At what point would YOU want to pull the plug on YOURSELF?

In My Humble Opinion
81

I believe physician-assisted suicide (PAS) should be a legal option in any enlightened society for exactly the same same reason we euthanize our pets who suffer—compassion. It is the humane way for chronically suffering people to end their lives painlessly and with dignity.

I do advocate for a significant, patient-specific waiting period (>6-months) and the unanamous decision of a PAS team (patient, doctor, psycologist, and estate attorney). And, close family members should be notified and their feelings should be respected and factored in.

It would be soothing to just know PAS was an option in the event you or a loved one reaches a point of unrelenting pain and suffering. Hopefully its an option you won’t need to take. I believe PAS would actually result in a decreased suicide rate. Instead of rushing into suicide when you have the guts and means to do it, many may hold off, knowing they can choose the time to end their life and that it could be done even after becoming too incapacitated to do it by your own hand. Many may hold off and never follow through with the PAS.

How nice it would be for suffering people to say goodbye to friends and family properly (perhaps with a Celebration of Life) before ending their lives painlessly, instead of resorting to an illegal act which carries a negative stigma, can be botched and painful, and often traumatises loved ones and onlookers.

For me, I would choose PAS only after reaching a high level of chronic pain and suffering, a lack of joy, increased burdonsomness, and only after getting my affairs in order and saying goodbye to those I love.

82

IMO the critical thing PAS needs is no doctor certification that death is imminent e.g. within 6 months. That puts a terrible burden of uncertainty on the doc and also leaves lots of chronically ill miserable people suffering for years until they get to the magic 6 month point.

Said another way, the 6-month certification is saying to the patient:

We will spare you up to 6 months of suffering, but no more. Too bad if your fate is to have 24 months of misery; we’re only offering you 6 months of relief. Just suck it up for the other 18.

Explained that way the 6 month certification is horribly barbaric. But will probably have to be one of the halfway houses our religion-soaked society goes through on its way to actual compassionate enlightenment.

I see no real role for close family in the decision. They can advise the patient. The patient will speak to the experts for the whole family. Letting family members lobby the rest of the PAS team is simply reducing the agency of the patient: the one and only person with an actual stake in the outcome, as opposed to a mere interest.

Obviously if the patient is mentally incompetent then either their written advance directives or their health care POA will have to speak on their behalf. To the degree there is written guidance made by the patient that should be honored by the PAS team even in the face of vehement objection from the family.

In my ideal world the patient is the only one with a vote. And patients would have had years of thinking about these scenarios so they are mentally / emotionally free to choose what they think is best for themselves, not best for a random menagerie of other people. We’re a long way from there.

83

This. Imagine a situation in which the only family member available is an abusive parent or sibling who wishes the patient to suffer as much as possible.

84

Hell, just imagine they’re somebody who totally loves their Mom and is simply in denial about the fact Mom is suffering terribly. And effectively in denial that their Mom could ever die, much less soon.

In many multi-child families there’s often one who is simply emotionally unready themselves to lose their parent and so is doing whatever it takes to push that horror away. Making Mom suffer longer is the mostly inadvertent outcome.

We’ve had threads and threads on this scenario playing out in various Doper families. Heck, there was an OP just yesterday by somebody whose father is starting down a bad road and the OP is catastrophizing over it. Dad may or may not die from this, and the OP may or may not be able to subordinate their own emotions to Dad’s best interests as Dad sees them. But that conflict is on display.

85

I think family should be notified and their feelings acknowledged because the death of a family member affects them greatly, too. And, in some cases, the patient may wish to not burden their family with the knowledge of their impending suicide, when in fact their input could help the patient decide more clearly. I don’t believe the family should have veto power, however. That decision should ultimately be the patient’s alone, providing they are of sound mind.

The doctor or psycologist should have veto power in cases when the patient may be temporarily delusional.

86

You saying this makes me think that you have the privilege of a caring and rational family. Many aren’t so lucky.

87

But many families do care. And for those that don’t, or have ulterior motives, their input can be ignored, and they won’t have veto power.

88

Beck that is damned hard and I don’t know what you should do either. But I’m really glad you can talk about it here at least, and also I gather to at least some extent with your family.

Can you get help from hospice? Can you find an end-of-life doula?

And I wish you the very best of luck with your Friday surgery; and am hoping very hard that you’ve got a lot of good days yet to come.

This. If you know that you can – then maybe you won’t need to.

And if you do need to, it should be available.

This.

Except that I think whether estranged family should be notified should be up to the patient. They shouldn’t have to notify an abuser, for instance.

Easier said than done, in many cases.

That is, their input can be overridden – but it may be very difficult to keep them from harassing the patient and/or caregivers about it; and some may take it into the courts, delaying and complicating everything.

So I wouldn’t favor a legal requirement that all family must be notified in all cases.

– Related to this thread in general, I think, as well as to the earlier discussion in the thread of DNR orders, is a story I saw this morning on NPR:

89

The ones that don’t, in many cases, should NOT be notified because it will cause problems.

90

Then I’ll amend my position. It should be the duty of the family physician and psycologist to recommend to the patient that their family should be involved. But, if they ascertain that the family should not be involved (or certain family member excluded) based on discussions with the patient, then they should not be notified.

91

If a family member is not affected by the patient’s suffering, then the impact of the patient’s death on them doesn’t merit much (if any) consideration.

In families with healthy interpersonal dynamics, a decision regarding physician-assisted death may be shared as a matter of course. In families with train-wreck interpersonal dynamics, it’s totally understandable that a patient may want to limit who gets informed of their choice.

Who makes the decision about whether a family member is “estranged” or an “abuser”? What would the legal criteria be for assigning a family member to one of those categories?

Patients aren’t required to inform family when they choose shorten their life by eschewing life-extending treatment, or by accepting palliative care that may unambiguously shorten their life. At its core, physician-assisted death is just one more mode of palliative care, and when it comes to spreading the news around, it should be treated the same. If bodily autonomy and privacy mean anything, they surely mean that a patient’s health care decisions should be kept entirely between the patient and their health care team, with nobody else being involved unless the patient consents. The patient, and nobody else, should be allowed to decide who is “family,” which of those family members get informed, and who is persona non grata.

92

That’s a good point. I think I’m in agreement with @Tibby that the physician(s) etc. discussing the case with the patient should discuss involving the family; but the patient shouldn’t have to take the recommendation of the medical personnel – I’m not sure whether Tibby’s saying that in some cases they should have to.

93

I think they should have to only in cases when they believe the patient isn’t thinking clearly (easy to have muddled thoughts when you are in chronic pain), and they believe it’s in the patient’s and family’s best interest to be notified. Otherwise, the decision should be solely that of the the patient.

As an example, if my father completed a PAS and he didn’t notify me because he didn’t want to burden me with worry, when in fact it would worry me less being involved, then it should be mandatory for the physician and psycologist to have this discussion with the patient before the fact and mediate the best decision for all involed.

94

Are you able to put yourself in the mind of someone with manipulative, narcissistic family members or who may mean well but share completely different values? And why does it have to be family at all when some people have close friends who are more “family” than family? And what about people who have happily lived their entire life as fiercely independent loners?

Again, you seem to have the privilege of a kind and functional family.

95

Yeah, valid point. I was one of four children, and my mother told me she chose me to be her POA for two reasons. 1) I am far and away the most pragmatic and least sentimental of the group. 2) I am the only atheist in the lot. The thinking being that at least I would never be tormented by ‘But what if God didn’t want me to let her die?’ type regrets.

As it happens, I did have to make the call. She’d had dementia for many years, and then had a massive stroke. She never regained consciousness, and the doctors thought there was no realistic chance she would. She wasn’t on a ventilator, but some other complication came up that would kill her if they didn’t act soon so they wanted to treat it with a relatively minor procedure. There was some discussion between the doctors and the three of her children who were there. (The fourth couldn’t travel due to his own health problems.)

I asked them, “Will her death from this complication be in any way worse for her than the way you expect her to die if you do it?” And they said no, they would use drugs to keep her painfree either way, it’s just that she would probably ‘live’ – unconscious but breathing – for a few more weeks if she had the procedure. So I said not to do it, and my brother and sister nodded. I don’t think they would have gone that way on their own, especially my sister who is an extremely religious person, but they could accept the decision once made by someone else.

That was about fifteen years ago. I haven’t had second thoughts or been ‘haunted’ about it at all in that time.

Her dementia was a relatively fortunate type, mostly leaving her just mildly bewildered or even comfortably content while reading or just watching tv for hours. But sometimes, usually at night, she would become distraught, realize that something was horribly wrong with her mind, and be upset and even terrified. She would ask over and over about her loved ones, her husband, siblings, parents, on and on, repeatedly asking about the same person many times just minutes apart, because she was incapable of remembering she’d already been told that, for example, her mother had died. She would complain, why haven’t I died? Why won’t God just take me? I don’t want to be like this? These sessions were horrible for her, and whichever of us was currently being her caretaker.

So, for me the decision was clear. She would have chosen not to have the procedure if she still had the ability to make (and express) any choice, so that is what I did for her.

96

Bad or estranged family members will be weeded out from notification in my scenerio, simple as that.

Are you able to put yourself in the mind of someone with caring family members who only have the best interests of the PAS candidate in mind? And, also in the mind of the patient, who may misguidely through pain-induced unclear (or delusional) thoughts believe they are helping their family members by not notifying them beforehand, when in fact they are hurting them? The patient should be advised properly by his physician and psychologist.

Also, remember that when the PAS patient dies, his pain and suffering will be over, while the caring family’s pain goes on. I’d want to know if any family member plans on PAS.

97

[quote=“thorny_locust, post:92, topic:984475”]
I think I’m in agreement with @Tibby that the physician(s) etc. discussing the case with the patient should discuss involving the family;[/quote]

I don’t think patients should be subjected to involuntary counseling regarding how to manage their relationships with other people.

It’s natural to want to know, but I don’t believe you have a right to know.

98

Check your privilege. I have family members who may well consider themselves caring but I disagree. There are scenarios where there are no caring members and they don’t fucking get to know.

I have one person, who is not a legal relative, who gets to decide and I don’t want them to be harassed by “well meaning” blood relatives.

99

I’m always reminded of my brother when I read threads like this. He always proclaimed loudly that if he ever got to a certain point that he would “just walk over the nearest hill and end it.” My retort to that was “You’re assuming you’ll be able to do that.” As it turns out, he wasn’t. Diabetes claimed one of his legs and he didn’t have the muscle strength for a prosthetic. He died of an infection later on.

I see people here in this retirement facility who are quite aged. This is not an assisted living facility, so while there are people with walkers and wheelchairs, they are largely able to care for themselves, with some requiring an aide for easier living. People like the wife and me, who only have wonky knees and the like are an exception.

As for when I would want to check out? Can’t say. I see 90+ year olds having robust lives, even with issues. Perhaps if senility became a problem, but I recall a movie about a woman who had a stash of pills to do herself in, but waited too long and couldn’t remember that she had stashed them. For good or bad, I’ll probably just let things run their course, like most people do.

100

Plus, there is enough of a problem already with medical personnel treating patients like children. Does the patient really need to be informed that relatives might care? If the patient isn’t at that level of awareness, I wonder if the patient is competent to make the decision.
My friend told family and friends. And look on the bright side - this is one way that you can attend your own funeral and hear everyone say nice things about you.