16 ms·

Palliative sedation, an end-of-life practice that is legal everywhere

136 points by spking 8y ago

jedberg 8y ago
I was found it odd that I can choose to euthanize my dog but not myself. This is an interesting workaround.
- whatshisface 8y ago
  Choosing to "euthanize" yourself is something that is so predominately chosen in fits of mental illness that society has probably made the right choice in banning it outright. Further, I think there's a strong argument that other people shouldn't be allowed to add any weight to the idea of killing you... As someone else brought up, there can be disagreements between family and an individual about when the right time for them to die is in both directions. Even in America this can be observed with things like life support for the very elderly, an intervention that is sometimes necessary for continued life but not considered euthanasia to forego. You won't have to dig very deep to find a doctor that has seen families argue about this. So, if you say "only I can make the decision," then mental illness becomes a lot more deadly than it has to be. If you say, "other people can weigh in," then what do you do when they want you to die more than you do (and start pressuring you, and you're old, and already depressed...)? This leaves us at our current state, which is "nobody gets to make the decision."
  - noarchy 8y ago
    >society has probably made the right choice in banning it outright If you're equating society with government, you're not correct in every case. Assisted suicide is legal in some jurisdictions. California is mentioned in the article, but another example: https://en.wikipedia.org/wiki/Euthanasia_in_Canada https://en.wikipedia.org/wiki/Euthanasia_in_Canada
  - deleted 8y ago
    [deleted]
  - shizcakes 8y ago
    This is not what actually happens in practice. There are a number of states with "Death with dignity" laws. Read up: https://www.deathwithdignity.org/faqs/ https://www.deathwithdignity.org/faqs/
    - whatshisface 8y ago
      The website you linked does not address the situation described in the comment above - where family members disagree with an individual about the time of death, and pressure them in to making a different decision than they would otherwise. (If it does, I missed it. For this reason it's often helpful to reprint your quote in the comment that contains the link.) Again, this can already be seen happening in life-support cases. I won't say "ask any doctor," because I haven't asked every doctor, but it's not too hard to find first-hand accounts.
  - nightcracker 8y ago
    > Choosing to "euthanize" yourself is something that is so predominately chosen in fits of mental illness No one is proposing to legalize impulsive suicide, and it's ridiculous to equate euthanasia with it.
    - bb101 8y ago
      Quite. By the same token, if I took my healthy dog into my vet to have it euthanized, I am sure my vet would refuse to do so, and probably inform the relevant authority.
      - rootusrootus 8y ago
        Actually that happens often enough that it has a name: convenience euthanasia. I believe most vets will try to find alternatives before they go through with it, but some physically healthy animals are definitely put down due to behavioral issues.
        wavefunction 8y ago
        Some vets will do it but not most according to my vet and vet tech friends. (Anecdotes, unfortunately.) They find even the proper application of euthanasia terribly emotionally draining though. It's being confronted by the feelings of the human family that is the worst for them.
        jonhendry18 8y ago
        "but some physically healthy animals are definitely put down due to behavioral issues." Most notably after a dog has mauled someone.
  - deleted 8y ago
    [deleted]
  - jopsen 8y ago
    In some countries (like NL) assisted suicide is only allowed when certain criteria is met, such a terminal illness with no chance of improvement, etc. Having seen some of my grandparents slowly fade with dementia, I'm sad they didn't have the choice to end it on their terms. Whether they would have chosen to do so I don't know. But the individual freedom to end your own pointless suffering seems very reasonable to me.
    - whatshisface 8y ago
      Dementia is a good example - how far gone can someone be before they are no longer able to request death? At present, you cannot be diagnosed until you have already suffered enough decline to have seen a doctor about it. Most people think the difference between suicide and euthanasia is that euthanasia is requested with a "sound mind," but the cases where euthanasia seems the most opportune are those where no sound mind is available.
      - Omnus 8y ago
        Exactly. Even if you try to make the decision ahead of time with a sound mind, where do you draw the line? And even if the line is drawn, what happens if you change your mind later but you're in the late stages? Which "you" gets precedence?
      - wavefunction 8y ago
        Perhaps you would plan ahead with a "living will" if those are available to you that states in the event that you are determined to no longer be capable of managing your affairs that you be euthanized. I am planning to set one up soon though I will hopefully have a few more decades ahead of me. It will specifically state that in the event I can no longer manage my affairs I wish to be transported to the nearest locale in which I can have my life ended.
        jopsen 8y ago
        > It will specifically state that in the event I can no longer manage my affairs I wish to be transported to the nearest locale in which I can have my life ended. Ha ha, "manage my affairs"... maybe give yourself a slightly longer rope :) My grandmother sure can't do her own taxes, but she has no illness - she's just old, and world has changed around her. Assuming you have well behaved kids, you'll likely stop managing your affairs long before you loose your health.
  - dmichulke 8y ago
    > This leaves us at our current state, which is "nobody gets to make the decision." Someone always decides what's right, either yourself or your family or the state (usually via law). You opt in favour of state and conveniently ignore the will of the people who would choose family or "they themselves" because law is not a person and therefore it can decide. That's not at all convincing.
  - bodas 8y ago
    I don't understand what you are saying, we are talking about terminally ill patients, what has mental illness got to do with it?
  - lisper 8y ago
    > This leaves us at our current state, which is "nobody gets to make the decision." Except that is not our current state. Our current state is that a bizarre legal process makes the decision, and that process is different in every state. Any time you have uncertainty, you necessarily have both type I and type II errors. You can tweak your decision criteria so that you get more of one or more of the other, but you can never eliminate errors entirely. The fundamental problem we have is that we can't agree which is worse: having someone die before their time, or having someone live past it. One thing that would help is to recognize that our choice of terminology is hurting us: we talk about "saving lives" but in fact there is no such thing as "saving" a life, only extending one. Once you look at it that way you realize almost immediately that if you're going to allocated resources to extending a life, it probably makes more sense to, say, allocate those resources to a 20-year-old rather than a 95-year-old.
    - whatshisface 8y ago
      >in fact there is no such thing as "saving" a life, only extending one. Most of the objection to euthanasia is focused on the case where you are administering deadly medications to a person that can survive on their own. Ending life support is another debate, although one that shares many properties and players with euthanasia.
      - lisper 8y ago
        Yeah, that's actually another thing that I think is messing us up, this idea that "letting nature take its course" is somehow better in and of itself than intervention. If you know that the outcome of "letting nature take its course" is going to be a bucketful of pain, and you have the option to eliminate that pain with a low-cost intervention, and you choose not to intervene, then IMHO that pain is on you every bit as much as if you'd actively tortured the person. (All this is assuming that the subject consents, of course. Some people might choose to experience the pain. I can respect that.) On the other hand, I really don't see the salient difference between euthanizing someone and sedating them until they die of starvation and dehydration. Once you start to intervene with the intent of producing a painless death, why not just get it over with?
  - mikeash 8y ago
    You’re so worried about making the wrong choice, yet you advocate for a situation where the law makes a blanket one-size-fits-all choice that’s inevitably going to be the wrong one sometimes. You (rightly) worry about a situation where someone is pressured into dying, or chooses to die because their brain is broken. But what about situations where someone is suffering horribly with no relief to come, and they want to end it, and their family agrees, and their doctors, but everyone is prevented from carrying out their wishes because of a blanket ban?
- atlantic 8y ago
  Nothing strange about it. Most legal systems attach far greater value to a human life than that of a dog, so the checks and balances around taking such a life are commensurably greater. And "workaround" seems a strangely lightweight term to use in this context. It's not an engineering problem you're faced with here. It's an ethical issue.
- 21 8y ago
  I find it odd that you find it odd. A dog is not exactly in the same category as a human, from many points of view.
Analemma_ 8y ago
This has been a thing-everyone-knows-but-no-one-talks-about in hospitals for a long time. And honestly, I wish it would stay that way. Because while I support the right of terminal patients to die at the time of their choosing and avoid pointless agony, opponents of euthanasia do have a good point– which is not appreciated nearly often enough– that state-sanctioned euthanasia opens the door for family members to start pressuring people to die when they don't really want to. This is a thing that happens more than anyone wants to admit in areas where it is legal. Deliberate ambiguity, where euthanasia is allowed but we all pretend it's not, is the best way to square this circle. Doctors have implicitly understood this for a while, hence this practice. Unfortunately, most people hate ambiguity in their laws, which I understand and think is a good priniple in general, but I wish they'd look more carefully and see that the benefits outweigh the costs here.
- hetman 8y ago
  It's a shame this was downvoted. It certainly adds an interesting perspective to the discussion even if not everyone agrees with the conclusion.
- pwned1 8y ago
  Not sure why you're getting downvoted. I agree with you.
- keldaris 8y ago
  I tend to disagree with that argument because I think the slippery slope issue can be mitigated sufficiently with proper procedures (waiting periods, psychiatrist interviews, etc.). However, it is a valid argument that must be addressed, is appropriately formulated and entirely on topic, so I'm confused as to why it was downvoted.
- dmurray 8y ago
  Euthanasia in practice but not in name is also easier to reconcile with various codes of ethics (especially religious ones) for the patient or his family. Suicide is taboo, large palliative doses of morphine are not.
- notahacker 8y ago
pwned1 8y ago
I just went through this with my grandmother. She decided she didn't want any more care in the hospital, so they morphined her up to the point that she never woke up again and she essentially starved and dehydrated to death, over about a five day period. The whole thing was disturbing to me.
- tinco 8y ago
  That's different from what I've heard from friends, they had to wait for their parent's hearts to stop. One sat with his father until three in the morning before it finally happened. I've not heard it's taken as many as five days though. This was in the Netherlands by the way, before euthanasia was legalized.
  - kqr 8y ago
    My experience mirrors yours. I've had relatives receive doses in the scale of things stop working within 24 hours. But at that point, they didn't have very long left anyway, so maybe it's different practises, and maybe it's about how healthy the body is when the process is initiated.
  - stef25 8y ago
    Same here, in Belgium where euthanasia is legal. I have no idea why they made it last the 5 days that it took.
- matte_black 8y ago
  Just to be clear, the morphine was her request, or was it some sort of vengeance on the part of the hospital?
  - pwned1 8y ago
    I don't think she specifically requested morphine, just that she no longer be treated. I'm honestly not sure how the decision-making process worked. It was kinda odd to me because no one said that she was going to be completely knocked out for the rest of her few days. If I had known exactly how it was going to work, I would have asked to talk to her more before they initiated the process. But I got there the day after she requested the cessation of care and she was out, never to be conscious again. She was then moved to hospice with a locked-up morphine machine and we all sat there for several days, watching her die. To call it vengeance would be inaccurate.
GoodOldNe 8y ago
I disagree with some of the above posters. This is often confused with, but is not the same thing as, physician aid-in-dying or euthanasia. People do talk about this in hospitals, and it is appropriate treatment for many patients at the end of life if they are suffering. The ethical principle of double effect makes this permissible in these contexts. If the aim of the treatment with a benzodiazepine or opiate is to reduce suffering, the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications to achieve the first aim of relieving or preventing suffering. Suggesting that this is a "workaround" for euthanasia distracts from the fact that this is not available as a treatment for most, if not almost all, dying patients. It is very different from physician aid-in-dying and is not a replacement for these other forms of end of life care.
- pfortuny 8y ago
  As a matter of fact, when curing is impossible, what doctors must to is to relieve the pain, nit to prolong life. That it has a negative outcome is (with the “proportionate” clause) secondary.
  - jessriedel 8y ago
    > what doctors must to is to relieve the pain, nit to prolon No, doctors implement the patient's wishes. If the patient would like to live as long as possible, even if in pain with an incurable condition, that's the patient's prerogative.
    - pfortuny 8y ago
      Nope: doctors are not obligated to provide care they deem futile. This is essential: you cannot force anyone to do something against their conscience. Notice the”futile”.
      - jessriedel 8y ago
        <eyeroll>. It's obvious that doctors don't have to implement any patient desire at all. It must be part of the doctor job description, and sham medicine is obviously not included. But living longer, even with pain and even if the patient is still going to die, is not considered futile or a sham. (We all have an incurable disease because we all are going to die eventually.) Doctors are of course able to decline to participate, but they must refer you to another doctor.
stef25 8y ago
A few years ago my 90 year old grandma had a stroke in her sleep and the doctors told us she'd never really have any more quality of life and what's usually done is just pull out the sugar drip and basically wait for her to (for lack of better word) starve to death. After a day or two with no food or water she'd drift in and out of consciousness. It was amazing how she would even refuse my offer of wetting her lips with a sponge. During a time I was alone with her, her breathing became so heavy, this rattling sound. I asked a nurse "can't you give her something" and he gave her a shot of morphine and a few min later the breathing stopped and that was that. It was quite a humbling experience. Another thing that comes to mind is the "Brompton cocktail", a mix of morphine/heroin, cocaine, alcohol and thorazine against the nausea: https://en.wikipedia.org/wiki/Brompton_cocktail https://en.wikipedia.org/wiki/Brompton_cocktail
- jonhendry18 8y ago
  When my dad was dying it took 4 days after he became unresponsive. They administered morphine all along but not enough in one dose to be fatal. The rattling came on day 2-3, then quieted down. The strange(?) thing was that he lost consciousness and became unresponsive shortly after my brother arrived at the hospital. My brother was the last of the immediate, local family to arrive. My dad acknowledged his presence and in a few minutes was unconscious. Then on the fourth day he passed shortly after his grandkids arrived from the airport.
- cinspicuous 8y ago
  http://charltonteaching.blogspot.com/2018/06/the-brompton-cocktail-and-decline-of.html http://charltonteaching.blogspot.com/2018/06/the-brompton-co...
intralizee 8y ago
I've been trying to receive "euthanasia" for myself. I suffer gender dysphoria. I think it's a shame how society can discriminate a person with an illness compared to another group with a different illness; when it comes to receiving what is considered a medical treatment for ending pain. The terminology for who qualifies & receives euthanasia is flexible in the jurisdictions that offer it by terminology but people will warp their own perception around who they view should have a right to qualify to die by personal opinions without understanding the pain of another. Society doesn't help some people and euthanasia can be a real solution for the current system until real help evolves; where euthanasia can be less thought about.
- hartator 8y ago
  I am sorry about that that. Feel free to reach me via PM (email in profile) if you want someone to talk to.
- ashleyn 8y ago
  It's far beter to consider current, effective treatments for this instead of considering euthanasia for it.
  - intralizee 8y ago
    I'm on the current medical treatment I can afford. I wouldn't combine the word effective in that sentence. I've given it enough time to decide the treatment is unacceptable in making the pain be bearable. I'm at a point where it's euthanasia or suicide and which is the case for people seeking euthanasia. Some people have more pain than others with the same illness classification and depending on how life transpired. It shouldn't be an outsider limiting others scenario.
    - md224 8y ago
      I’m sorry you’re going through so much suffering. I personally don’t think anyone experiencing mental anguish should commit suicide before giving “drugs of abuse” a try. These drugs are so popular and addictive precisely because they’re so good at making you feel better. They’re a last resort, but I think they’re a better last resort than suicide. Here’s a link to a recent Reddit comment where I discussed this idea, along with suggestions of drugs to try: https://www.reddit.com/r/depressionregimens/comments/8wcv8f/comment/e1uym6u https://www.reddit.com/r/depressionregimens/comments/8wcv8f/...
danielam 8y ago
End of life decision-making vis-a-vis the doctrine of double effect[0]. This section addresses specifically some of the claims made in the posted article. [0] https://plato.stanford.edu/entries/double-effect/#End https://plato.stanford.edu/entries/double-effect/#End
vslira 8y ago
Something I wish was more common is some type of therapy for treating death anxiety. I read somewhere that LSD can reduce the fear of death[0]. I can think of few things I’d like more in life than not being afraid to cease to exist[1] in my deathbed. I suppose those going through terrible terminal illnesses suffer enough to accept death over the suffering, but I don’t see why one should need to experience such extremes to accept the inevitable. [0] That’s a big maybe, don’t go around self medicating serious issues based on unsourced comments on unregulated drugs [1] I know religion or philosopy can sometimes fill this gap, but let’s remember those who are skeptical or didn’t have a lot of time to prepare
- wpietri 8y ago
  I had one parent die from brain cancer in 2011, and another was just diagnosed with a terminal brain tumor, so this is on my mind. Honestly, I don't think this is a problem specifically for the person with the terminal illness. So much of the difficulty comes from everybody else. American culture does not prepare people to face death, either their own or of loved ones. So a lot of my energy goes in to helping other people manage their feelings at a time when I don't have energy to spare. I want other people to take LSD or do Zen retreats or serve at a hospice or whatever they need to do so they can manage their own death anxiety. Speaking of which, I strongly recommend the "ring theory of grief" article. The gist is that if bad shit is happening to somebody, you help them rather than imposing on them. It sounds obvious, but I promise that it's unfortunately rare. Here's the article: http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407 http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-s...
  - Omnus 8y ago
    I'm skeptical that any of those things actually "prepare" people to face death in the first place. Feeling like you're "prepared" weeks, months, or years before the final hours of your self or a loved one does not necessarily translate to those final moments when you are actually going through it.
    - hanshan 8y ago
Steve0407 8y ago
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ananonymoususer 8y ago
When my mother was dying from pneumonia (after it had destroyed her lungs), she had been on a respirator for several weeks and was only getting worse. She also had been unconscious because she had been "fighting" the machine. She had told us that she never wanted to end up that way, but she did not have an advance directive on record. The family made a decision to pull the plug and her doctor administered a large dose of morphine to ease her passing. She went peacefully. We were all very grateful to the doctor for this.
alberthartman 8y ago
Best choice is to follow the wishes of the person who’s in the heat of the battle. Be cognizant that those wishes may change as the illness progresses. Do it as being of maximal service to the loved one.
JudasGoat 8y ago
I watched this in action with my father's death. My mother had a long nursing career and had a talk with the doctor that lasted about 15 minutes (it was 20 years ago), after that a large morphine dose was added to his IV. Within 5 minutes I watched my dad stop breathing. My Dad was in his early sixties, morbidly obese, this condition was aggrevated by his lifelong fear of doctors. Dad needed hip replacements but wouldn't consider it because of his medical phobia. This caused his lack of mobility which caused urinary track infections from his dificulty moving to a toilet chair. He was in the hospital for chronic UTI's when my mom made the decision. He was lucent and not at all ready to die. Mom has passed too and it feels cathartic to say this.
- SteveNuts 8y ago
  So your mom just straight up murdered your dad? Why on earth would the doctor authorize giving him a lethal morphine drip for a UTI? What was the fallout from the autopsy, etc.? This baffles me
  - JudasGoat 8y ago
    In my opinion the medical profession know quite well how to run the system. My mom spent most of her career in a terminal cancer hospital. I was an active opiate addict at the time, so my opinion wasn't solicited.
  - ams6110 8y ago
    Autopsy is often not performed. Neither of my parents were autopsied after they died.
mirimir 8y ago
> Doctors wrestle with what constitutes unbearable suffering ... Huh? It's whatever a patient says it is. Otherwise, it's torture.
- saagarjha 8y ago
  What if the patient cannot speak?
  - mirimir 8y ago
    Well, it's a tough call if they're totally paralyzed. That's quite the horror, no? Brings to mind Catch 22, and that Metallica song. But otherwise, there are other ways to communicate.
Simulacra 8y ago
I think it should always be left up to the patient, what they wish to do, and doctors should support it. If it gets to that point, I would very much like to spend my last days stoned and comfortable, and die peacefully. But if I have a terminal illness or I am in great pain, I very much want that choice of when to go.
BrandoElFollito 8y ago
I would be thrilled by the possibility of having an implant which requires a timed confirmation (every 6 months or so) and if there is no, it would pour poison in the bloodstream. I am terrified by the possibility of not being capable to end my life when I want to, either because I am too disabled, or senile to the point of forgetting to do that.

136 points by spking 8y ago

jedberg 8y ago

I was found it odd that I can choose to euthanize my dog but not myself. This is an interesting workaround.

whatshisface 8y ago
Choosing to "euthanize" yourself is something that is so predominately chosen in fits of mental illness that society has probably made the right choice in banning it outright. Further, I think there's a strong argument that other people shouldn't be allowed to add any weight to the idea of killing you... As someone else brought up, there can be disagreements between family and an individual about when the right time for them to die is in both directions. Even in America this can be observed with things like life support for the very elderly, an intervention that is sometimes necessary for continued life but not considered euthanasia to forego. You won't have to dig very deep to find a doctor that has seen families argue about this. So, if you say "only I can make the decision," then mental illness becomes a lot more deadly than it has to be. If you say, "other people can weigh in," then what do you do when they want you to die more than you do (and start pressuring you, and you're old, and already depressed...)? This leaves us at our current state, which is "nobody gets to make the decision."
- noarchy 8y ago
  >society has probably made the right choice in banning it outright If you're equating society with government, you're not correct in every case. Assisted suicide is legal in some jurisdictions. California is mentioned in the article, but another example: https://en.wikipedia.org/wiki/Euthanasia_in_Canada https://en.wikipedia.org/wiki/Euthanasia_in_Canada
- deleted 8y ago
  [deleted]
- shizcakes 8y ago
  This is not what actually happens in practice. There are a number of states with "Death with dignity" laws. Read up: https://www.deathwithdignity.org/faqs/ https://www.deathwithdignity.org/faqs/
  - whatshisface 8y ago
    The website you linked does not address the situation described in the comment above - where family members disagree with an individual about the time of death, and pressure them in to making a different decision than they would otherwise. (If it does, I missed it. For this reason it's often helpful to reprint your quote in the comment that contains the link.) Again, this can already be seen happening in life-support cases. I won't say "ask any doctor," because I haven't asked every doctor, but it's not too hard to find first-hand accounts.
- nightcracker 8y ago
  > Choosing to "euthanize" yourself is something that is so predominately chosen in fits of mental illness No one is proposing to legalize impulsive suicide, and it's ridiculous to equate euthanasia with it.
  - bb101 8y ago
    Quite. By the same token, if I took my healthy dog into my vet to have it euthanized, I am sure my vet would refuse to do so, and probably inform the relevant authority.
    - rootusrootus 8y ago
      Actually that happens often enough that it has a name: convenience euthanasia. I believe most vets will try to find alternatives before they go through with it, but some physically healthy animals are definitely put down due to behavioral issues.
      - wavefunction 8y ago
        Some vets will do it but not most according to my vet and vet tech friends. (Anecdotes, unfortunately.) They find even the proper application of euthanasia terribly emotionally draining though. It's being confronted by the feelings of the human family that is the worst for them.
      - jonhendry18 8y ago
        "but some physically healthy animals are definitely put down due to behavioral issues." Most notably after a dog has mauled someone.
- deleted 8y ago
  [deleted]
- jopsen 8y ago
  In some countries (like NL) assisted suicide is only allowed when certain criteria is met, such a terminal illness with no chance of improvement, etc. Having seen some of my grandparents slowly fade with dementia, I'm sad they didn't have the choice to end it on their terms. Whether they would have chosen to do so I don't know. But the individual freedom to end your own pointless suffering seems very reasonable to me.
  - whatshisface 8y ago
    Dementia is a good example - how far gone can someone be before they are no longer able to request death? At present, you cannot be diagnosed until you have already suffered enough decline to have seen a doctor about it. Most people think the difference between suicide and euthanasia is that euthanasia is requested with a "sound mind," but the cases where euthanasia seems the most opportune are those where no sound mind is available.
    - Omnus 8y ago
      Exactly. Even if you try to make the decision ahead of time with a sound mind, where do you draw the line? And even if the line is drawn, what happens if you change your mind later but you're in the late stages? Which "you" gets precedence?
    - wavefunction 8y ago
      Perhaps you would plan ahead with a "living will" if those are available to you that states in the event that you are determined to no longer be capable of managing your affairs that you be euthanized. I am planning to set one up soon though I will hopefully have a few more decades ahead of me. It will specifically state that in the event I can no longer manage my affairs I wish to be transported to the nearest locale in which I can have my life ended.
      - jopsen 8y ago
        > It will specifically state that in the event I can no longer manage my affairs I wish to be transported to the nearest locale in which I can have my life ended. Ha ha, "manage my affairs"... maybe give yourself a slightly longer rope :) My grandmother sure can't do her own taxes, but she has no illness - she's just old, and world has changed around her. Assuming you have well behaved kids, you'll likely stop managing your affairs long before you loose your health.
- dmichulke 8y ago
  > This leaves us at our current state, which is "nobody gets to make the decision." Someone always decides what's right, either yourself or your family or the state (usually via law). You opt in favour of state and conveniently ignore the will of the people who would choose family or "they themselves" because law is not a person and therefore it can decide. That's not at all convincing.
- bodas 8y ago
  I don't understand what you are saying, we are talking about terminally ill patients, what has mental illness got to do with it?
- lisper 8y ago
  > This leaves us at our current state, which is "nobody gets to make the decision." Except that is not our current state. Our current state is that a bizarre legal process makes the decision, and that process is different in every state. Any time you have uncertainty, you necessarily have both type I and type II errors. You can tweak your decision criteria so that you get more of one or more of the other, but you can never eliminate errors entirely. The fundamental problem we have is that we can't agree which is worse: having someone die before their time, or having someone live past it. One thing that would help is to recognize that our choice of terminology is hurting us: we talk about "saving lives" but in fact there is no such thing as "saving" a life, only extending one. Once you look at it that way you realize almost immediately that if you're going to allocated resources to extending a life, it probably makes more sense to, say, allocate those resources to a 20-year-old rather than a 95-year-old.
  - whatshisface 8y ago
    >in fact there is no such thing as "saving" a life, only extending one. Most of the objection to euthanasia is focused on the case where you are administering deadly medications to a person that can survive on their own. Ending life support is another debate, although one that shares many properties and players with euthanasia.
    - lisper 8y ago
      Yeah, that's actually another thing that I think is messing us up, this idea that "letting nature take its course" is somehow better in and of itself than intervention. If you know that the outcome of "letting nature take its course" is going to be a bucketful of pain, and you have the option to eliminate that pain with a low-cost intervention, and you choose not to intervene, then IMHO that pain is on you every bit as much as if you'd actively tortured the person. (All this is assuming that the subject consents, of course. Some people might choose to experience the pain. I can respect that.) On the other hand, I really don't see the salient difference between euthanizing someone and sedating them until they die of starvation and dehydration. Once you start to intervene with the intent of producing a painless death, why not just get it over with?
- mikeash 8y ago
  You’re so worried about making the wrong choice, yet you advocate for a situation where the law makes a blanket one-size-fits-all choice that’s inevitably going to be the wrong one sometimes. You (rightly) worry about a situation where someone is pressured into dying, or chooses to die because their brain is broken. But what about situations where someone is suffering horribly with no relief to come, and they want to end it, and their family agrees, and their doctors, but everyone is prevented from carrying out their wishes because of a blanket ban?
atlantic 8y ago
Nothing strange about it. Most legal systems attach far greater value to a human life than that of a dog, so the checks and balances around taking such a life are commensurably greater. And "workaround" seems a strangely lightweight term to use in this context. It's not an engineering problem you're faced with here. It's an ethical issue.
21 8y ago
I find it odd that you find it odd. A dog is not exactly in the same category as a human, from many points of view.

Analemma_ 8y ago

This has been a thing-everyone-knows-but-no-one-talks-about in hospitals for a long time. And honestly, I wish it would stay that way. Because while I support the right of terminal patients to die at the time of their choosing and avoid pointless agony, opponents of euthanasia do have a good point– which is not appreciated nearly often enough– that state-sanctioned euthanasia opens the door for family members to start pressuring people to die when they don't really want to. This is a thing that happens more than anyone wants to admit in areas where it is legal. Deliberate ambiguity, where euthanasia is allowed but we all pretend it's not, is the best way to square this circle. Doctors have implicitly understood this for a while, hence this practice. Unfortunately, most people hate ambiguity in their laws, which I understand and think is a good priniple in general, but I wish they'd look more carefully and see that the benefits outweigh the costs here.

hetman 8y ago
It's a shame this was downvoted. It certainly adds an interesting perspective to the discussion even if not everyone agrees with the conclusion.
pwned1 8y ago
Not sure why you're getting downvoted. I agree with you.
keldaris 8y ago
I tend to disagree with that argument because I think the slippery slope issue can be mitigated sufficiently with proper procedures (waiting periods, psychiatrist interviews, etc.). However, it is a valid argument that must be addressed, is appropriately formulated and entirely on topic, so I'm confused as to why it was downvoted.
dmurray 8y ago
Euthanasia in practice but not in name is also easier to reconcile with various codes of ethics (especially religious ones) for the patient or his family. Suicide is taboo, large palliative doses of morphine are not.
notahacker 8y ago

pwned1 8y ago

I just went through this with my grandmother. She decided she didn't want any more care in the hospital, so they morphined her up to the point that she never woke up again and she essentially starved and dehydrated to death, over about a five day period. The whole thing was disturbing to me.

tinco 8y ago
That's different from what I've heard from friends, they had to wait for their parent's hearts to stop. One sat with his father until three in the morning before it finally happened. I've not heard it's taken as many as five days though. This was in the Netherlands by the way, before euthanasia was legalized.
- kqr 8y ago
  My experience mirrors yours. I've had relatives receive doses in the scale of things stop working within 24 hours. But at that point, they didn't have very long left anyway, so maybe it's different practises, and maybe it's about how healthy the body is when the process is initiated.
- stef25 8y ago
  Same here, in Belgium where euthanasia is legal. I have no idea why they made it last the 5 days that it took.
matte_black 8y ago
Just to be clear, the morphine was her request, or was it some sort of vengeance on the part of the hospital?
- pwned1 8y ago
  I don't think she specifically requested morphine, just that she no longer be treated. I'm honestly not sure how the decision-making process worked. It was kinda odd to me because no one said that she was going to be completely knocked out for the rest of her few days. If I had known exactly how it was going to work, I would have asked to talk to her more before they initiated the process. But I got there the day after she requested the cessation of care and she was out, never to be conscious again. She was then moved to hospice with a locked-up morphine machine and we all sat there for several days, watching her die. To call it vengeance would be inaccurate.

GoodOldNe 8y ago

I disagree with some of the above posters. This is often confused with, but is not the same thing as, physician aid-in-dying or euthanasia. People do talk about this in hospitals, and it is appropriate treatment for many patients at the end of life if they are suffering. The ethical principle of double effect makes this permissible in these contexts. If the aim of the treatment with a benzodiazepine or opiate is to reduce suffering, the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications to achieve the first aim of relieving or preventing suffering. Suggesting that this is a "workaround" for euthanasia distracts from the fact that this is not available as a treatment for most, if not almost all, dying patients. It is very different from physician aid-in-dying and is not a replacement for these other forms of end of life care.

pfortuny 8y ago
As a matter of fact, when curing is impossible, what doctors must to is to relieve the pain, nit to prolong life. That it has a negative outcome is (with the “proportionate” clause) secondary.
- jessriedel 8y ago
  > what doctors must to is to relieve the pain, nit to prolon No, doctors implement the patient's wishes. If the patient would like to live as long as possible, even if in pain with an incurable condition, that's the patient's prerogative.
  - pfortuny 8y ago
    Nope: doctors are not obligated to provide care they deem futile. This is essential: you cannot force anyone to do something against their conscience. Notice the”futile”.
    - jessriedel 8y ago
      <eyeroll>. It's obvious that doctors don't have to implement any patient desire at all. It must be part of the doctor job description, and sham medicine is obviously not included. But living longer, even with pain and even if the patient is still going to die, is not considered futile or a sham. (We all have an incurable disease because we all are going to die eventually.) Doctors are of course able to decline to participate, but they must refer you to another doctor.

stef25 8y ago

A few years ago my 90 year old grandma had a stroke in her sleep and the doctors told us she'd never really have any more quality of life and what's usually done is just pull out the sugar drip and basically wait for her to (for lack of better word) starve to death. After a day or two with no food or water she'd drift in and out of consciousness. It was amazing how she would even refuse my offer of wetting her lips with a sponge. During a time I was alone with her, her breathing became so heavy, this rattling sound. I asked a nurse "can't you give her something" and he gave her a shot of morphine and a few min later the breathing stopped and that was that. It was quite a humbling experience. Another thing that comes to mind is the "Brompton cocktail", a mix of morphine/heroin, cocaine, alcohol and thorazine against the nausea: https://en.wikipedia.org/wiki/Brompton_cocktail https://en.wikipedia.org/wiki/Brompton_cocktail

jonhendry18 8y ago
When my dad was dying it took 4 days after he became unresponsive. They administered morphine all along but not enough in one dose to be fatal. The rattling came on day 2-3, then quieted down. The strange(?) thing was that he lost consciousness and became unresponsive shortly after my brother arrived at the hospital. My brother was the last of the immediate, local family to arrive. My dad acknowledged his presence and in a few minutes was unconscious. Then on the fourth day he passed shortly after his grandkids arrived from the airport.
cinspicuous 8y ago
http://charltonteaching.blogspot.com/2018/06/the-brompton-cocktail-and-decline-of.html http://charltonteaching.blogspot.com/2018/06/the-brompton-co...

intralizee 8y ago

I've been trying to receive "euthanasia" for myself. I suffer gender dysphoria. I think it's a shame how society can discriminate a person with an illness compared to another group with a different illness; when it comes to receiving what is considered a medical treatment for ending pain. The terminology for who qualifies & receives euthanasia is flexible in the jurisdictions that offer it by terminology but people will warp their own perception around who they view should have a right to qualify to die by personal opinions without understanding the pain of another. Society doesn't help some people and euthanasia can be a real solution for the current system until real help evolves; where euthanasia can be less thought about.

hartator 8y ago
I am sorry about that that. Feel free to reach me via PM (email in profile) if you want someone to talk to.
ashleyn 8y ago
It's far beter to consider current, effective treatments for this instead of considering euthanasia for it.
- intralizee 8y ago
  I'm on the current medical treatment I can afford. I wouldn't combine the word effective in that sentence. I've given it enough time to decide the treatment is unacceptable in making the pain be bearable. I'm at a point where it's euthanasia or suicide and which is the case for people seeking euthanasia. Some people have more pain than others with the same illness classification and depending on how life transpired. It shouldn't be an outsider limiting others scenario.
  - md224 8y ago
    I’m sorry you’re going through so much suffering. I personally don’t think anyone experiencing mental anguish should commit suicide before giving “drugs of abuse” a try. These drugs are so popular and addictive precisely because they’re so good at making you feel better. They’re a last resort, but I think they’re a better last resort than suicide. Here’s a link to a recent Reddit comment where I discussed this idea, along with suggestions of drugs to try: https://www.reddit.com/r/depressionregimens/comments/8wcv8f/comment/e1uym6u https://www.reddit.com/r/depressionregimens/comments/8wcv8f/...

danielam 8y ago

End of life decision-making vis-a-vis the doctrine of double effect[0]. This section addresses specifically some of the claims made in the posted article. [0] https://plato.stanford.edu/entries/double-effect/#End https://plato.stanford.edu/entries/double-effect/#End

vslira 8y ago

Something I wish was more common is some type of therapy for treating death anxiety. I read somewhere that LSD can reduce the fear of death[0]. I can think of few things I’d like more in life than not being afraid to cease to exist[1] in my deathbed. I suppose those going through terrible terminal illnesses suffer enough to accept death over the suffering, but I don’t see why one should need to experience such extremes to accept the inevitable. [0] That’s a big maybe, don’t go around self medicating serious issues based on unsourced comments on unregulated drugs [1] I know religion or philosopy can sometimes fill this gap, but let’s remember those who are skeptical or didn’t have a lot of time to prepare

wpietri 8y ago
I had one parent die from brain cancer in 2011, and another was just diagnosed with a terminal brain tumor, so this is on my mind. Honestly, I don't think this is a problem specifically for the person with the terminal illness. So much of the difficulty comes from everybody else. American culture does not prepare people to face death, either their own or of loved ones. So a lot of my energy goes in to helping other people manage their feelings at a time when I don't have energy to spare. I want other people to take LSD or do Zen retreats or serve at a hospice or whatever they need to do so they can manage their own death anxiety. Speaking of which, I strongly recommend the "ring theory of grief" article. The gist is that if bad shit is happening to somebody, you help them rather than imposing on them. It sounds obvious, but I promise that it's unfortunately rare. Here's the article: http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407 http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-s...
- Omnus 8y ago
  I'm skeptical that any of those things actually "prepare" people to face death in the first place. Feeling like you're "prepared" weeks, months, or years before the final hours of your self or a loved one does not necessarily translate to those final moments when you are actually going through it.
  - hanshan 8y ago

Steve0407 8y ago

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ananonymoususer 8y ago

When my mother was dying from pneumonia (after it had destroyed her lungs), she had been on a respirator for several weeks and was only getting worse. She also had been unconscious because she had been "fighting" the machine. She had told us that she never wanted to end up that way, but she did not have an advance directive on record. The family made a decision to pull the plug and her doctor administered a large dose of morphine to ease her passing. She went peacefully. We were all very grateful to the doctor for this.

alberthartman 8y ago

Best choice is to follow the wishes of the person who’s in the heat of the battle. Be cognizant that those wishes may change as the illness progresses. Do it as being of maximal service to the loved one.

JudasGoat 8y ago

I watched this in action with my father's death. My mother had a long nursing career and had a talk with the doctor that lasted about 15 minutes (it was 20 years ago), after that a large morphine dose was added to his IV. Within 5 minutes I watched my dad stop breathing. My Dad was in his early sixties, morbidly obese, this condition was aggrevated by his lifelong fear of doctors. Dad needed hip replacements but wouldn't consider it because of his medical phobia. This caused his lack of mobility which caused urinary track infections from his dificulty moving to a toilet chair. He was in the hospital for chronic UTI's when my mom made the decision. He was lucent and not at all ready to die. Mom has passed too and it feels cathartic to say this.

SteveNuts 8y ago
So your mom just straight up murdered your dad? Why on earth would the doctor authorize giving him a lethal morphine drip for a UTI? What was the fallout from the autopsy, etc.? This baffles me
- JudasGoat 8y ago
  In my opinion the medical profession know quite well how to run the system. My mom spent most of her career in a terminal cancer hospital. I was an active opiate addict at the time, so my opinion wasn't solicited.
- ams6110 8y ago
  Autopsy is often not performed. Neither of my parents were autopsied after they died.

mirimir 8y ago

> Doctors wrestle with what constitutes unbearable suffering ... Huh? It's whatever a patient says it is. Otherwise, it's torture.

saagarjha 8y ago
What if the patient cannot speak?
- mirimir 8y ago
  Well, it's a tough call if they're totally paralyzed. That's quite the horror, no? Brings to mind Catch 22, and that Metallica song. But otherwise, there are other ways to communicate.

Simulacra 8y ago

I think it should always be left up to the patient, what they wish to do, and doctors should support it. If it gets to that point, I would very much like to spend my last days stoned and comfortable, and die peacefully. But if I have a terminal illness or I am in great pain, I very much want that choice of when to go.

BrandoElFollito 8y ago

I would be thrilled by the possibility of having an implant which requires a timed confirmation (every 6 months or so) and if there is no, it would pour poison in the bloodstream. I am terrified by the possibility of not being capable to end my life when I want to, either because I am too disabled, or senile to the point of forgetting to do that.