Physician Assisted Suicide

[coquina]

My mom was 95 when she broke her hip and subsequently developed a staph infection between the bone and prosthesis. She fought hard to overcome it despite getting bedsores and then having an idiot in the nursing home dislocate her hip. I had never heard her cry before, but when the nurses changed her dressings, I could her her screams at the opposite end of the hall. Then the infection went septic and she had a massive GI bleed.

 

I called her doctor and told him "no more". He gave her a fentanyl patch and an increased her morphine dose and she just wound down like an old clock.

 

During the last day, I wouldn't let any of the nursing staff near her, not even to take her vitals - I figured they had tormented her enough.

 

Doctors commonly hasten the death of the terminally ill - I believe the term commonly used is to "snow" them with pain meds.

 

In Mom's case I guess it was "physician assisted homocide" because it was me that asked him to terminate her suffering. I'd do it again.

 

I do think that terminally ill patients should have the right to palliative care and the right to die with dignity. I am a widow - my husband didn't have a terminal illness - he had been fine the day before, but when I woke up the next morning he was dead. However - I participate in another forum for the "involuntarily unspoused" and have read some real horror stories of long years of debilitating illness.

 

I will say that several of the spouses did commit suicide so they could die with dignity. None of them did it with their spouses knowledge or approval, and I believe the suicide increased their bereavement. Sometimes there are no good answers...

[MolecularMan14]

I honestly dont know what to say to that, other than Im sorry. I dont like asking, but would anyone mind if I use their opinions in the forum as quotes? I am now doing a debate about PAS, and I dont know where else to look.

Does anyone have any good resources for this topic, or another opinion, whether it be in favor or against.

Thanks once more.

 

Edit* Im not sure If I posted this here before, but I would just like to say that, yes, I am in favor of euthenasia, when circumstances are at a condition worse than death.

[Drug addict]

a couple of journals you might want to look at:

 

The journal of medical ethics: http://jme.bmjjournals.com

the british medical journal: http://bmj.bmjjournals.com

JAMA: http://jama.ama-assn.org

New England Journal of medicine: http://content.nejm.org

 

and any other medical journals you can get access to, such as the Lancet.

 

there's also the PJ: http://www.pharmj.com

 

hope these are of some use

[YT2095]

what ever happened to "Do No Harm"?

[coquina]

I think the hardest part of it is to be sure the person really wants to die.

 

The person might get the impression that his family wants him dead and ask for it to relieve them of the financial burden of medical expenses and nursing home care.

 

If the patient is terminally ill, and can push a button, I think the thing to do would be to give him a morphine machine with out the governor that limits the dose.

[Artorius]

I recently seen a documentary on this.Some people who were going to sign a living will...they had been depressed due to serious illness.Upon recovery they were all glad to be alive and that they did not go through with signing it.

[YT2095]

I can well beleive that!

 

I`ve known a few "Suicides" that ended that way too, Ultimately pleased that it DIDN`T work for them! )))))

[sepultallica]

I don't believe suicide is illegal anywhere; assisting in a suicide is illegal.

 

actually, suicide is considered murder isnt it? by definition anyways. but not that youd get a judge or jury to convict anyone of murder in cases of suicide.

 

on a different note, ive read in a couple books that there isnt much pain that cant be relieved by treatment.

[Artorius]

erm...you ever ate a crisp when you have mouth ulcers m8...bloody hurts!!

 

 

crisps are potato chips..some are even supernatural

http://www.chipofthemonth.com/html/gallery.html

[sepultallica]

what the hell is a crisp?

[Glider]

what ever happened to "Do No Harm"?

Oh, it's still there. The problem is it isn't alone, it coexists with "Ease Suffering" and "Preserve Life".

 

This is where the core of the conflict lies. In cases of intractable pain associated with a terminal condition, the level of drugs used to "Ease suffering" does harm (if the intent is also to preserve life).

 

Under those circumstances, interventions used to preserve life also does harm, because it prolongs suffering.

 

The essential argument is about how we deal with those cases where the principles "Ease Suffering" and Preserve Life" come into direct conflict.

 

Of all three, the principle "Do no harm" is the most flexible. Under this principle, the short term cost and long term gains must be weighed carefully. If the principle was taken literally, we couldn't use chemotherapy (a seriously poisonous mix of cytotoxins). But the short term harm is weighed against the longer term gain of defeating a potentially lethal disease.

 

In reality, given that medicine is actually quite brutal in many cases, the principle "Do no harm" translates as "Do the least harm" or "Do the best for your patient". This means that the other principles, "Ease Suffering" and "Preserve Life", must be weighed against each other on the merits of each individual case. In every single case, the degree of suffering, its controllability and the potential for life and quality of life must be considered.

[YT2095]

I agree that Quality of life is far better than Quantity (In my opinion).

 

but I can`t help but feel that this idea (like many others) is and will be subject to abuse, and certainly Mistakes (

I consider ONE mistake, far too many.

[goodyhi11]

what i think life is, first we should have a quantity life style. for instance we should experience different things. quality might be important but quality can't always brings you happiness.

[slickinfinit]

If I was in such pain that I dreded being awake I would want the option of suicide, but I cant speak for anyone else or make that decision for them and will I be in a cognitive state of mind being terminaly ill ? That is the most important question to answer before implementing PAS,is this what is best for the patient in making them stop suffering.

[Glider]

but I can`t help but feel that this idea (like many others) is and will be subject to abuse' date=' and certainly Mistakes (

I consider ONE mistake, far too many.[/quote']

I may be wrong (Christmas eve tequila and all that), but weren't you in favour of capital punishment in another thread?

[coquina]

I think this is the most important part of being able to choose your family physician (or group) that will interact with your physical problems throughout your life.

 

When a doctor has been treating a patient for 30 years, s/he knows you as well as your family does, and can talk to you in the same manner.

 

This can't happen in a situation where group coverage dictates you see the "doc du jour" - the guy doesn't know diddly about you, your personality, or whether you prefer quality of quantity of life.

 

My mother's doc was our family doc, and my friend. When push came to shove, we together decided not to prolong an immensely painful situation that was destined to the same outcome.

 

It is a terrible, terrible shame, that more people cannot have that same relationship with their family doctor.

 

As far as I'm concerned "playing God" doesn't come into it. A doc "plays God" (I'm not criticizing, please understand) when s/he recommends a cutting edge technology that may or may not extend a person's life.

 

There has to be a point that a patient and doc come to the understanding that more treatment is fruitless. When that point comes, the decision to be made is whether the patient endures the end cold turkey, or benefits from whatever medicines are available to alleviate pain and suffering.

[sepultallica]

If I was in such pain that I dreded being awake I would want the option of suicide.

 

even if there was treatment to relieve the pain?

[slickinfinit]

even if there was treatment to relieve the pain?

That is a very complicated issue, in my opinion yes if u can keep the pain away and keep the person alive then there is no point to refuse treatment but when suffering cant be cured and the person has made the choice to have a doctor assist in a peaceful death they should have the right. This is a issue that we all will probably have to deal with so I cant say what is the right thing to do in every case because they will all be differant and some people believe differant things.

[sepultallica]

That is a very complicated issue, in my opinion yes if u can keep the pain away and keep the person alive then there is no point to refuse treatment but when suffering cant be cured and the person has made the choice to have a doctor assist in a peaceful death they should have the right. This is a issue that we all will probably have to deal with so I cant say what is the right thing to do in every case because they will all be differant and some people believe differant things.

 

i posted earlier, that i read in a couple different books, that most pain can be treated. i dont know how acurrate that is but if it were true, would we be justified in allowing physician assisted suicide? is the point of PAS only to relieve pain or to relieve mental suffering as well? can PAS be justified if it is intended to relieve mental suffering?

 

 

that's for anyone.

[muad'dib]

i posted earlier, that i read in a couple different books, that most pain can be treated. i dont know how acurrate that is but if it were true, would we be justified in allowing physician assisted suicide? is the point of PAS only to relieve pain or to relieve mental suffering as well? can PAS be justified if it is intended to relieve mental suffering?

 

 

I read an article in my Bioethics textbook that said often (I don't remember the actually statistics, I will try to find them) when terminally ill patients request suicide it is for psychological reasons, such as isolation, a feeling of hopelessness, etc. If we were to say yes it is okay to use PAS to relieve this mental suffering people suffering from bipolar disorder will probably be seeking PAS as a solution, as well as anyone suffering any mental pain; where would we draw the line?

[MolecularMan14]

Peter Rogatz, Greenhaven Press, 2003

 

The slippery slope argument discounts the real harm of failing to respond to the pleas of real people and considers only the potential harm that might be done to others at some future time and place. As in the case of other slippery slopes, theoretical future harm can be mitigated by establishing appropriate criteria that would have to be met before a patient could receive assistance.

 

1. The patient must have an incurable condition causing severe, unrelenting suffering.

2. The patient must understand his or her condition and prognosis, which must be verified by an independent second opinion.

3. All reasonable palliative measures must have been presented to and considered by the patient.

4. The patient must clearly and repeatedly request assistance in dying.

5. A psychiatric consultation must be held to establish if the patient is suffering from a treatable depression.

6. The prescribing physician, absent a close preexisting relationship (which would be ideal) must get to know the patient well enough to understand the reasons for her or his request.

7. No physician should be expected to violate his or her own basic values. A physician who is unwilling to assist the patient should facilitate transfer to another physician who would be prepared to do so.

8. All of the foregoing must be clearly documented.

[Artorius]

This structure and format is very similar to what they already have in switzerland,is that were you got this list from ...Switzerland by the way has the highest PAS in the world.

My own personal opinion is we need no change in the law.To safeguard members of the public PAS should remain a criminal offense.The doctor-patient relationship in a severe terminaly ill scenario,is a private and unique one.It is for the people concerned and wether the doctor chooses to ease the suffering of his patient is a very upsetting and private act.Remaining a criminal offence will desuade and hopefully catch any mad doctors bumping off people willy-nilly.Harold shipman springs to mind,im sure he helped a few really ill patients however whatever clinical illness he suffered from gave him free reign to murder people.

If it is ever de-criminalised im certain no matter what guidlines are in place they will always be ways around it and falsification.You have to realise the moral code and duty these people swear to uphold when we place ourselves in there care.What would be their moral guidence when their board of directors at the local hospital trust says "oh we cannot afford such and such drugs just put them out of their misery...besides we need the bed" !!!

[sepultallica]

I read an article in my Bioethics textbook that said often (I don't remember the actually statistics, I will try to find them) when terminally ill patients request suicide it is for psychological reasons, such as isolation, a feeling of hopelessness, etc. If we were to say yes it is okay to use PAS to relieve this mental suffering people suffering from bipolar disorder will probably be seeking PAS as a solution, as well as anyone suffering any mental pain; where would we draw the line?

 

where do we draw the line indeed. that's always the final answer. i think i would have to go on the side of, if a patient has significantly lost quality of life and the bad outweighs the good, with no chance of reversal. i dont think that it should be strictly for those in pain where treatment cant help.

[MolecularMan14]

This structure and format is very similar to what they already have in switzerland' date='is that were you got this list from ...Switzerland by the way has the highest PAS in the world.

My own personal opinion is we need no change in the law.To safeguard members of the public PAS should remain a criminal offense.The doctor-patient relationship in a severe terminaly ill scenario,is a private and unique one.It is for the people concerned and wether the doctor chooses to ease the suffering of his patient is a very upsetting and private act.Remaining a criminal offence will desuade and hopefully catch any mad doctors bumping off people willy-nilly.Harold shipman springs to mind,im sure he helped a few really ill patients however whatever clinical illness he suffered from gave him free reign to murder people.

If it is ever de-criminalised im certain no matter what guidlines are in place they will always be ways around it and falsification.You have to realise the moral code and duty these people swear to uphold when we place ourselves in there care.What would be their moral guidence when their board of directors at the local hospital trust says "oh we cannot afford such and such drugs just put them out of their misery...besides we need the bed" !!![/quote']

 

First off, no, I used an online debate resource center for a class debate on PAS. So, onto your other arguements-

Peter Rogatz, Greenhaven Press, 2003

It is argued that permitting physician-assisted suicide would undermine the sense of trust that patients have in their doctors. This is curious reasoning; patients are not lying in bed wondering if their physicians are going to kill them--and permitting assisted suicide shouldn't create such fears, since the act of administering a fatal dose would be solely within the control of the patient. Rather than undermining a patient's trust, I would expect the legalization of physician-assisted suicide to enhance that trust. I have spoken with a great many people who feel that they would like to be able to trust their physicians to provide such help in the event of unrelieved suffering--and making that possible would give such patients a greater sense of security.

 

Kenneth Cauthen (who happens to be a Baptist Minister), Greenhaven Press 2000

there are times when we need to rethink received wisdom by subjecting our principles, codes, and traditions to a fresh exposure to real life experience. Sometimes ideals that are designed to protect and enhance life may actually degrade life and be the source of unnecessary suffering

 

James D. Torr, Greenhaven Press 1999

Slippery slope arguments against euthanasia hold that if voluntary, physician-assisted suicide is allowed in certain cases, it will inevitably be allowed in cases that are not as clear-cut, and eventually there will be an unstoppable army of euthanasia-happy doctors running the nation's hospitals. Once terminally ill patients are allowed access to assisted suicide, the argument goes, no amount of vigilance can prevent the ensuing bloodshed. Women, the disabled, the poor, the elderly, and any number of minority groups will become victims of forced euthanasia, or so Americans are told.

If this scenario sounds alarmist, that's because it is. Slippery slope arguments are designed to play on people's fears. But where is the evidence that such nightmarish scenarios are unavoidable? Why must euthanasia for those who want to die inevitably lead to euthanasia for those who do not if there is a clear law that requires the patient to request it multiple times and in the presence of witnesses? How can euthanasia for the terminally ill be transformed into euthanasia for people who are not dying if the law clearly requires such a diagnosis from a doctor?

 

If it is ever de-criminalised im certain no matter what guidlines are in place they will always be ways around it and falsification.

From the criteria listed in my previous post' date=' please provide a way through an unseen loophole, just to better the process. Illegal actions take place now, so in debate terms, you arguement is non-unique.

 

"oh we cannot afford such and such drugs just put them out of their misery...besides we need the bed"

...cold and callous...why would the hospitals have the ability to dispose of patients without their concent...as seen in the criteria above- specifically #3, #4, and #6

 

I dont mean to shoot anyone down, but I feel that these are some of the most important arguments.

[Artorius]

In short your criteria still allow a homicidal doctor to falsify and kill people.Perhaps adding that an independant board of physiciansm must sanction the patients request.And only after 2-3 doctors from different practices appeal on the patients behalf.Do you think that this may be a added criteria.