Euthanasia

[EMTCop86]

In regards to the OP... If you want to die then you should be allowed to be put out of your misery. I had to watch my grandpa die from lung cancer. The last few months of his life were horrible, he couldn't get out of bed, feed himself, go to the bathroom, or basically do anything. That last week of his life I was giving him liquid morphine every 2 to 4 hours for the pain. As far as the family being ready or not, that should not factor into the equation. The family is not the one suffering, the patient is. I much rather of seen my grandpa go a few month earlier then dying later being in the pain that he was in.

 

[akflightmedic]

What about the youth in Asia?

Something going on?

 

[Sasha]

To Sasha, yes I agree with human euthanasia. I feel it should be used in place of DNR's, the only problem with that thought is like I believe AK mentioned there are families, POA's whatever that won't sign DNR's because they're still holding on too tight. I am all for the idea as long as it's implementation involves a vigorous check and balance system to prevent abuse.

No, the only problem with that is people who are so vehemently against it and for a "Right to life" believe life is measured by quantity and not quality. Discussing this with someone last night "Well, how do you KNOW they are a vegetable? Maybe they're having thoughts and feelings while they're in the coma." Which would make it even worse, right? To lay there, day in, day out, not being able to move, speak, get up, eat, drink. To just lie there. I think it would be very boring, wouldn't it? And you sit there, day in and day out, because everyone is holding onto that hope that one day Mom or Dad or Daughter or Brother will wake up and be back to the way they were before. Or because they have occular movement they must not be in a vegetative state.

We allow our animals and pets and fur children the mercy of a painless death when life becomes too painful for them, why can't we allow our terminal, pain ridden humans the same?

 

[Meursault]

It almost certainly isn't ethically justifiable for EMS providers to be assisting in euthanasia.

/thread

 

[JPINFV]

It almost certainly isn't ethically justifiable for EMS providers to be assisting in euthanasia.

/thread

Could you please elaborate on why EMS assisting with euthanasia as a part of a larger care team would be any more or less unethical than any other medical or health care provider?

 

[Sasha]

I'm not saying EMS providers should be allowed to euthanize people, I'm saying I'm in support of euthanasia, it was a point put up for debate, not to expand a scope of practice.

 

[VentMedic]

Alot of speculation and injection of your own personal beliefs are not going to stop a physician and a hospital's ethics committee from doing what is best for the patient within the guidelines of the law.

Along with all of the other classes I have recommended on this forum to prepare one for a career as a medical professional, I am now going to suggest that some enroll in a college level Medical Law and Ethics course to see what rights you and the patient have under Federal and your state's laws. There are gray areas but for the most part, there are laws to define the guidelines for ending life support. As well, organ procurement has also changed the rules for brain death not always being necessary.

Many of the other healthcare professions do require this class because some will be directly involved in ending life support and others will be taking care of the patient with many family members asking questions.

This situation does not just concern the elderly or injured/sick adult. These decisions about the quality of life are made everyday in some NICU or PICU in this country.

We have had some landmark cases involving patients of all ages. Not all court decisions are popular but someone has to make the decisions if those who love the patient can not see past their own issues. When the loved ones start using the word "I" in the conversation more than referring to the patient, one has to wonder who they are really making the decision for.

Here's some articles of interest for those who want more information to assist you in forming an opinion.


California
Elite triathlete was paralyzed after bike crash
She asked to be taken off life support. ‘No athlete would like to have a life with only their eyes talking,’ said her twin sister, also a triathlete.
By M The Associated Press
August 29, 2008 in print edition B-8

http://articles.latimes.com/2008/aug/29/local/me-warren29

Guidelines for Treatment and Life-Support Decision Making for (Minor) Patients

http://www3.utsouthwestern.edu/pmh-ethics/lifesupportminors.pdf

This article is about end of life for a baby in the NICU.

Understanding, Avoiding, and Resolving End-of-Life Conflicts in the NICU

http://www.mssm.edu/msjournal/73/73_3_pages_580_586.pdf


Florida's SCHAVIO case
http://www.myfloridalegal.com/schiavo.pdf


Now, here is another controversial subject. In the past "Brain Death" was the standard criteria for organ procurement. Today we can now use "Cardiac Death".

Organ Donation after Cardiac Death

http://content.nejm.org/cgi/content/full/357/3/209

Volume 357:209-213 July 19, 2007 Number 3

Since 1968, when an ad hoc committee at Harvard Medical School proposed a brain-based definition of death that became widely accepted, organs for transplantation have been removed primarily from hospitalized patients who have been pronounced dead on the basis of neurologic criteria, when they are on ventilators and their hearts continue to function. The continued circulation of blood helps to prevent the organs from deteriorating.

Obtaining organs from donors after cardiac death — when the heart is no longer beating — is the approach that was generally followed in the 1960s and earlier. Today, such donations typically involve patients who are on a ventilator as the result of devastating and irreversible brain injuries, such as those caused by trauma or intracranial bleeding. Potential donors might also have high spinal cord injuries or end-stage musculoskeletal disease. Although such patients may be so near death that further treatment is futile, they are not dead.

The United Network for Organ Sharing, a private nonprofit group based in Richmond, Virginia, operates the Organ Procurement and Transplantation Network under contract with the federal government and is committed to increasing the number of donors. OPTN/UNOS, as the networks are collectively known, has developed rules for donation after cardiac death. According to these rules, finalized in March 2007, the process begins with the selection of a suitable candidate and the consent of the legal next of kin to the withdrawal of care and retrieval of organs. Subsequently, life-sustaining measures are withdrawn under controlled circumstances in the intensive care unit (ICU) or the operating room; donation after an unexpected fatal cardiac arrest is rare.

The Definition of Death and the Ethics of Organ Procurement from the Deceased

http://www.bioethics.gov/background/rubenstein.html

Along similar lines, the 1999 IOM report specifies that "in most cases, the patient who becomes a non-heart-beating donor has suffered devastating neurological damage, most often from trauma or stroke. In rare cases, a conscious, paralyzed, ventilator-dependent person has requested non-heart-beating donation." (IOM 2000, p. 42)

Pallative Care website with more links to info.

http://www.stoppain.org/palliative_care/content/pallcare/palliativecare.asp


End-of-Life Physician Education Resource Center

http://www.eperc.mcw.edu/

 

[Veneficus]

Vent,

You are using the "E" word again.

 

[csly27]

Oh my gosh, this is horrible. Suicide is illegal, and rightly so! Where do people get the right to end their lives? So selfish! Don't get me wrong, I'm all for self rights. But think what it does to their families. Suicide is so horrible, and wrong, and messy. I give all my patients a stern talking to, suggest they think of its impact on those who love them, rather than ending a temporary bout of self pitty. Sorry if that sounds offensive, but it's just how I see things.

wow, I am a little disterbed by this. first of all it is not illegal to off yourself. If you were all for self rights then you would not say they dont have the right to do what they want. It is their life and if they dont want live how ever it is they are living weather it is mental disease or terminal or just plain old age taking its toll.

Would you really want to live stuck in a bed with bed sores craping all over yourself because you can no longer get up and go on your own, and because no one cares enough to take care of you, or you get stuck in a home where the staff is understaffed over worked and sometimes just dont give a damn.

Their are so many scenarios that can be used but when it comes right down to it, does anyone really want to live that way. I know i sure dont want that nor do I want that burden on my family. I would hope someone would have enough respect to respect my wishes. So yes I do beleive in euthanasia in some cases. When you can no longer take care of yourself, and have no quality of life then really what is the point.

A last thought, everyone knows that ems is only prolonging the inevitable. Everyone is gonna die at somepoint there is just no getting around it. Ems is there to help people when they need it most. Sometimes you will get the results you are hoping for and sometimes not. That is just how life is.

 

[trevor1189]

This is why I have a living will and durable power of attorney.... and yes I am 19.

 

[daedalus]

May I inquire as to your training in psychological counseling?

Unfortunately, due to the stupidity of using ambulances to transport interfacility pysch patients, EMTs are de facto Licensed therapists in LA without having to go through the years and years of training real MFTs have.

Since it is within my scope to obtain a history and converse with a patient, I can talk to a patient or yell at him as much as I want. So in fact, no matter how unethical or wrong, cowgirl is well within her rights to do so.

 

[daedalus]

I'm sorry, I don't believe in mental illness, my beliefs don't permit treatment for such ailments. Other than making them feel like it's not actually an illness, more of a feeling that was caused by their actions and views of life. That is just the way I was told to act and feel, I'm not brain washed, but what else am I supposed to do?

But, in retrospect, if they do have a terminal illness or are a medico veggie, then they should have the right to decide if they continue treatment, or die in a comfortable nirvana. I agree with that.

Practicing scientology while providing patient care is not allowed.
You are a medical provider, you are not to treat your patients the way you see fit, but according to acceptable medical standards.

 

[akflightmedic]

Since it is within my scope to obtain a history and converse with a patient, I can talk to a patient or yell at him as much as I want. So in fact, no matter how unethical or wrong, cowgirl is well within her rights to do so.

Practicing scientology while providing patient care is not allowed.
You are a medical provider, you are not to treat your patients the way you see fit, but according to acceptable medical standards.

So you are saying acceptable medical standards allow you to yell at patients and act as a LMT since you are a de facto one simply due to the fact that you transport psych patients?

And all of this is within the acceptable medical standards?
I dunno, but the two quotes seemed contradictory to me.

 

[akflightmedic]

And still, all this talk about dying and what not, and not one single person has discussed the youth in Asia. You know, what the thread is all about. Sheesh, stay on topic people!

 

[Sasha]

And still, all this talk about dying and what not, and not one single person has discussed the youth in Asia. You know, what the thread is all about. Sheesh, stay on topic people!

Funny :]

10chars

 

[daedalus]

So you are saying acceptable medical standards allow you to yell at patients and act as a LMT since you are a de facto one simply due to the fact that you transport psych patients?

And all of this is within the acceptable medical standards?
I dunno, but the two quotes seemed contradictory to me.

Heck no!
The first post was sarcasm directed at local policy about ambulance only transport after a psych hold is signed. Example- a child is placed on a hold at school for drawing a picture of himself in hell (holds have been used in lessor circumstances, I have done this for over a year now in LA). Instead of the two licensed mental health workers talking the little boy in their white sedan to a pysch facility (much less dramatic), they require full ambulance response and transport, no exceptions. This makes me uncomfortable because I have no formal training in handling psychiatric emergencies, or how to speak to a depressed/suicidal patient trying to escape my ambulance. I also hate when my co-workers take it on themselves to act as therapists in the back, because they are totally and completely un-impeded in this practice in practice. This is an insult to the people that spend years becoming licensed therapists and/or PsyDs.

The second post describes my point of view. You cannot in corporate pesudo-science like Dianetics (the mental health theory of scientologists) into practice of conventional medicine when you have a duty to act!!!

 

[daedalus]

ak, looking back I worded the first post wrong. It is meant to read as I am no fan of people using the opportunity of unimpeded and private access to a pysch patient in the back of the unit to spew their opinions or beliefs on them.

 

[akflightmedic]

Roger....that's why I asked.

 

[Meursault]

I am now going to suggest that some enroll in a college level Medical Law and Ethics course to see what rights you and the patient have under Federal and your state's laws.

I haven't taken the relevant law, but I finished a biomedical ethics course last semester and euthanasia is a softball as compared to things like healthcare allocations, organ donation, and all the other limited-resources problems.

The problem with euthanasia, as seen in this thread, is that lots of vague personal beliefs creep in.

As far as the relevance of this thread to EMS, which was the point of my earlier post, euthanasia doesn't happen in the prehospital environment. Outside of that, any EMS providers involved seem to be techs under the direction of a doctor, which is a different environment. Ethical issues are less important there because you're not making any ethically significant decisions beyond participate/find another job. As much as I love interesting, discussion-provoking threads, this doesn't seem to have provoked discussion as much as shouting matches.

Also, is there really a Scilon on here?

 

[VentMedic]

Heck no!
The first post was sarcasm directed at local policy about ambulance only transport after a psych hold is signed. Example- a child is placed on a hold at school for drawing a picture of himself in hell (holds have been used in lessor circumstances, I have done this for over a year now in LA). Instead of the two licensed mental health workers talking the little boy in their white sedan to a pysch facility (much less dramatic), they require full ambulance response and transport, no exceptions. This makes me uncomfortable because I have no formal training in handling psychiatric emergencies, or how to speak to a depressed/suicidal patient trying to escape my ambulance.

There are safety reasons why some vehicles are used for transport and others are not. Also, Licensed Mental Health Professionals to stretched very thin. Just like EMS complains about being used for routine transports, the mental health professionals could put their education/skills to better use doing something other than a 30 minute transport for about 50 patients per day which is a slow day for some centers. That is why PD and EMTs are used to transport these patients.

As far as children are concerned, we have a locked secure facility attached to the hospital for children that makes me shake in my sneakers when get a call there. Damien and Michael have nothing over these kids.