Come on, you’re saying “If they’re in so much pain you CANT KILL THEM! But you can give them so many drugs they you know they’ll die”?
I really cant understand the idea of someone thinking “Sure they’ll either be doped up or be in indescribable pain for the next few days, but life is precious!”
Do you really see a moral differnece in “Oh well, I can’t give you morphine until you die, but i will gladly increase it un you are no longer suffering*”
*even though we both know that that means ‘until you’re dead’/
Question for you, say i have a family member on life support, they are technically alive, would you ever suggest that i kill them by “pulling the plug”?
I apologize if my comments came across as “anti-doctor.” I think my questions are far broader - and many would consider even more offensive. Bottomline and without taking the time to put this nicely, I think society should favor the killing of this particular old lady. I do not understand the benefit anyone derives from the current situation (other than salaries/fees to some caregivers/providers).
I am fortunate that my parents died quickly in their sleep, and I was spared any such decisions. I imagine my wife’s friends bear as much responsibility as anyone else for choosing the current situation.
I guess I lack compassion or some other emotion that would lead someone to say the cost of keeping such people alive outweghs the societal cost of deciding to kill such people.
Let’s just start with saying humans are not properties. That is the reason why a veterinarian can legally kill her/his patient, while a doctor cannot do the same.
I am completely for euthanasia in every way. Let the old lady die. Let healthy people die if they choose to. Let mentally ill people die if they derangely want to. Let children die if their parents give them permission.
Not to hijack the thread, but I do want to clarify: Is it ethical and legal for a doctor to continue to prescribe ever increasing doses of pain/anxiety medication to a terminally ill patient to treat symptoms, even if he/she has very good reason (or almost certain reason) to think that a dosage that high would kill the patient?
ETA: In other words, if I am dying, can I tell a doctor, “I want you to give me enough meds to be stoned out of my mind because I am really, really afraid of dying” and the doc would have an obligation to keep me in a drug induced haze for my remaining month, six months, year?
The major dividing line here is whether or not the intention is to kill the patient. Depressing someone’s respiratory drive by giving them huge doses of morphine is ethically the same as exacerbating someone’s congestive heart failure by giving them a lot of fluids to treat dehydration. Yes, you are arguably harming the patient, but it’s not like withholding the treatment wouldn’t do them just as much harm. So if you look at it strictly from a standpoint of not doing any harm whatsoever to the patient, you’re damned if you do and damned if you don’t. Fortunately for the terminally ill, medical ethics doesn’t look at things in quite such a black and white way.
The other factor is whether the negative outcome is certain or merely a possibility. Saying “I’m gonna pump morphine into you till you’re good and dead” means the patient is definitely going to die from the treatment. Compare that to “At this dosage, morphine can depress the respiratory drive, and with someone who is already this debilitated, it could be fatal.”
We’ve gone through this since the turn of the year, and I’ll flat tell you this: if the shots they put my grandpa on that last day or so sped up his death, it wasn’t by more than a day or two. If any of us had to choose between the extra time and him being in the sort of pain and agitation he was in prior to the shots…it would be a heartless fucking beast who would eschew the shots from fear of hastening his death.
And that’s what we’re talking about when we talk about upping someone’s pain meds to possibly fatal levels. We’re talking about people who, to put it crudely, shouldn’t be buying any green bananas. Most of them have hours or days left anyhow, so giving such high doses isn’t changing the outcome appreciably.
If the symptoms are severe enough, and the patient understands, and there’s truly no other way to alleviate those symptoms, then yes, it can be. (Obviously every situation has its own complications.)
That’s not so clear-cut. There are ways to deal with the fear of dying other than a drug-induced haze, so I would feel obligated to exhaust them first. If the drug-induced haze really is the best state you can be in, then the doc is at least justified in keeping you there. (Whether he has an “obligation” to do so is even stickier.)
It’s not exactly theoretical–situations like this come up in hospice care all the time, though usually not quite so explicit.
I’m just saying that the canon of medical ethics considers them to be very different situations, and that active euthanasia is generally considered to be unethical. Note that everybody doesn’t feel that way; a lot of people (including me) believe it is justifiable in the right situation, which is why it’s legal in Oregon. But moral or not, it’s illegal for most of us.
(On review, I realize I was not clear about this originally.)
Of course I would. I have made just that recommendation many dozens of times.
FWIW, I didn’t consider your comments to be “anti-doctor” at all.
Hell, I can’t even find much to disagree with you about. I’m not sure society should favor euthanasia in cases like these, exactly, but I wish society were neutral enough about it that it could be a more explicit option.
I don’t even feel like we’re quite there with hospice care itself. We’ve re-branded the treatment of disease (especially cancer) as a “fight”, so accepting a terminal diagnosis and foregoing longshot treatments in favor of palliative care is “giving up”. I don’t think society should discourage people from undergoing whatever reasonable treatments are available, but it also shouldn’t see hospice care as a moral failing. (I don’t see this attitude often these days, but I still see it.)
I wish I were close enough to these people to discuss this openly with them (much later of course.) For the past several weeks my wife has heard from them about how horrible things were at their house. Day before yesterday my wife went over to help them change the old lady, as some relatives were coming in from out of town and my wife seems less bothered by some things like that than they are.
Then we stopped by yesterday to offer our condolences, and the woman was talking about one period a week or so ago that the old lady was lucid and talking. So I wonder if she (or the old lady if she could express an opinion) would think those couple of hours were worth everything involved in the final month?
These people are Lutheran, so I don’t know how much their religion influenced their choices/actions. I don’t think the old lady had many assets, but they may have acted as they did to avoid exhausting all of her assets. And they had her room fixed up really nicely, so I guess it was as pleasant of an environment to die in as any. I don’t know exactly what the old lady’s meds were, and was not privy to any of their discussions with caregivers.
Personally, I would wish to die before “imposing” myself upon my kids in this manner. When and if the situation arises I hope to take care of things myself instead of putting my kids in such a position.
It’s important to discuss these things with a clear perspective, but unless you’ve had to deal with it firsthand, you can’t possibly understand what’s going through the family’s mind, much less the patient’s.
I saw how my father and mother grappled with these choices during my mother’s final illness, and it still didn’t prepare me for when my father had a stroke and it was my responsibility to make those decisions.
Having gone through it myself, all I can say is that I don’t think it’s a good idea for health care providers to suggest either to the family or the patient that maybe they could speed things up.
For my family… mom was an atheist, and most of the rest of the family is the same or agnostic. So religion doesn’t enter into it.
She had great insurance, so cost was not a factor.
We brought mom home and took care of her the last few months. There were definitely some icky parts. On the other hand, at no point did we see a need to “hurry” anything along. We just let things happen in their own time while keeping mom as comfortable as possible.
Heck, mom wiped my butt and cleaned up my puke for a couple years, from infancy until I turned into a self-aware human being - I’m going to begrudge mom a couple months of such care?
I’m not going to argue you out of your opinion. It’s how you feel. But do try to understand that not everyone else feels that way, and it’s not always a matter of religion.