Physician assisted suicide

[pizzaman]

Voters in Massachusetts were the latest to weigh in on whether it should be legal for doctors to prescribe drugs to help terminally ill patients end their lives.
The vote failed.

NPR conducted a poll and found that 55 percent of Americans favored it, and 45percent were opposed.

Maybe because I'm getting on in years and I've seen family members linger between life and death in pain or because I've mercifully been with 5 dogs that had to be euthanized but I just don't understand why physicians are legally prohibited from assisting in suicide for the terminally ill.

I'm beginning to think that a move to Washington where I will legally be able to get really stoned and call the doc when I'm ready to check out is the answer.

Link: http://www.npr.org/blogs/health/2012...terminally-ill

[Cool Hand Luke]

Jack Kevorkian was a hero. It may take 10 years, 50 years or 250 years, but eventually he will get the recognition he deserves in trying to move forward this issue. We own our bodies. We have free will. No government can tell me how/when/why I choose to exit.

There is a stigma attached to his name -- there are certainly many valid criticisms of him to be debated -- but it is very slowly fading over time. Eventually universities and research centers will name buildings for him in appreciation of his efforts.

[FeelYourPaign]

I've been watching my in-laws BOTH suffer with dimensia and altzheimers for nearly 10 years. 10 years !! Sheesh.

In the case of my mother-in-law, there is no doubt in my mind that she is not living 1% the life that she would want to live. She cannot talk, she does not have the presence of mind to take care of her appearance, she does literally nothing. But her body is strong and she carries on breathing, eating, vegging. Sorry, but it is vegging. She would not wish this upon herself.

I'm a HUGE fan of Dr. Kevorkian and assisted suicide.
I've already told my children that if such a sad slow decline is obviously my future, expect me to take pills on whatever day I decide is the last good one.

[DaytonIllini]

Originally Posted by FeelYourPaign

I've been watching my in-laws BOTH suffer with dimensia and altzheimers for nearly 10 years. 10 years !! Sheesh.

In the case of my mother-in-law, there is no doubt in my mind that she is not living 1% the life that she would want to live. She cannot talk, she does not have the presence of mind to take care of her appearance, she does literally nothing. But her body is strong and she carries on breathing, eating, vegging. Sorry, but it is vegging. She would not wish this upon herself.

I'm a HUGE fan of Dr. Kevorkian and assisted suicide.
I've already told my children that if such a sad slow decline is obviously my future, expect me to take pills on whatever day I decide is the last good one.

Assisted suicide is not generally for those that are suffering from dementia. That would be assisted murder. To commit suicide you have to have the mental capacity to make that decision for yourself.

Think instead a quadraplegic or a cancer sufferer in incredible pain or a person facing ALS (Lou Gehrig's disease).

Assisted suicide doesn't apply to withholding ventilators or avoiding CPR/ACLS. Those things are already accounted for with Living Wills, DNR orders, etc.

Cool Hand may have it right but as someone that deals with the terminally ill everyday I can tell you the decisions are seldom straight forward and many of the people that ask about putting an end to it have viable and reasonably effective treatments available. Those who have nothing left to try are often the most desperate to avoid dying.

It's a very complex topic. Who decides? Who administers? I can tell you that almost every terminal cancer patient is given a prescription for long acting narcotics and is advised how the drugs are instantly lethal if something particular is done to them. In 20 years I have never had a patient purposefully do that thing and end it all. As a resident I did have one young woman use a .38 and end it. That was devastating for everyone involved.

Anecdotally, several of you know that my wife recently suffered a devastating illness where medically there appeared to be no hope. This Fall she was hanging upside down on a ventilator, on dialysis, on broad-spectrum antibiotics, on full dose pressors. Her doctors, and to be honest her husband, were giving up hope. But that lady is returning clothes at the mall as we speak. Miracles happen. Medicine is a wonderful thing. Prayer is better. Combined they can be remarkable. Giving up is understandable but seldom can we see the future with any clarity. Imagine if I had asked them to extubate her. Presumably I am a lot more qualified to judge when to do that than the average spouse. Some decisions should probably not be left to man.

[Cool Hand Luke]

Dayton, there's a whole lot going on in that post. Some things I would debate with you, but it doesn't seem like the proper time so that stuff can wait.

I'd just say I am sorry for what you and your wife went through but it was awesome to read that she is now doing well. Great story. I did not know. Would you be inclined to share what it was/is she was battling? Upside-down on a ventilator? Holy hell.

[pizzaman]

Originally Posted by DaytonIllini

Assisted suicide is not generally for those that are suffering from dementia. That would be assisted murder. To commit suicide you have to have the mental capacity to make that decision for yourself.

Think instead a quadraplegic or a cancer sufferer in incredible pain or a person facing ALS (Lou Gehrig's disease).

good post Dayton and thanks for perspective from the medical field. My father died after declining with Alzheimers and he was not capable of making any decisions at all. Suicide was not on his mind.

My mother simply got too old to function and openly expressed a desire to die in her last days. She still was of sound mind but her body failed her (she was 95) and she chose to basically starve herself to death. I'm fairly certain that she would have preferred to say goodbye and be peacefully euthanized.

Great news about your wife.

[DaytonIllini]

Originally Posted by Cool Hand Luke

Dayton, there's a whole lot going on in that post. Some things I would debate with you, but it doesn't seem like the proper time so that stuff can wait.

I'd just say I am sorry for what you and your wife went through but it was awesome to read that she is now doing well. Great story. I did not know. Would you be inclined to share what it was/is she was battling? Upside-down on a ventilator? Holy hell.

Thanks. She had sepsis. Started as a simple flu and somehow a bacteria got in her blood. Her pressure dropped so fast that her kidneys, liver and heart failed. The efforts to resuscitate her with fluids and blood products flooded her lungs. She doubled her body weight (almost) in 36 hours because of the excess fluids. Her clotting system fell apart and she had what is called multi-system failure. It was pretty gruesome. All's well that end's well I guess. All her organs have fully recovered and aside from some unexplained hair loss she's back 100%. A rough month though.

Originally Posted by pizzaman

good post Dayton and thanks for perspective from the medical field. My father died after declining with Alzheimers and he was not capable of making any decisions at all. Suicide was not on his mind.

My mother simply got too old to function and openly expressed a desire to die in her last days. She still was of sound mind but her body failed her (she was 95) and she chose to basically starve herself to death. I'm fairly certain that she would have preferred to say goodbye and be peacefully euthanized.

Great news about your wife.

Thanks.

There certainly are times when it would make sense. Sounds like you mother could really have avoided some unnecessary suffering if we had a better handle on how to deal with end of life situations. It is so complex and emotional and personal for each family. Hard to imagine a one-size-fits-all solution. I am sorry you went through that. It had to be awful.

[Cool Hand Luke]

Wow. That's nuts man. When she got the flu did she go the hospital to get IV fluids or anything? Is that where the bacteria could have come from?

The unexplained, out-of-the-blue illnesses are the worst. Not that any illness is good. I have been battling unexplained blood clotting in my lungs. Went through literally dozens of tests/exams. No answers other than the ruling out of certain causes. At the end of all the testing the doc literally says "Well, you're a bit of a mystery." Not exactly what you want to hear. It can be frustrating. So, I take Coumadin. I am treating a symptom rather than a cause. It can wear on you after a while. But it sounds like I have it easy compared to what she went through. That's just terrible.

There's weird stuff out there. One day you're fine, the next day you're barely hanging on, then a bit later you're returning clothes at a department store. Again, glad to hear she came out okay.

[illinicb]

Like most topics, there are all kinds of issues. I think if you believe that only God can give or take life, then you are anti-abortion, anti death penalty and anti assisted suicide. I think that is a simple, consistent stance to take.

I consider myself to be pro-choice (not pro abortion), anti death penalty (despite wanting to see certain people offed in a heartbeat) and probably pro assisted suicide. BTW, the use of "pro" doesn't sound quite right in this context.

I totally understand wanting to end one's life in a way to lessen the pain and financial burden to those that remain. As Dayton mentions, who decides? I might be fully in favor of it today, but when the time comes, I might feel differently.

From a political perspective, it becomes a difficult issue to address and the last people that like to address difficult issues are politicians. Also like decriminalizing pot, no politician wants to be "pro drug" or in the case of assisted suicide, "pro death".

[FeelYourPaign]

Originally Posted by DaytonIllini

Assisted suicide is not generally for those that are suffering from dementia. That would be assisted murder. To commit suicide you have to have the mental capacity to make that decision for yourself.

I do understand that and did at the time I posted as well. I just didn't express myself very well. The point I was trying to make is that watching someone live a life that they never wanted and always feared is frustrating. Knowing that someone can be locked in their body (ALS a great example), unable to achieve the end that they want would be beyond my own personal tolerance. I won't get there except accidentally. But that is just me, so I should have been more careful in expressing myself. Poorly done.

Glad to hear that your wife is well. That is wonderful.

As interesting for me is your general description of the pattern of end of life medicine and patient decisions. Your perspective is MUCH deeper than mine, so that was eye opening. Thanks for sharing. Message boards can be educational if people are willing to make them so

[bdutts]

Originally Posted by DaytonIllini

Thanks. She had sepsis. Started as a simple flu and somehow a bacteria got in her blood. Her pressure dropped so fast that her kidneys, liver and heart failed. The efforts to resuscitate her with fluids and blood products flooded her lungs. She doubled her body weight (almost) in 36 hours because of the excess fluids. Her clotting system fell apart and she had what is called multi-system failure. It was pretty gruesome. All's well that end's well I guess. All her organs have fully recovered and aside from some unexplained hair loss she's back 100%. A rough month though.



Thanks.

There certainly are times when it would make sense. Sounds like you mother could really have avoided some unnecessary suffering if we had a better handle on how to deal with end of life situations. It is so complex and emotional and personal for each family. Hard to imagine a one-size-fits-all solution. I am sorry you went through that. It had to be awful.

My mom passed away from sepsis after getting pneumonia. I'm glad your wife made it. Prayer is very strong. That and medicine kept my mom alive when she had ARDS when she coded at least twice.

I hope you and your wife have many, many happy years left.

[illinicb]

Originally Posted by pizzaman

My mother simply got too old to function and openly expressed a desire to die in her last days. She still was of sound mind but her body failed her (she was 95) and she chose to basically starve herself to death. I'm fairly certain that she would have preferred to say goodbye and be peacefully euthanized.

My mother was not in the exact same situation, but in general there is nothing worse than to still have all of your mental capabilities, but to have everything elese deteriorating. Knowing what you once were and could do and seeing it gone is very hard.

[illinicb]

Originally Posted by DaytonIllini

Thanks. She had sepsis. Started as a simple flu and somehow a bacteria got in her blood. Her pressure dropped so fast that her kidneys, liver and heart failed. The efforts to resuscitate her with fluids and blood products flooded her lungs. She doubled her body weight (almost) in 36 hours because of the excess fluids. Her clotting system fell apart and she had what is called multi-system failure. It was pretty gruesome. All's well that end's well I guess. All her organs have fully recovered and aside from some unexplained hair loss she's back 100%. A rough month though.

Dayton, I wasn't aware of your wife's situation, but that sounds unimaginable. Thank God for the outcome she and you had. I hope 2013 brings good health to your family.

[AK Illini]

pathetic that this is still an issue

[DaytonIllini]

Originally Posted by bdutts

My mom passed away from sepsis after getting pneumonia. I'm glad your wife made it. Prayer is very strong. That and medicine kept my mom alive when she had ARDS when she coded at least twice.

I hope you and your wife have many, many happy years left.

So sorry about your mother. It's an awful thing to go thru. ARDS is such a mess. Thankfully my wife's ARDS cleared fairly quickly. Some surivors require respiratory support for months.

Originally Posted by illinicb

Dayton, I wasn't aware of your wife's situation, but that sounds unimaginable. Thank God for the outcome she and you had. I hope 2013 brings good health to your family.

Thanks cb. Appreciate the kind thoughts. To you as well.

Originally Posted by AK Illini

pathetic that this is still an issue

AK, imagine a 25 year old with stage IV seminoma. Cure rates in the 70%+ range but requiring pretty nasty chemotherapy. He is afraid and asks to be euthanized. Would that be allowed? And if it is, why not allow anyone that wants to commit suicide to do so. A little depressed? Nobody will stand in your way. I think the situation of suicide is extraordinarily complicated. Most people probably would, at least, understand the desire to end things for someone with end stage cancer, no hope and horrific pain. What about the not so clear situations though?

I am all for finding a solution that liberalizes things somewhat. I just am not smart enough to know what that solution looks like.

[jmwillini]

It is a hard decision, and I guess I am in favor in cases where the eventual outcome is clear and the pain and suffering are too much to handle.

Someone mentioned living wills. If you don't have one, you should have one made up. Even with one, shutting off all life support is the most horrendous decision to have to make on the part of a loved one. When they say all life support, they mean it, no IV feeding or fluids, etc, and it isn't like the movies, it can take days. With a living will, at least you know what you are doing is what they wanted.

[Leonardite]

Originally Posted by illinicb

Like most topics, there are all kinds of issues. I think if you believe that only God can give or take life, then you are anti-abortion, anti death penalty and anti assisted suicide. I think that is a simple, consistent stance to take.

I consider myself to be pro-choice (not pro abortion), anti death penalty (despite wanting to see certain people offed in a heartbeat) and probably pro assisted suicide. BTW, the use of "pro" doesn't sound quite right in this context.

I totally understand wanting to end one's life in a way to lessen the pain and financial burden to those that remain. As Dayton mentions, who decides? I might be fully in favor of it today, but when the time comes, I might feel differently.

From a political perspective, it becomes a difficult issue to address and the last people that like to address difficult issues are politicians. Also like decriminalizing pot, no politician wants to be "pro drug" or in the case of assisted suicide, "pro death".

I believe that God SHOULD be the only one to give and take your life (unless you're in a state of real, constant physical pain), but I don't feel like I should be pushing my morals on everyone else through politics or force. I feel the same on all the other social issues (gay marriage, abortion, drugs, etc.). This is a free country, built on individual rights. It's your own body, you should be able to do with it as you please.

[bmb777]

Originally Posted by DaytonIllini

Assisted suicide is not generally for those that are suffering from dementia. That would be assisted murder. To commit suicide you have to have the mental capacity to make that decision for yourself.

Think instead a quadraplegic or a cancer sufferer in incredible pain or a person facing ALS (Lou Gehrig's disease).

Assisted suicide doesn't apply to withholding ventilators or avoiding CPR/ACLS. Those things are already accounted for with Living Wills, DNR orders, etc.

Cool Hand may have it right but as someone that deals with the terminally ill everyday I can tell you the decisions are seldom straight forward and many of the people that ask about putting an end to it have viable and reasonably effective treatments available. Those who have nothing left to try are often the most desperate to avoid dying.

It's a very complex topic. Who decides? Who administers? I can tell you that almost every terminal cancer patient is given a prescription for long acting narcotics and is advised how the drugs are instantly lethal if something particular is done to them. In 20 years I have never had a patient purposefully do that thing and end it all. As a resident I did have one young woman use a .38 and end it. That was devastating for everyone involved.

Anecdotally, several of you know that my wife recently suffered a devastating illness where medically there appeared to be no hope. This Fall she was hanging upside down on a ventilator, on dialysis, on broad-spectrum antibiotics, on full dose pressors. Her doctors, and to be honest her husband, were giving up hope. But that lady is returning clothes at the mall as we speak. Miracles happen. Medicine is a wonderful thing. Prayer is better. Combined they can be remarkable. Giving up is understandable but seldom can we see the future with any clarity. Imagine if I had asked them to extubate her. Presumably I am a lot more qualified to judge when to do that than the average spouse. Some decisions should probably not be left to man.

my grandma had alzheimers for about 7 years before she died 2 years ago. getting a DNR order on her was one of the hardest things we had to do. but it was the right thing.

I think one of the dumbest things I've seen is people will not get a DNR order on their loved one, but will get a "compressions only" order in event of cardiac arrest. whats the point? without ventilations/intubation, compressions only are not usually going to do anything.

as a paramedic, one of hardest things we had to do, was when someone called 911, we'd respond. person would be in cardiac arrest. they would say they had DNR, but didnt have a copy of it. they didnt understand without a copy of it, we had to start ACLS/CPR.

I'm not sure what I think of assisted suicide. I dont think I could do it, and I dont think I would want to see a family member do it. but I might think differently if I was in that situation.

[DaytonIllini]

Originally Posted by bmb777

my grandma had alzheimers for about 7 years before she died 2 years ago. getting a DNR order on her was one of the hardest things we had to do. but it was the right thing.

I think one of the dumbest things I've seen is people will not get a DNR order on their loved one, but will get a "compressions only" order in event of cardiac arrest. whats the point? without ventilations/intubation, compressions only are not usually going to do anything.

as a paramedic, one of hardest things we had to do, was when someone called 911, we'd respond. person would be in cardiac arrest. they would say they had DNR, but didnt have a copy of it. they didnt understand without a copy of it, we had to start ACLS/CPR.

I'm not sure what I think of assisted suicide. I dont think I could do it, and I dont think I would want to see a family member do it. but I might think differently if I was in that situation.

Sometimes cardioversion, say of V-Tach, can be a quick therapy that can sustain quality life. I have bagged people for quite a long time while we shocked them repeatedly. Sometimes they recover if their underlying protoplasm is good.

Agree 100% with jmwillini that withdrawing life support is often a multi-hour or even day event. It can be made much more bearable (and shorter) if the medical team is willing to titrate up the morphine drip to maintain comfort. It lowers the respiratory rate considerably and is often done.

[illini80]

Tough subject and certainly an emotional one. Dayton, I didn't realize it was that bad. Must have been devastating for your family.

I probably have an odd take on this considering my stance on other things. I think that it should be allowed. I know it opens a multitude of problems that would have to be addressed somehow. But I also know people who are miserable and tortured in their lives. They can't help it. It is how their brain is wired. If they choose to fight through their suffering and make the best life they can, I applaud them and they deserve a special place in heaven. If they choose otherwise, I think they have the right to do so in the least difficult way possible.

I know it is unimaginable for those who love life and see it as a gift. But I also know that for some, it is a sentence to a lifetime of hell that I will never understand.

[bmb777]

Originally Posted by DaytonIllini

Sometimes cardioversion, say of V-Tach, can be a quick therapy that can sustain quality life. I have bagged people for quite a long time while we shocked them repeatedly. Sometimes they recover if their underlying protoplasm is good.

Agree 100% with jmwillini that withdrawing life support is often a multi-hour or even day event. It can be made much more bearable (and shorter) if the medical team is willing to titrate up the morphine drip to maintain comfort. It lowers the respiratory rate considerably and is often done.

yeah I know you could cardiovert someone with a quick run of V-Tach or with someone in SVT. I'm not talking about that. I mean people who will get an order for compressions only. no ventilation nor defibrillation or cardioversion.

and to be curious, why did you bag them for a long time and not intubate them? only way we'd ever bag them for a long time was if for some reason couldnt get them intubated. I think the longest I've seen someone successfully resuscitated was 45 minutes. and after that we airlifted him out and soon as a helicopter could get here.

I hope Im never in the situation of having to decide to withdraw life support on a family member. I cant even imagine how hard that would be.

[pizzaman]

Originally Posted by bmb777

I hope Im never in the situation of having to decide to withdraw life support on a family member. I cant even imagine how hard that would be.

I've been there and its not that difficult if the person has lived a long life and the end is near. The difficult part is waiting while the person "exists" in a coma simply delaying the inevitable. Both my parents "lived" their last 5-7 days like that. My father was 90, my mother 95. If I had the power to give them a shot that would end their life, it would not have been a problem. I realize that is not assisted suicide and even if assisted suicide were legal, once they were in a coma, no one else could have done anything to end it sooner.

[DaytonIllini]

Originally Posted by bmb777

and to be curious, why did you bag them for a long time and not intubate them? only way we'd ever bag them for a long time was if for some reason couldnt get them intubated. I think the longest I've seen someone successfully resuscitated was 45 minutes. and after that we airlifted him out and soon as a helicopter could get here.

They had a DNI (Do Not Intubate) order in their living will.

[bmb777]

Originally Posted by DaytonIllini

They had a DNI (Do Not Intubate) order in their living will.

Ah makes sense then. Ive never run into that situation, to do CPR on someone with a DNI order.

[DaytonIllini]

Originally Posted by bmb777

Ah makes sense then. Ive never run into that situation, to do CPR on someone with a DNI order.

They used to be real common when I was an intern in the early 90's. People were not too sure about DNR and the DNI was easy to sell them because they were afraid of being 'hooked to a machine'. I don't know if they still are popular. Most of what I see goes the hospice route which of course is kind of assisted-suicide "lite". For people that have terminal loved ones, the hospice program can be a God's send.