[quote=“Machine_Elf, post:97, topic:984475”]
I’d expect it in some cases to be quite a short discussion. But some people just have trouble bringing up the subject, or thinking of all the things that might need consideration. I think the physician should ask who else should be involved, whether genetic/legal family and/or chosen family.
I’m not at all sure that that doesn’t describe my mother; though I didn’t find the evidence for it until after her death, and that evidence isn’t entirely clear.
You are not taking into account that a physician and psychologist on the PAS team. They don’t want, nor should they incur increased liability by threat of being sued by family members who have legitimate reasons for being notified about their family member’s upcoming PAS.
We are on the same page so far as some family members should not be notified, and they won’t if the patient signs a form stating that the PAS team discussed contacting family members, and they opted out.
Think of it as a medical Miranda warning. The cop can be in trouble if he doesn’t read them to those he arrests.
I agree. It should be part of the “do you have your affairs in order” checklist.
Do you have a medical power of attorney on file?
Yes
Ok, next question, …
Which family members have legitimate reasons? What happens if the patient, even after being nagged by the doctor, still refuses to inform those family members?
See above. The patient just needs to sign a form that he opts out of informing them.
The form needs to be opt in. The default should be no information given.
I suppose if the patient says ‘I want to die under hospice care in my daughter’s house’ then the daughter has legitimate reasons to be involved in the decision.
So there’s at least one type of possible instance. However, I have trouble imagining patient and medical caretakers just all showing up at the daughter’s without its having been checked out first. (‘What? I haven’t seen Mother since she threw me out of the house when I was fifteen and I live and work from home in a studio apartment!’)
ETA: I think I had legitimate reasons to want to be involved in my mother’s decisions; and I think I have legitimate reasons to want to be at least notified about the terminal condition, should it occur during my lifetime, of some people now living. But I don’t think that those reasons should overwhelm any decision of theirs otherwise; it has to be up to them.
In the midst of my mother dying I noticed a few interesting things about the medical system while negotiating it. One of them was the unstated but palpable relief the various doctors and social workers expressed when they found out I was her only child.
I’ve treated enough chronically ill, elderly patients in my career to assure you that there are many who are in a grey area—competant enough to make a PAS decision, but too overcome by illness to weigh all the consequences properly. These people need proper counceling, including involvement of family.
I’d heard, years ago, that the “success” rate for CPR is a LOT lower than people think, especially when done on the elderly. I have a vague memory of the article I read saying something like the best success rate is when the victim is young, and the arrest is caused by something sudden, from which the person is extricated very quickly (e.g. electrocution or something).
In the article, it mentions a nurse in an assisted living refusing to provide CPR. My general understanding is that UNLESS THERE IS A DNR IN PLACE, responders are legally required to make all reasonable efforts at resuscitation.
Having actually done CPR (as part of my EMT training in the early 1980s, doing an ER rotation, a fellow came in with his 4th or 5th heart attack): the fellow seemed somewhat aware, at least at first - certainly he responded with pain when my hands were misplaced at first. I was not aware of any broken ribs, but this guy was relatively “young” - maybe 50s or so (seemed old to me at the time but I was 22) and his bones may be been stronger.
And even though the actual arrest took place after he’d arrived at the hospital, he did not make it.
This reminds me of a sports writer who committed suicide in 2013 on his 60th birthday. He posted a very detailed account of his decision online after his death. He claimed that he wasn’t depressed or had any particular mental health disorders. He simply made a decision that he didn’t want to fall into bad health and not be able to either live life the way he wanted to, or absent that, not have the ability to end it.
I think his decision was particularly drastic, but given the prohibition on P.A.S., one that I can’t say was entirely irrational.
Daughter already has control over her house and will not be letting anyone in without her permission, so there’s no need for the health care team to compel a discussion with her.
Generally speaking, a physician isn’t required to be present when the patient ingests the lethal prescription, and any other health care provider would only need to be present insofar as the patient needs health care at that moment. When my mom died, the only people in the room were her family. It happened at an assisted-living facility, and we made it a point to keep staff out while we dealt with a very private family moment.
I am 100% pro-PAS, but I have grave reservations about self-inflicted suicide. Sure, you should have the right to end your life on your terms, but not when it puts others in harms way, and it’s very difficult to not harm someone when you off yourself in the wild (not hospital).
There’s the obvious physical harm, like falling onto a pedestrian when you jump from the Empire State Building. And there’s the less obvious psychological harm, like traumatizing the train engineer when you jump in front of an oncoming train. And there’s even the lesser obvious psychological harm of finding a dead body when you go visit an ailing friend with a plate of cookies.
Rest in peace by all means, but don’t hurt others in the process.
So, let’s make PAS legal everywhere, but do so with proper protocols in place.
I was positing hospice care, in which case the hospice caregivers, while not necessarily present at the time of death, would certainly have to be there at some point.
And I very much doubt that they’d want to take the chance of showing up, all ready to set the patient up, and only at that point find out that the daughter (or whoever) knew nothing about it and was entirely unprepared for the situation and possibly entirely unwilling to go along with it. Sure, she could lock the door and refuse to let them in – but why on earth would anyone let it get to that point? I’d expect the hospice people to check out the available space first, in order to know what equipment they could fit where, and also to talk to the daughter (or whoever) to get an idea how prepared they were and what information they might find useful (assuming that they did want to do this.)
That one might happen without any suicide having been involved.
– I agree that a person who feels that they have to do this themself ought to do their best to be careful about who’s going to find them. And this is (as I think you meant) yet another reason for providing a legal way to go about it; not only does that provide a legal way to have someone there at the time so that there won’t exactly be any “finding” to be done, but if somebody’s determined to die alone it would at least give them a way to notify the right person, or possibly even the undertakers, without having to try to find some technique to make sure they didn’t get the notification until after the fact, but did get it soon enough to prevent someone unprepared from walking in on the body.
You’re comingling the logistics of death (the when/where) with the manner (physician-assisted death). It should be obvious that regardless of whether a patient’s death will be natural or physician-assisted, no hospice care team would transport a patient to a new location without first confirming whether that new location is ready and willing to receive the patient.
Whether a patient’s death will be natural or physician-assisted, discussions between the patient and their physicians about how the patient wishes to go about this which by necessity involve other people in the planning require that those other people be consulted about the relevant parts of the planning.
All I was doing was indicating a specific kind of case in which a family member might have “legitimate reason” to be consulted in discussions as to how their relative wishes to die.
This might be clearer than the question of whether to let the patient in the door in the first place: If the death’s going to be in the relative’s living room, and the relative is horribly uncomfortable with its being by active means whether physician-assisted or not, that needs to be discussed ahead of time (and if the patient wants to be able to use such means it’s probably better to choose another place.) The time to find out that the relative is going to make objections is not while trying to swallow the meds.
We’re putting a lot on the doctor/physician. I know we have a few doctors here on the SDMB - I wonder how they would feel if one of their patients requested PAS. Paging @Qadgop_the_Mercotan or @DSeid or any other doctors or nurses.
Anyway, doctors are not Gods. They are humans and can fail in this exercise the same as any family member. I am not suggesting doctors be removed from the equation here, but is it possible a family doctor could be opposed to PAS and refuse to carry thru with it, even if their long-time patient has asked for it? Then what - you have to go doctor-shopping for someone that will partner with you, perhaps a stranger?
End-of-life care might be a specialty?
It would have to be all right to work with one’s usual physician, however, presuming that that person was willing and was up to it.
To some extent, it already is: it’s called hospice. Though I don’t know if, or how, a hospice team would be involved in a PAS scenario. When my mother was in the hospital, she was deciding whether or not to go on trying to treat the cancer; while at that point they knew it was terminal, there were more aggressive options aimed at palliative care, as opposed to comfort-only care which would be provided by hospice. The oncologist team would basically have washed their hands of her entirely if she’d gone the hospice route - which seemed kind of cold to me.
It turned out not to be a problem; she slipped away faster than any of the family expected (though one nurse had warned us, she had seen people in Mom’s situation before and thought it likely that Mom was not going home at all).
When my FIL was in the hospital this year, and it was determined he was not waking up, I was a little surprised that when they moved him to the hospice wing, he basically had nothing - no monitoring whatsoever. No IVs, I can understand - I think they had a catheter in place to administer meds to keep him comfortable, but no other fluids. No BP, ditto (I don’t know if the nurses even checked his BP during rounds - couldn’t blame them for not doing so, as a BP reading can be painful). But not even a pulse oximeter. I guess they basically checked him every hour or three, and at some point found he’d passed away since their last visit.
I’ve taken care of a lot of hospice/palliative care patients. To be in hospice care in my state, the patient needs to be appropriately qualified; i.e. have a diagnosis that is expected to be terminal within at least 6-12 months.
With that criteria met, I have discontinued life-prolonging medication when the patient desired to do that, including stopping things like insulin, blood thinners, blood pressure meds, etc. The emphasis of treatment was thus easing of pain, anxiety, distress, and so forth. We (the palliative care team) ordered a lot of opioids, benzodiazepines, and even stimulants and other meds as appropriate to improve the patient’s comfort level. I’ve ordered things I knew would very probably shorten their life, but it was given to make them comfortable, not to end their life.
I would not give a med or treatment if the planned effect of it was to cause death. “Primum non nocere” (first, do no harm) is one of the first things I learned in medical school. I’ll stop all life-extending treatments and make them as comfortable as possible even if that shortens their life, but I won’t end it.
If I was in that position as a patient, I’d want that sort of treatment for myself.
All of that requires open, honest communication and education with the patient and allowing them to choose which available options they prefer.
I realize this excludes patients who have conditions that make life unbearable for them yet don’t cause death. I admit I’m not sure the best way to handle that.