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 The Issues
 Physician-Assisted Suicide (Page 1)
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| Author | Topic: Physician-Assisted Suicide |
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Stamm44 Moderator Posts: 63 |
posted 07-30-2000 07:39 PM
  
Should physician-assisted suicide be made legal? What are the pros and cons involved? |
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geedel Member Posts: 13 |
posted 08-03-2000 01:37 AM
I am in favor of legalizing assisted suicide, but not limiting it to physicians. Doctor already have too much power over life and death. All a physician is needed for now is to prescribe the necessary drugs; who administers them should be left up to the sick person. Further, I'm for removing the silly limit that assisted suicide can only be done for the terminally ill, those with six months or less to live. Usually, those are people who don't need to suicide to escape the horrors of their condition; they will escape soon. The people who really need to escape by gentle means are those being slowly destroyed by chronic diseases for which there is no cure -- cystic fibrosis, multiple sclerosis, Altzheimer's, Huntington's chorea, ALS, etc. It is beyond me why society insists that these people should suffer the long agony of their diseases. It is cruel and utterly inhumane. |
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dorothy Member Posts: 14 |
posted 08-08-2000 10:06 PM
You cannot legalize this as the Supreme Court has spoken in 1997 saying that Americans do not have a Constitutional right to Physician Assisted Suicide. The only way left is by state initiative. That's what the Supreme Court did. It threw it back to the states. So far only Oregon has a track record for PAS (Physician Assisted suicide) and the record is not good - full of abuses etc. A lot of bioethicists have written about Oregon's first year. One can look to the Dutch too for the inherent abuses. email me if you have more questions. cheers/peace Dorothy guellec@purvid.purchase.edu |
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swilford Member Posts: 14 |
posted 08-09-2000 09:13 AM
I do not believe in physician assisted suicide and do not think it should be made legal. I have been a hospice nurse for 21 years and absolutely can attest to good management of symptoms, both spiritually, physically and emotionally. This is not to say that there needs to be much more work in this area. But let us concentrate on good hospice and palliative care and not killing people. Let us spend our money on valuing life and not de valuing it. There is opportunity at the end of life that is taken away by suicide. There would not be any time for growth and self actualization. Suicide takes away this opportunity for the patient and the family. |
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Stamm44 Moderator Posts: 63 |
posted 08-10-2000 12:55 AM
quote: This seems to me a very important point which the proponents of assisted suicide need to address. |
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geedel Member Posts: 13 |
posted 08-12-2000 06:21 PM
Opponents of assisted suicide cite abuses in Holland, suggesting the Dutch aren't civilized enough to correct the abuses -- if they existed. The stories of abuses in Holland are by and large gross exaggerations put out by US and Dutch opponents of assisted suicide. Opponents of assisted suicide also talk of the spiritual and emotional growth that can take place in the last days of life, suggesting that someone who decides on an assisted suicide hasn't gone through considerable growth, talked with family and friends about the decision, and made peace with God. In fact the person deciding on assisted suicide is far more likely to have accomplished these important activities than is the person who thinks the doctors will restore him or her to health. And yes hospice is a wonderful thing for those who don't mind dragging things out, but what a waste of resources when there are 40 million Americans without health insurance, 10 million of them children. Hospice is a great improvement over most of the alternatives, but it is just another part of a medical system that is wasting resources on death avoidance instead of using them for real health care. |
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michael5070 Member Posts: 18 |
posted 08-13-2000 09:28 AM
geedel, I don’t think anyone doubts, by this time, that you are in favor of euthanazing a wide variety of individuals for a broad range of reasons, including economics. You seem not the least bit interested in discussing the issues involved, only in denigrating all who possess views other than your own. As one who has worked intimately with hundreds of dying people over a period of many years, I am not so much interested in your outlandish views as I am in how you came to possess them. In other words, what occurred in your personal life that has made you such a doggedly ardent proponent of euthanasia on a large scale? |
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Stamm44 Moderator Posts: 63 |
posted 08-17-2000 10:18 PM
quote: From what i have seen of hospice, it does not drag things out, rather helps ease the last days of those whose illness is likely terminal. The resources devoted to hospice are not taken from the 40 million Americans without health insurance - hospice care in America with all its professionals and volunteers could end tomorrow and those 40 million would remain uninsured. That problem is a political one, a result of the struggle over issues which have nothing to do with hospice. |
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MrMello Member Posts: 21 |
posted 08-19-2000 11:58 AM
Having worked in a busy Burn ICU for years and recently been getting more involved in the end of life issues from a hospice or at home point of view my opinion is that we do a terrible job of symptom control and pain management. Many choose to die as opposed to live in pain and suffering and who can blame them. I believe that we as a society are just now becomming mature enough to look at some of the real tough issues about ourselves, our fear of death being just one of them. This initial effort at self awareness is in my view admirmable and it will be up to people who are in contact with the people who are in pain, be it physcial, emotional or spiritual pain to truely become patient advocates. Begin to "be" with people as opposed to "do" to people and assist with the natural pathophysiological aspects of healing via and individuals faith and belief. Faith being more that religion, being the essence of themselves combined with the best of allopathic medicine and whatevewr else they feel could work for them. Delivered in a non judgemental health care system by people who have done and are doing the self work needed to accomplish such intimate work. I sense assisted suicide could be and option to untracable pain but only in such dire situations. Michael (aka MrMello) MDWpartner@aol.com |
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michael5070 Member Posts: 18 |
posted 08-19-2000 08:32 PM
MrMello brings up some interesting issues regarding pain and pain management. In my experience, physicians tend to be more liberal when ordering pain medications with terminal patients than with non-terminal patients, and are most liberal with terminal patients after they have signed into a hospice program. Since the bulk of MrMello's experience appears to have been "in a busy burn ICU," I suspect that has been instrumental in forming his opinion "that we do a terrible job of symptom control and pain management." In non-hospice patients I would agree with that opinion, but in hospice patients, I would not agree at all. However,there is such a thing as a hospice patient with intractable pain. Such cases are rare, but they do happen and are heart-rending to patient, family and clinician alike. Ira Byock, MD, a leading physician in palliative care, addressed "Terminal Sedation" in an article which appeared in the Annals Of Internal Medicine (see Dr. Byock's website @ www.dyingwell.com... look under "Pertinent Articles.") Just as "AA" spawned a dizzying array of 12-step programs, I suspect that what is being learned in hospice today will eventually lead to much improved pain control for everyone, not just the terminally ill.
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MrMello Member Posts: 21 |
posted 08-20-2000 10:07 AM
Michael5070, I must tell you I am new to this discussion forum and I have been reading all I can of the posted material, I have found your responses to be heartfelt and it's obvious you have a wealth of experiance. Your website is wonderful, I love the music and the quotes, I will return again often I am sure. My experiance has been mostly in "a busy Burn ICU", but I have found some similarites in the last year of home hospice care. I feel we as health care provides fall short in the education department. Issues such as "Principle of Double Effect" when it comes to pain management, the need of hydration and nutrition in the terminaly ill, as well as the assessment of the spiritual needs of our patients. I have been surprised to find that even hospice nurses have difficulty "being" as as opposed to "doing" when caring for people. I don't know if this is unique to my geographic location or maybe even just the particular hospices I have associated with but the mind set is there. Acting like a nurse or doctor or care provider is less personal, less vulnerable then being ourselves with people, clinicial tasks are solid and we can find safer boundries in the care delivery. Opening up to anothers pain is another story, when I talk of pain control issues I speak of the bi-direction flow of energy between humans as they interact, we can feel their pain, we act and react in direct proportion to our ability to cope with the experiance. I have met some progressive insightful people but I believe we as a profession are in the infancy of catching up emotionaly and spiritual with what it is we intuitively know. It's a process, self work is a prerequsite, one which is not taught nor given the attention it demands. Issues of pain control are multidementional, addressing the problem holisticly body, mind , and spirit, is in my opinion where we fall short, be in in an ICU or someones home. Thanks for your response and I look forward to more conversation...... |
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geedel Member Posts: 13 |
posted 08-27-2000 07:25 PM
[QUOTE]Originally posted by swilford: But let us concentrate on good hospice and palliative care and not killing people. Let us spend our money on valuing life and not de valuing it. Suicide does not necessarily devalue life. In fact, it may affirm it in a way that is far superior to that simple definition of life that is only a beating heart and brain waves. A chosen death at the right time can be an affirmation of the larger life of the family or other group and an affirmation of life as independence, self-sufficiency, and contribution to society. |
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geedel Member Posts: 13 |
posted 08-27-2000 07:30 PM
[QUOTE]Originally posted by Stamm44: [B] From what i have seen of hospice, it does not drag things out[B] I stand properly corrected, Stamm44. You are correct to to say it is a political issue, not a medical one, and that hospice could vanish tomorrow and our 44 million uninsured would remain uninsured. The problem is a complex psycho-social one of death denial that leads society to spend billions on deny death when it is time (and often way past time) while providing insufficient funds for basic health care for the poor, minorities, and those who need broad social support in order to lead a satisfying life. |
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tap New Member Posts: 1 |
posted 09-08-2000 03:56 PM
I posited this information and question at a lecture given at a local college earlier this week sponsored by our local hospice, hospitals and colleges. If we can agree that death is inevitable, despite our best efforts to the contrary. If we can agree that what historically caused death were trauma and communicable diseases. If we understand that our three major causes of death now, heart, cancer and stroke, are consequences of life style choices. If we acknowledge that millions have been and continue to be spent on dealing with these causes of death. What would and could we, individually and as a society, choose to die from? Old age and the benign degeneration of our bodily functions until we peacably slip away into the night? Until we can acccomplish this why do we persist in subscribing to the technological impetus to keep us alive for as long as possible, at what costs, to achieve mental, social and spiritual states whose quality is something we would never consciously have chosen to devolve to, to postpone the inevitable? |
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Stamm44 Moderator Posts: 63 |
posted 09-08-2000 08:54 PM
quote: Tap, thanks for the provacative - if i can use the word- comments. I'd suggest first of all that heart, cancer, and stroke deaths are neither inevitable nor necessarily caused by lifestyle choices. For example, many nonsmall cell lung cancer deaths - a major cause of death these days, happen to nonsmokers. There are many causes of these diseases which are not lifestyle-related. Maybe genetic, maybe environmental, who knows? Next, some of these diseases can be defeated. While life expectancies for advanced lung cancer, for example, at diagnosis are poor, some people, with proper treatment, do manage to live far beyond the median with productive and rewarding lives. Thirty years ago, leukemia was usually a death sentence for children. Now most patients survive. Spending miney to keep patients alive while cures are found is a good investment - the problems we run into is when the docs try to postpone the inevitable, often at the family's urging even when the patient does not want extraordinary measures to be taken to prolong life. |
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Robert Lewis Member Posts: 6 |
posted 09-09-2000 02:30 PM
quote: (Originally posted by swilford: ....There is opportunity at the end of life that is taken away by suicide. There would not be any time for growth and self actualization. Suicide takes away this opportunity for the patient
*********************** The answer to this is very simple - this opportunity is not being "taken away" by anyone, except the terminally-ill persons themselves. It is inhumane and illiberal for society to take away from the individual the decision whether or not to take advantage of this "opportunity," and especially force this spiritual or emotional quest on people at the often outrageous costs in terms of pain and the loss of dignity that sometimes come with postponing an imminent death. It is also absurd to insist that, if the person eventually decides to commit suicide, that there will not be "any time" for all the wonderful things that may (or may not) occur in a lingering death. If anything, the prohibition on physician-assisted suicide shortens the time many terminally-ill persons may feel they have for this reflection and preparation: people often now feel that, if they wish to avoid a prolonged death, they must act while they have the physical capacity to do so. How much more time might many of these people take for this opportunity if they could trust that, when they reached the point they have rationally decided is an appropriate end, a physician would be there and willing to follow their wishes and bring a painless and prepared release? |
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genie Member Posts: 3 |
posted 09-10-2000 11:05 PM
quote: We rushed to my Dad's side on August 31 (other side of the country). He had been hospitalized twice over the past 6 months because of pneumonia but were led to believe that he was going to long-term care (ie improving). We arrived to find that he was combative, fluids and foods had been withdrawn and he was gasping for air. No one told us that in the previous incidents he had incurred irreversible lung and kidney damage, but his heart was very strong and so he lingered. The doctor didn't show up until 3 days later after we requested that fluids be re-started but his veins collapsed and we realized the futility. His pain medication was changed and he stopped being combative. We knew that he could hear us. He responded with single words. But the last 3 days were incomprehensible to me, watching him waste away, obviously thirsty (sucked on a wet cloth). Generalizations about the right and wrong of euthanasia are wrong. In my Dad's case, his last week of life there was no growth, no self-actualization, only gasping for air and wasting. Each situation must be judged on its own and demands cooperation between the doctors and the loved ones in deciding when enough is enough. Our attempt to broach this subject with the doctor, once he told us all the facts, was met with "it's against the law and my values". It's not about doctor's values, it's about stopping needless end-stage suffering. Now that I know that attitudes have still not changed, I will prepare to do for myself what doctors don't have the guts to do...help a person to die quietly, peacefully and with dignity. God bless my Dad |
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KathyMSW Member Posts: 2 |
posted 09-10-2000 11:50 PM
Those of you who are against PAS, sound like you are allowing your religion to get in the way of your rational thinking. A person's terminal illness is not about YOU. It is about THEM. As a society we have created a cultural lag in which we are now responsible to come to terms with. I presently work in Hospice, and yes, it is a wonderful service, but it is not enough. In addition, it does not tend to the needs of all of the dying. This is an issue of self-determination. Loss of control over one's life, is the greatest fear that the terminally ill have. Due to our own fears relative to death/dying, and bogus religious dogma,in addition to our remarkable technological advancements, we are forcing those with terminal illnesses to die painful prolonged deaths. And we are doing this all in the name of LIFE. Give me a break ! |
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KathyMSW Member Posts: 2 |
posted 09-11-2000 12:13 AM
quote: We rushed to my Dad's side on August 31 (other side of the country). He had been hospitalized twice over the past 6 months because of pneumonia but were led to believe that he was going to long-term care (ie improving). We arrived to find that he was combative, fluids and foods had been withdrawn and he was gasping for air. No one told us that in the previous incidents he had incurred irreversible lung and kidney damage, but his heart was very strong and so he lingered. The doctor didn't show up until 3 days later after we requested that fluids be re-started but his veins collapsed and we realized the futility. His pain medication was changed and he stopped being combative. We knew that he could hear us. He responded with single words. But the last 3 days were incomprehensible to me, watching him waste away, obviously thirsty (sucked on a wet cloth). Generalizations about the right and wrong of euthanasia are wrong. In my Dad's case, his last week of life there was no growth, no self-actualization, only gasping for air and wasting. Each situation must be judged on its own and demands cooperation between the doctors and the loved ones in deciding when enough is enough. Our attempt to broach this subject with the doctor, once he told us all the facts, was met with "it's against the law and my values". It's not about doctor's values, it's about stopping needless end-stage suffering. Now that I know that attitudes have still not changed, I will prepare to do for myself what doctors don't have the guts to do...help a person to die quietly, peacefully and with dignity. God bless my Dad[/B][/QUOTE] There is presently a shortage of hospice nurses due to the fact that the issue of dying counters the perspective in which they were trained. I find it interesting that a good # of those who are against PAS, happen to be hospice nurses. Hospice nurses are trained within the mentality of a medical model perspective. As a result, the death of a patient represents failure incarnate. In addition, they, and many others in hospice cannot come to terms with the fact that sustaining from all life prolonging efforts is in reality, passive euthanasia. And that by adminisering morphine (the common pain reliever of chioce in the field), active euthanasia is actually taking place. Morphine speeds up the dying process. Now, it is not evoking an event that is not inevitable to begin with, but it does speed up the dying process just the same. So...how bout we all get honest with ourselves. This is a HOT subject now. This is due to the fact that it is time for a change in how we as a society see and deal with death & dying. It is LONG overdue ! |
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genie Member Posts: 3 |
posted 09-11-2000 05:31 AM
KathyMSW said: In addition, they, and many others in hospice cannot come to terms with the fact that sustaining from all life prolonging efforts is in reality, passive euthanasia. And that by adminisering morphine (the common pain reliever of chioce in the field), active euthanasia is actually taking place. Morphine speeds up the dying process. Now, it is not evoking an event that is not inevitable to begin with, but it does speed up the dying process just the same. So...how bout we all get honest with ourselves. This is a HOT subject now. This is due to the fact that it is time for a change in how we as a society see and deal with death & dying. It is LONG overdue ! genie: Sorry, the reply with quote didn't work. It was exactly at the point when we were discussing whether the morphine was helping or hurting, and he had just told us that death was unquestionably certain within a week, if not days, that I suggested that perhaps increasing the morphine, in increments, might be a more humane way of helping Dad rather than just sit there and monitor his "un-progress"..ie which organ was going to give out first. It felt like we were in some kind of weird Dr. Who experiment and/or people (in the hospital) were placing bets on which organ would fail and how long it would take. It was not his will to live that kept him hanging on (he had already stated some months earlier his desire to end the suffering, he was 83, if there was no hope of some quality of life) but his heart was so strong, surprisingly so to the medics. Don't get me wrong..my "heart" was screaming "stay", but my head was saying "why?". He had already been a partial paraplegic for 35 years. The day they said "long-term" care, possibly flat on his back is the day he and we knew that death would be a blessing. Physicians and their "ethics" need to be re-evaluated, in my opinion. Where's the ethics in prolonging suffering? Where's the ethics in the "roller-coaster" he's gained two pounds and is now eating, he's lost 5 pounds and is having breathing difficulty, he's gained one pound and comfortable, he's lost 4 pounds and his lungs are full of fluid again...sheesh |
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Suni Member Posts: 7 |
posted 09-11-2000 02:09 PM
There are so many good and thought provoking posts here! I am very much in favor of assisted suicide. Like someone else said, I too question why it would have to be a doctor, altho to safeguard people there would need to be the doctor and/or hospice aware of what was to be done. We each need to be able to make that choice for ourselves, or some trusted friend or family member needs to make the decision if we can not. This should never be left up to the medical community. That's not anything against hospice care - they are wonderful, and when my Dad died in 1990 in his own home, Mom and I could not have managed it at all without our hospice nurse! For those who choose that way of death, hospice should be available. I will be forever grateful the hospice nurse who helped us through an awful ordeal. |
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Jim RN Member Posts: 3 |
posted 09-12-2000 07:46 AM
Legalization of physician assisted suicide poses numerous problems, not all of which can be addressed well in a single post on a web board, but I would like to share a few of them. Having worked for thiry years as a nurse, I have seen many horrible consequences of amateur suicide. If undertaken, suicide should certainly not be attempted by an amateur. The consequences of a botched job are simply horrendous. Jim |
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Jim RN Member Posts: 3 |
posted 09-12-2000 08:19 AM
[QUOTE]Originally posted by KathyMSW: >>Those of you who are against PAS, sound like you are allowing your religion to get in the way of your rational thinking. Gee Kathy, if I don't agree with you I'm not rational? >>A person's terminal illness is not about YOU. It is about THEM. Yes, but your buying into their HOPELESSNESS isn't helping them at all. >>As a society we have created a cultural lag
>>I presently work in Hospice, and... it does not tend to the needs of all of the dying. And suicide does? >>This is an issue of self-determination. Absolutely. Let's not drag unwilling participants into it. >>Loss of control over one's life, is the greatest fear that the terminally ill have. For some, that is true, however I would argue that suicide represents the ultimate in loss of control - quitting. For most clients, the greatest fear is fear of the unknown. What will the future bring? It is our job to do our best to illuminate and to educate. That is not accomplished by either horribilizing or trivializing the challenges that lie ahead. >>Due to our own fears relative to death/dying, and bogus religious dogma,in addition to our remarkable technological advancements, we are forcing those with terminal illnesses to die painful prolonged deaths. I find it inconceivable that these words are written by a hospice MSW. Nobody is forcing anyone to die. How very powerful and all-knowing you must be to determine which religious dogma is "bogus". >>And we are doing this all in the name of LIFE. Give me a break ! By all means, take a break... Jim
[This message has been edited by Jim RN (edited 09-12-2000).] |
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Stamm44 Moderator Posts: 63 |
posted 09-12-2000 08:33 AM
quote: Kathy, thanks for the perspective. This is a topic in which words are often used to hurt those on either side of the discussion or, imho, to play ethical gotcha games rather than address real situations. Your comments, like so many posted here, add to the discussion rather than subtract from it. It has been our experience from a patient and family perspective that Hospice nurses do not think in terms of their efforts, whether in non-medicine comfort care or in administering the pain-killers prescribed at Hospice, as amounting to passive or active euthanasia. Rather they seem to have their focus on the particular patient moving to the end of life at their own pace with the least possible pain and greatest possible support, without medical attempts for cures or life prolonging measures. I think there is a line which they and we feel is clear, at least to us, between what Hospice is doing and either passive or active euthanasia. I don't want to play with words here either. Withholding measures like feeding tubes (should that be the patient's wishes) is not euthanasia - it's unnecessary and harmful for the terminally ill patient. Medical personnal who have hangups about letting people die when their time has come (I know, that's a loaded term, but not meant to be here) should walk away from cases when the patient and family make their wishes clear. Defying the patient and family is playing God in an area where the Almighty has not made His wishes known. I am still very concerned that if that line is crossed into active euthanasia, that something may be taken from the patient and family, some opportunity for communication perhaps, if not growth. Looking at the series, I am sure that the families, and the patients (insofar as we can tell) at some of those events happening very near the end wanted the process to happen that way - and it would not ahve happened if physician-assisted suicide had moved the pace faster. I am not making a slippery slope argument that PAS would become common if legal, since in our culture, the overwhelming majority of medical personnel err if anything on the other side of the issue. I cannot walk down a corridor in a nursing home i visit hearing the moans of the demented and the hopelessly sick and pained individuals without being puzzled as a stranger in a strange land about the culture which imprisons some of these poor souls far beyond their years allotted. Nevertheless, I prefer in my and my family's case the attitude of the Hospice personnel we experience at our local Hospice. I think that they value life so much that they do not hurry the passage over to death, nor do they want that life devalued by pain or prolonged without quality. There's a balance there, bringing to mind lines from the poet Willaim Yeats of balance with this life, this death. When younger, I thought more often of the lines by Dylan Thomas of not going gentle to that good night. Yeats ages better. |
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Jim RN Member Posts: 3 |
posted 09-12-2000 09:52 AM
Originally posted by KathyMSW: >>There is presently a shortage of hospice nurses due to the fact that the issue of dying counters the perspective in which they were trained. I think the shortage of Hospice Nurses has more to do with the lousy pay. I worked 7 years in ER 13 years in critical care and 7 years in hospice. They are different jobs with different goals. >>...As a result, the death of a patient represents failure incarnate. This is simply untrue. >> sustaining from all life prolonging efforts is in reality, passive euthanasia. Some consider "passive euthanasia" to be an oxymoron. In our hospice we sometimes use blood transfusions to alleviate the suffering some experience from fatigue. We also use intravenous fluids in some situations to alleviate suffering that may come from dehydration in some instances. On the other hand, we frequently withhold intravenous infusions in situations that would likely cause more suffering - for example the person with ascites and low vascular volume, or the person who is likely to develop CHF from infusion therapy.
What hospice do you work for? Morphine in a few circumstances can have a negative effect on longevity, however we frequently use morphine to alleviate the shortness of breath that accompanies CHF. While not the primary desired effect, administration of morphine in this situation causes vasodilatation which unloads the heart, reduces the myocardial oxygen demand, and can (frequently) have a paradoxical effect of prolonging life. I don't mind prolonging life if the side effect is short term comfort. >>...but it does speed up the dying process just the same. In very few instances does morphine "speed up" the dying process. One example can be terminal COPD with a low respiratory rate and a high Oxygen flow. Yes, in that situation Morphine can "speed up" the dying process. In many other situations, however, the administration of Morphine SLOWS the dying process. Examples: >>So...how bout we all get honest with ourselves. You need to get educated before you can profess honesty. Deceit can be caused by ignorance as well as intent. Jim |
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