritize a humane death for animals. Whereas humans, the priority is quantity of life it seems (from an outside perspective). And that isn't dignified from my perspective. Allowing active euthanasia of a human doesn't make them any less dignified.

I would venture to say that I would argue that humans arent more deserving of dignity just based on the premise of being human. But that's not the point of this discussion.

That's all I needed to hear. Everything you say is correct going forward.

She's perfect!! I've shared her picture in the dog lounge thread. She's a small hot mess (missing both coxofemoral joints and her spleen at this point). Bur still perfect!!

 

[dchristismi]

Fascinating discussion, and I appreciate our veterinary colleagues' input.

<wearing touchy-feely hospice hat>
I routinely tell my families that when one reads obituaries that say "died peacefully surrounded by his loved ones" that means hospice, because that's about the only way to get that ending. That doesn't happen in the hospital, and that's why I left the hospital.

I tried to do it for my last dog. My husband is a critical care nurse who works on the "other side." He wasn't ready when my beloved border collie got to the point where we knew her kidneys were gone. I had already talked with my vet and we had the closest thing to a dog hospice kit assembled. Like a syringe of oral midazolam in the fridge just in case. (My human hospice kits have small amounts of morphine, ativan, haldol, zofran, levsin... for the families to have for a hospice nurse to use in an emergency because of course there won't be a pharmacy open in the middle of the night when you need it.)
And one night around midnight, I just knew that I couldn't let her suffer any longer. I could see it. Husband was still struggling but he finally got it. At least with my humans, I schedule stuff. She was on meds (um, yay gabapentin) but I'm not a vet. I know human nonverbal signs of pain, but dogs are stoic as hell. And I just couldn't do it. So my vet helped her over.

I have seen thousands of humans die. I hold their hands. I can't help them cross. But I try to make that crossing easier.

I do think EM and HPM are a natural continuum, which is why transitioning to Hospice was very easy. But I completely agree that we don't do death and dying well in this country at all. We don't talk about it, we don't plan for it, and considering that the entire world is grieving right now, we still aren't doing a decent job. So I will continue to drive my poor husband nuts talking about death and dying. I'm less fun at cocktail parties I imagine, though... the rectal foreign body stories, that's what I thought people wanted. But oddly enough, people would rather tell me about when they lost their moms now. And that's ok.

/resume hippocrates argument

 

[Angry Birds]

She's not arguing about the worth of a human life vs. an animal life. I think her point can be summarized as "in your quest to designate human life as exceptional, you are actually treating humans less humanely than animals."

Yes, but what I am saying is that we treat animals differently because they are not humans. It is not simply compassion but our limited compassion thereof which causes us to extinguish their lives early.
If we see an animal hit by a car that is about to die, it is conceivable that we just terminate its life in order to act "humanely." However, if this was a person, we would use all resources to save life.

 

[Angry Birds]

I would venture to say that I would argue that humans arent more deserving of dignity just based on the premise of being human. But that's not the point of this discussion.

Haha. Good to see you say it outright.

 

[AlmostAnMD]

incoherent drunk rambling

 

[bravotwozero]

You have no "purpose," you have no "meaning," you aren't even yourself because the electrons you were born with have long since traded into other forms.

You are not better than a dog.

I see that that’s you’re opinion, and we’ll have to agree to disagree there.

 

[WilcoWorld]

Darnit.

These discussions are much more interesting before we start attacking each other.

 

[battie]

Haha. Good to see you say it outright.

I have no problem making that statement. Humans wouldn't have the societies they have without animals, so why do humans deserve to be treated with a higher level of dignity? Animals deserve dignity for their contributions, especially as welfare science advances and we have research showing how to improve quality of life.

It is not simply compassion but our limited compassion thereof which causes us to extinguish their lives early.

I disagree. I don't euthanize animals that potentially could be saved because they aren't worthy of the effort to save them. The number one reason is if they'll have a life worth living following treatment. The decision comes down to prognosis, quality of life after treatment, and finally finances.

A common case I see on ER is a senior large breed dog that has seemed "off" the last week or so. Then a few days ago, they stop eating and drinking, not wanting to get up. On presentation, pale gums, lethargic mentation, and a distended abdomen are clinical findings of major significance. Some of these kiddos can by tachycardic and/or tachypnic. I perform a TFAST/AFAST. Fluid present in all quadrants of the abdomen, and then a decent percentage have pericardial effusion. For a decent percentage of these guys, we can see the splenic or hepatic mass during our scan.

Next steps diagnostically: full abdominal ultrasound, blood transfusion, fluid therapy, cbc/chem, and surgery to remove what is hopefully just a splenic mass with close assessment of the liver for any other nodules/masses. If present, biopsy. Histopath of the mass(es).

Next steps practically: statistically, the most likely issue here is hemangiosarcoma, which has a MST of 3-6 months following surgery and with chemo according to AAHA guidelines. The question becomes is surgery and chemo (and all the adjacent shenanigans) worthwhile *for the dog*? Its such a personal question rooted exclusively in compassion and dignity for the dog. This week at my hospital, we've had two dogs go to surgery and one sent home for at-home euthanasia. None of those decisions were wrong and *they were all rooted in compassion and dignity for the dogs*.

I highly encourage you to spend time with the emergency and critical care service of your local veterinary referral center to truly see the perspective I'm trying to describe. If someone has never made the decision to recommend euthanasia as a viable treatment option, it's hard to conceptualize the reasoning behind it.

And, honestly, I think having that connection between vet med and human med is very important as human medicine introduces euthanasia as a service.

I'll also repeat that euthanizing something does not inherently decrease the level of dignity it is being afforded. I'm not really seeing your argument on how euthanizing something is showing it a poor level of dignity, or why trying every last-ditch treatment option does convey dignity.

 

[dadaddadaBATMAN]

Yeah, would love to focus more on the euthanasia than the “are humans better than dogs” aspect of the discussion.

If we have to pursue that example further we could point out that the reasons we don’t pursue a lot of major treatment plans in dogs are exactly the same as for humans: quality of life years left.

A dog is always on a shorter clock. If a person had three years left to live in their life expectancy you might not try to do a bunch of major surgeries. This is relatively well accepted, a family of a 74 year old would not be thought crazy for making them comfort care with a major trauma.

It’s also the exact situation a 2 year old St. Bernard is in.

The example fails for many reasons, and is also a derailment.

I am still lost in the argument that angry birds is making about life being sacred. I accept this is a commonly held truth, but it does not mean that it is sacred beyond any and all other virtues.

The argument that something should be a certain way because it has been a way may be popular among beaurocrats but holds little sway for me personally. That is essentially what im getting out of the references to the enlightenment or that it’s a bedrock value. I also don’t see how the sacredness of life holds more value than dignity or autonomy.

I have yet to see a response to a branch of philosophy that’s about 2000 years older starting with zeno.

 

[Southpaw]

If humans are such awesome dignified beings why don’t we deserve a glorious death of our choosing at the precise moment we desire that glorious death?

 

[deleted941485]

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

Is it truly a right, if I can't off myself or ask someone else to help me?

 

[deleted941485]

If humans are such awesome dignified beings why don’t we deserve a glorious death of our choosing at the precise moment we desire that glorious death?

If there is one thing I've learned being a doctor, its that humanity is vastly overrated. It has no problem mythologizing its own suffering or asserting its rights to anything and everything while making life positively miserable for those who "care" for them.

 

[Birdstrike]

Pets are better than people.

 

[AlmostAnMD]

Yeah, would love to focus more on the euthanasia than the “are humans better than dogs” aspect of the discussion.

Unfortunately, with respect I say that's impossible. At the very core of this argument is "sanctity" of human life above all else. If you apply a holy connotation to life itself extinguishing it is somehow bad, regardless of context. But no one thinks of animals as holy, at least not any large group of meaningful political power, which is the real and true reason why we euthanize them without regard.

Its also the reason most of this arguing is circular, here and other topics. Two people with core sets of beliefs on diametric opposites cannot possibly come to terms with euthanasia. One will always be wrong to the other.

I was appalled when I took our cat to the vet. Like the above poster had mentioned I was willing to spend crazy money on her. Won't say how much. When she got too sick in the small animal icu they straight came out to tell me I had to put her down.

I was sad, but then immediately thought of my own job. If those words ever left my mouth I'd be fired on the spot. Real, true end of life care is probably somewhere in between but it's not what I do now, which is keep grandma alive for millions a month as a cadaver with a heartbeat.

 

[dadaddadaBATMAN]

Unfortunately, with respect I say that's impossible. At the very core of this argument is "sanctity" of human life above all else. If you apply a holy connotation to life itself extinguishing it is somehow bad, regardless of context. But no one thinks of animals as holy, at least not any large group of meaningful political power, which is the real and true reason why we euthanize them without regard.

Its also the reason most of this arguing is circular, here and other topics. Two people with core sets of beliefs on diametric opposites cannot possibly come to terms with euthanasia. One will always be wrong to the other.

I was appalled when I took our cat to the vet. Like the above poster had mentioned I was willing to spend crazy money on her. Won't say how much. When she got too sick in the small animal icu they straight came out to tell me I had to put her down.

I was sad, but then immediately thought of my own job. If those words ever left my mouth I'd be fired on the spot. Real, true end of life care is probably somewhere in between but it's not what I do now, which is keep grandma alive for millions a month as a cadaver with a heartbeat.

I am sad to hear about your cat.

However, I politely disagree.

while it might be true that ones religious beliefs may touch on a topic like end of life care, it doesn’t mean that bringing in the question of whether there is a god, etc moves the argument forward. A topic can be related or parallel and still be a derailment.

 

[RustedFox]

Pets are better than people.

I've said this frequently on here: "I like most animals more than I like most people."

I made my mind up about this a long time ago, as well:

If a future exists in which I have a terrible disease and there's no way to not be miserable, then I'm having a "good last day" and taking lethal means and a drug of choice into the wilderness and I'm not coming home.

 

[Franzd'Epinay]

I've said this frequently on here: "I like most animals more than I like most people."

I made my mind up about this a long time ago, as well:

If a future exists in which I have a terrible disease and there's no way to not be miserable, then I'm having a "good last day" and taking lethal means and a drug of choice into the wilderness and I'm not coming home.

What if you could 3D print one of these?

 

[Apollyon]

If humans are such awesome dignified beings why don’t we deserve a glorious death of our choosing at the precise moment we desire that glorious death?

"Today is a good day to die!"

Let your inner Klingon fly!