Euthanasia

[Sasha]

Yesterday I was talking with a coworker (not my partner, because he was a butt, but a different coworker) about human euthanasia.

After working with a very good deal of nursing home and hospice patients, I've reworked my stance to where I'm in favor of it. People are being drawn out through long, horrible deaths. Some who are no longer competent enough to sign the DNR are made to suffer even more by family members who cannot just let go and sign it themselves. I feel people should be entitled to a painless, self elected death when their health is failing that badly and they're in constant pain, etc.

So, I'd like to read other's thoughts on the matter.

Ready, set, go! (Keep it civil please!)

 

[akflightmedic]

Summed it up nicely Sasha.

I was pro death before Kevorkian made his stance and I have always supported him and others like him 100%.

Prolonging one's life is akin to a funeral. It is typically something that is done for the living, as the ones dying or dead reap no benefit from it.

When I say prolonging, I mean longer than a few days to allow goodbyes to be said, family travel in, whatever. But when they go on and on for months and even years, this does nothing for us as social creatures.

It drains the living emotionally and financially. Visiting Jimmy on the vent becomes a burden. As a parent, we will always say no it doesn't but it does, as eventually you stop living your own life cause vented Jimmy sucks up so much of your time. This emotional drain then parlays into other relationships and strains them. You have nothing to talk about with friends, your spouse may elect to move on emotionally and when you do not, they move on physically.

Same goes for a parent or grandparent wasting away in a bed in a far corner. My parents and grandparents have earned the right to a much more dignified death. It becomes a burden to visit, people get resentful, finances strained, if not personally, then the social finances are strained as well. Watching your family member soil themselves and not be able to do a thing about it, knowing it happens 10 x a day when you are not there. It is quite the cruel and unusual punishment.

Many cultures have endorsed euthanasia 100s and even 1000s of years before us more "civilized" folks decided to get back on board with it. The Native Alaskans (Eskimos) used to set themselves adrift on a ice flow when they were becoming too old to contribute to the village's success. It was a dignified death. They realize they were more of a burden than a help, so they go and get on a ice berg and float away.

I am not suggesting killing off old people, as I hope to be one someday. But in situations of terminal illness or permanent vegetative states, one should have the right to request death or been allowed to request it at some point in their life before the vegetative state ensued.


This is something my family has discussed and we all are pretty much on the same page ironically. Being an adult is when you reach the age to make your own decisions and be responsible for them. One of the coolest aspects of being an adult is we can indeed choose when to "move on" in our own terms.

 

[medicdan]

I appreciate the way both of you summed it up; you expressed my opinion better than I could ever. While I agree above, you may disagree with my below, I apologize for unintended insensitivity.

I am interested in healthcare as a whole, and recently from a policy and economic point of view. Some statistics. $2.4 trillion on healthcare last year in the US. ~17% GDP spent on purely healthcare. According to one estimate, end-of-life care accounts for about 10-12% of all healthcare spending. Annual spending for home-care is $29 million, and hospice is $3.5 billion. “Of the 2.3 million people who died in 1997, 80% were Medicare beneficiaries at the time of death3. Of that 80%, one-fifth were also eligible for Medicaid (the ‘dually eligible’).” (Raphael, Financing end-of-life care in the USA)

We have roughly half a million patients on acute (thrice-weekly) outpatient dialysis treatment for End Stage Renal Disease (or CRF). Here in the US we have more patients on dialysis then any comparable OECD country (other countries with comparable levels of healthcare), yet have lower life-spans.

Medicare automatically kicks in for any patient in ESRD, no questions asked, and pays 100% for dialysis treatment (and associated services such as Ambulance transportation to the clinic) with no assessment of needs or benefit to society.

My company transported a patient for close to six years (before she died a few moths ago, bless her soul), who was actually a vegetable. She was in an acute nursing home, unconscious most of the time when she wasn’t moaning. She had family, but they visited twice a year, and refused to sign a DNR. She often had a BP before dialysis of 60/P, and 210/P after. We (the US, the government, through our taxes), pay for her acute nursing home, ambulance transportation to dialysis, dialysis treatment, and monthly visits to the hospital, etc.

What is her quality of life? Contribution to society? Improvement in condition with treatment?

We are lucky, in the US, to be a powerhouse of medical technology and innovation, but we have grown to over-use technology, whether it is diagnostics in the ER when doctors practice defensive medicine, or HEMS for patients that don’t need it, acute outpatient dialysis, or full ACLS on a vegetable.

I am in full support of hospice programs. One of my favorite teachers, mentors and friends works as a chaplain for an in- and out-patient hospice. We spoke just last week about the thresholds that her hospice holds between comfort care, treatment, and respite care. It has now become acceptable (and standard) to prescribe antibiotics for hospice patients with infections.

To summarize: We need to look not only at the quality of life, but also a cost benefit analysis for treatment. We need to start incorporating family and friends in these decisions. Although it will be hard in the American culture, we need to


Quick Bibliography:

Altman, Stuart H., and Michael Doonan. "Can Massachusetts Lead the Way in Health Care Reform?" New England Journal of Medicine 354.20 (2006): 2093-5.
Poisal, J. A., C. Truffer, et al. (2007). "Health Spending Projections Through 2016: Modest Changes Obscure Part D's Impact." Health Affairs 26.2: w242-253.
United States. Medical Payment Advisory Commission (MedPAC).How Medicare pays for Services: An Overview. Washington DC: MedPAC,
U.S. Renal Data System, USRDS 2008 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2008.
Carol Raphael, Joann Ahrens, and Nicole Fowler J R Soc Med. 2001 September; 94(9): 458–461.

 

[Veneficus]

I am wondering if the previous posters are speaking about withholding treatment vs. actively killing somebody? The responses seem to be geared towards the former.

As food for thought, without my opinion. If wanting to kill yourself is considered a psychological disorder in the young, why would it not be in the elderly or infirm?

Is it psychotic for a wounded soldier on a battlefield to ask his comrades to end his life quickly?

How about to sacrifice himself after receiving a mortal wound to aid his comrades? That is a concious decision of death.

What makes it different when a terminally ill person is willing to sacrifice themselves for the good of their family? (socially and economically)

Why are condemned prisoners considered psychologically unstable when they ask for a faster execution date?

Moderators here don't like passionate, controversial topics, so I am not sure how long this thread will last, but I am interested in what people think.

 

[WiFi_Cowgirl]

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.

 

[JPINFV]

As food for thought, without my opinion. If wanting to kill yourself is considered a psychological disorder in the young, why would it not be in the elderly or infirm?

Is it psychotic for a wounded soldier on a battlefield to ask his comrades to end his life quickly?

How about to sacrifice himself after receiving a mortal wound to aid his comrades? That is a concious decision of death.

What makes it different when a terminally ill person is willing to sacrifice themselves for the good of their family? (socially and economically)

Why are condemned prisoners considered psychologically unstable when they ask for a faster execution date?

Moderators here don't like passionate, controversial topics, so I am not sure how long this thread will last, but I am interested in what people think.

Why is it ok to kill an injured animal but not kill an animal for the sake of killing an animal? You can't simply say that all forms of suicide are necessarily the same. Were the Buddhist monks who burned themselves alive in protest of the Vietnam war passionate or insane? I don't think that we can compare someone contemplating suicide in an effort to save others (the proverbial leaping onto the hand grenade) with suicide to end suffering from incurable diseases with suicide due to psychological stresses.

 

[JPINFV]

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.

May I inquire as to your training in psychological counseling?

 

[triemal04]

I am wondering if the previous posters are speaking about withholding treatment vs. actively killing somebody? The responses seem to be geared towards the former. I think it was more told physician-assisted suicide, which I am in favor of. If it was someone deciding to not be treated, same deal.

As food for thought, without my opinion. If wanting to kill yourself is considered a psychological disorder in the young, why would it not be in the elderly or infirm? A 15-year old doesn't have to same mental capacity as a 75-year old. And deciding to kill youself due to Tommy asking Sharon to the dance and not you is a little different than deciding to kill yourself because you have a very painful, terminal disease.

Is it psychotic for a wounded soldier on a battlefield to ask his comrades to end his life quickly? Absolutely not.

How about to sacrifice himself after receiving a mortal wound to aid his comrades? That is a concious decision of death. Nope. Not a problem here.

What makes it different when a terminally ill person is willing to sacrifice themselves for the good of their family? (socially and economically) It doesn't. As well, more will come into play beyond just the social/economic sides. If you have a terminal disease with only a few excruciatingly painful and degrading monthes left to live, deciding to die on your own terms is in no way, shape or form wrong.

Why are condemned prisoners considered psychologically unstable when they ask for a faster execution date? I don't have a clue. Maybe because the people calling them unstable are the same ones trying to abolish the death penalty.

Moderators here don't like passionate, controversial topics, so I am not sure how long this thread will last, but I am interested in what people think.

I give it 17 responces past yours.

 

[WiFi_Cowgirl]

State of Wisconsin, Emergency Medical Services

 

[akflightmedic]

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.

Hee hee, "suicide is illegal".

Umm, after I kill myself, please do not send me to jail. Please!!

And your "talking to patients" sounds more as if you are referring to the patients that call for the attempts or thinking of attempting.

I think we are discussing on the more deeper level of terminally ill or vegetative patients. Huge difference, very different scenarios.

And if you think those who are suicidal are a result of temporary self pity, I seriously recommend you go to medical school and become a full fledged psychologist or psychiatrist before you start dispensing mental health advice in the streets.

 

[WiFi_Cowgirl]

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.

 

[JPINFV]

State of Wisconsin, Emergency Medical Services

So you do not have any specific training on psychological counseling, just what's fed to you though your EMT course?

edit:

I'm sorry, I don't believe in mental illness, my beliefs don't permit treatment for such ailments.

You've never really worked with patients that suffer from disorders like bipolar disorder or schizophrenia, have you?

 

[EMTWintz]

I may have an odd outlook on this subject, but If Vinnie the Veggi wants to die, let him(help him) whatever. That is just one person less in the world that is already overcrowded. It is his choice and for the most part pt's that are terminal have thought long and hard about the decision to self terminate I would feel more comfortable with them having medical help than to do it themselves.JMO

 

[ffemt8978]

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.

Interesting comments there... you don't believe in mental illness and YOUR beliefs don't permit treatment for such ailments.

I'm serious in asking this, and would really like to know the answer...
How many of your other beliefs do you let interfere with the care and treatment you provide to your patients? Where do you draw the line at who you are going to treat, and who you won't treat because of your beliefs?

 

[EMTWintz]

that is an interesting question. was wondering the same thing

 

[ffemt8978]

Especially when you consider what was written in this post

Who are we to dictate who is worthy and not worthy of our services? We should transport anyone that calls, regaurdless of if they can pay or can't, or whether their problem is important in our eyes. It's their emergency, it may not be one in ours, but it is to them. People shouldn't be made to feel bad for calling 911. That goes against all that we stand for. What kind of EMT or Medic are you, to refuse someone their right to care and transport? We better stop advertising, call 911 in an emergency, if you're not going to render aid to their emergency, not just what you view as emergent or not.

 

[Sasha]

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.

If you really talk to your attempted suicide patients like that at a time where they're very vulnerable like that... You deserve to be kicked in the teeth.

Who are YOU to spread your beliefs onto others in a time where they called you into their home, office, wherever, to help them, in their time of need?

 

[EMTWintz]

So basically what that person is saying, she will deny no one regardless whether its an open fracture or paper cut....But its a whole nother ball game if the person is in the throws of a manic attack(as in the case of a bipolar)? DOUBLE STANDARD

 

[downunderwunda]

Medicine today has given us improvments in quantity of life with no regard for quality of life.

Illnessess such as Alzheimers & Parkinsons were not common because people died well before they took hold. Yes they existed, but not in the numbers of today. But we need to delve deeper.

Euthenasia is a taboo subject because the church makes it a taboo subject. The right of a person to choose their time of death is offensive to some, however, consider what I said earlier & then translate it to patients with cancer.

Today we treat cancer patients with any number of treatments including chemo & radiotherapies. What if they do not work? What is there for the patient???? Indeterminate periods of pain, unless they are drugged out & a slow & painful death.

50 years ago the vast majority of these patients would have been dead through the initial cancer (& the euthenasia practiced by many doctors with an oops OD), Yes we have given them more time with their families but, when all treatments fail, what do we give them? emaciation, morphine & an 'Oh well, we tried'.

I believe that a person should try everything they can to beat the cancer, but iI know that I would not want my kids to watch me wither away to nothing & remember me as a drugged out man. If I was in that position, I would much rather choose to end my life so my family could have better memories, but knowing I did everything I could to beat it.

WiFi_Cowgirl - 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

Isnt this a mentality borne of the middle ages? Is this not the attitude that had people burned at the stake for witchcraft? WiFi Cowgirl, do you believe that cardiac illness is pathalofical, after all we can see elevations in troponin, or is diabeties pathalogical? we can see the results of it after all, so why is Mental Illness, that has been proven to be pathalogical, as well as chemical, a life action result? Yes SOME mental Illness is resultant of peoples actions, psycosis due to excessive marijuana use, but that is by far the lower end of the mental illness tree. I suppose next you will argue that it is really demon possesion.

 

[EMTWintz]

I suppose next you will argue that it is really demon possesion.

Call a priest, get the wholy water, DO SOMETHING