What rules would you propose for legalized euthanasia?

In My Humble Opinion
1

Though whatever contrivances you care to postulate, euthanasia is legalized is your jurisdiction. The approved method is a poison so quick-acting and lethal that, once injected, the person loses consciousness before blinking twice and dies in less than a minute; it can be administered like insulin–in other words, without a doctor’s assistance. Supplies of the toxin are strictly controlled and monitored.

The specific conditions under which the toxin can be released to a prospective suicide have not yet been determined. A blue-ribbon panel is to be appointed by your jgurisdiction’s overnor, president, or whatnot to set up the rules. You are asked to chair this panel.

Now for the thread questions:

[LIST=i]
[li]Do you accept this nomination?[/li][LIST=a]
[li]If so, why?[/li][li]If not, why not?[/li][/LIST]
[li]Assuming you agree to serve on the panel…[/li][LIST=a]
[li]What constraints do you try to place on the procedure?[/li][li]What constraints do you work hardest to keep off the table?[/li][/LIST]
[li]Do you foresee unintended consequences if all your recommendations are put into effect? What, in particular, do you fear?[/li][/LIST]

2

ia) Yes, in a few years. I’m just begining my nursing career, but once I have more experience with palative care patients, I would want to be on the panel. It’s an issue that I think is very important.

iia) The final decision to euthanize must be made by the patient. This means that in the event that the patient cannot act as his own medical power of attorney, a living will must be consulted. Family will not be able to make the choice for them. Furthermore, they must have a terminal illness, with medical opion stating that they have less than one year (perhaps six months? Need to think on this more) to live.

iib)I’d worry about too much freedom with this right than too much constraint. Mainly, I’d want to ensure that people can be allowed to die in as much comfort and with as much dignity as possible, and that the choice be entirely within their hands from start to finish.

iiia) I’d fear a slipery slope effect, allowing family members to make the final call to euthanize in events where the patient cannot speak for themselves. In other words, a system that allows cousin Billy to order the death of rich Uncle Paul with the Porche, ‘out of kindness for the old man.’

3

Well, I’m torn. For one, I’m not sure I’m really qualified (legally, or medically) to chair such a panel…but on the other hand, I’d rather it be me than a number of other people or groups that I explicitly don’t trust. I might be underqualified, but at least I’m not a fanatic or a political loonie.

And for the record, is this policy just on a voluntary euthanasia procedure, or are we drafting rules for—well, I hesitate to use the term “involuntary,” with what that can imply, but never the less, the euthanasia of patients who aren’t actually making the decision themselves?

I mean, everyone’s afraid of jumping down certain slopes that’ve had some really *bad * historical precedents. But I have to say that there are surely medical situations where the least merciful thing would be to prolong life.

4

Voluntary, I’d say. I’d also say the panel’s job is to define the rules as to make sure we’re only talking voluntary euthanasia, if for no other reason than to shut Sarah Palin up.

5

(certified hospice volunteer hat on) You know, of course, that euthanasia is already practiced for at-home terminaly ill? “I’ll be back to check in on her in a day or two, but in case she’s in major pain, here’s a whole shitload of morphine (wink wink)”

Having been involved in hospice, I can offer anecdotal experience that, if treated for depression, most terminal patients will delay suicide for as long as they can. They look forward to visitors, and want to accomplish reasonable tasks (getting their gardens harvested one last time, organizing their memorabilia, etc).

If Obama is relishing the notion of denying the elderly medical care, frog-marching them off to hospice for premature deaths, he’ll soon face the reality that those programs actually improve quality of life and the patients will stick around as long as possible, and he’ll have to have puppies brought to the White House shooting range to get his jollies instead.

6

I’m sorry, did you mistake this for the Pit?

7

Wow. I absolutely don’t agree with any of this. I mean, I understand where you’re going, but I think I should be able to off myself even if I don’t have a prognosis of a year’s life. If I know I will live for many years yet but in pain I want to die. Hell, I think if I have reached a certain age, say 80, and think I have lived my life, I would like to be able to say goodbye and die without even being ill. And what happens if I am brain-dead? I need my husband to be able to say I want to die.
I don’t know the answers but it needs to have less constraint. Way less constraint.

8

No Scold I mean Skald, but I guess I mistook it for a “humor not forbidden” thread. There’s no such thing as your euthanasia board, but there is such thing as a weekly meeting of hospice staff, where there’s no shortage of humor (just not at the patient’s expense).

9

I think the word “euthanasia” should be left out of the whole thing. Legalize state-assisted suicide for everyone of legal age. Make this euthanasia substance available through psychiatric institutions and clinics by prescription only. Anyone who is not clinically depressed may go to the clinic to be evaluated, and if in their sane and non-depressed mind, they wish to go through the process of suicide certification, they may. Also, the drug should not harm the organs, and organ donation should be mandatory. The process should be informed consent, a 5 day waiting period in which you receive counseling, and a fee for handling the (remains of the harvested) body.

The process may be terminated at any time by the counselor or the patient. If the counselor finds the patient non-sane or depressed, the procedure is terminated. If the patient changes his or her mind at any point between application and the actual injection, the procedure is terminated. No family, friends, or anyone else other than the actual individual, through completing this process (which can/would include a living will and situational cancellation clauses), may make this decision in regards to any other human being. Family, friends, and other individuals will not be permitted to participate in the counseling session, or have contact during the counseling period. Children, teens included, are not considered to be eligible for the suicide program.

Once the entire process has been gone through, one is sure, and one has received their “certificate of authorized suicide”, then one may make one’s death plan. One’s death plan is the circumstance under which you wish to administer your injection, or have a certified professional administer your injection. Family members, friends, and other witnesses may not administer the dosage. Death should be permitted at home, at hospice, in hospital, or other public or private location approved for the purpose. (We could have a whole new industry! “Die at Mount Vernon! Follow in the footsteps of Presidents!” It’s already used for weddings, baptisms, and other parties.) Organ harvesting ambulances will be standing by. The injection itself; the state/federal/government counseling; and a basic living will, if desired, is free. The ambulance for the body is free. Everything else can be any way you pay for it to be.

Killing a certified suicide still counts as murder. Legal status of the individual does not change. If they become insane or depressed at a later time, but have a living will or death plan in place, the certification for suicide remains, as long as the living will or the death plan indicate so. If they are diagnosed as depressed or insane without a living will or death plan, then the certification for suicide is revoked, and the process must be restarted from the beginning. Attempting suicide in any form other than this one should be illegal, and require psychiatric attention. Anyone who has ever attempted an illegal suicide (once above the legal age, since we shouldn’t hold children’s foibles against them) should be ineligible for the program. I’m sure I’m missing something important, but this is a good starting point.

10

[LIST=i]
[li]Do you accept this nomination?[/li][LIST=a]
[li]I accept, because I am a godless heathen, not obligated to enforce or favor the strictures of any one religious or ethical system over any other, and because I am an arrogant and obnoxious person, unconcerned with the near-certainty that many people will think I am wrong, and because I am right.[/li][/LIST]
[li]Assuming you agree to serve on the panel…[/li][LIST=a]
[li]The most important constraints, in my mind are these:[/li][LIST=i]
[li]The request for euthanasia must come from the patient. Not from the patient’s legal guardian, spouse, child, or self-appointed proxy (folks who interfered with the Schiavo case, I’m looking at you). [/li][li]Any directives in favor of euthanasia should have been made before the patient became ill, if at all possible. That is, decisions regarding when and if euthanasia is desirable or acceptable should have been made, in writing, as part of the general end-of-life planning that all adults should do, along with writing a will, power of attorney for healthcare, and so forth. If the initial request for euthanasia is made after the patient becomes ill, the request should be subject to additional scrutiny in order to ensure that the patient is fully aware of the significance of their request and to ensure that the patient has considered other options regarding the management of their illness and end-of-life care. However, the decision ultimately must belong to the patient, and the patient shouldn’t be prevented from choosing euthanasia simply because they didn’t address end-of-life issues earlier.[/li][/LIST]
[li]No restrictions on life expectancy - if all other criteria are met, euthanasia is an option whether the patient has 6 months to live or 5 months and 29 days to live. It’s impossible to accurately predict the course or duration of many terminal illnesses, and the patient should be able to decide when they no longer wish to live without being second-guessed.[/li][/LIST]
[li]I forsee two circumstances that are likely to get ugly:[/li][LIST=i]
[li]A terminally ill patient did not leave any written documentation requesting euthanasia (or the documentation is insufficiently clear as to the details of the patient’s wishes), but the patient is no longer able to clearly understand or express their desires. Family members would not be able to make a decision on the patient’s behalf and would instead be confronted with the unwelcome choice of continuing life support (possibly against the patient’s wishes) or withdrawing support and allowing the patient to die naturally (which may take longer and cause distress or discomfort to the patient).[/li][li]A terminally ill patient did leave clear instructions expressing a wish for euthanasia, but the patient is no longer able to communicate and family members do not wish for euthanasia to be carried out. Care providers are left with the unwelcome choice of continuing life support against the patient’s wishes or performing euthanasia against the family’s wishes.[/li][/LIST]
[/LIST]

11

What if you were sixty or forty or twenty? A depressed teen? A bipolar man on a downswing? I believe that medically assisted suicide should be a tool for those who are terminal and who wish to avoid suffering. A person simply seeking death … well, I don’t think it’s a doctor’s (or nurse’s) responsibility to ease the passing of a person he could otherwise save. It feels unethical to ask that of medical personel.

As for medical proxy making the final call…it bothers me because I feel it’s open to abuse, but to be honest, I don’t think there would be any way to legally stop it. As far as I know, the word of power of attorney is as good as the word of the patient himself. That’s unlikely to change for a new medical procedure. I just personally would feel better about turning up the morphine if I knew for sure. And I believe everyone should fill out a living will.

12

I don’t see why there needs to be any rules and laws for me to kill myself.

13

Do you accept this nomination?
Yes. Making a long story short, because it’s an issue that’s important to me, I’ve given it a lot of thought and I’m not in an extreme position about it.

What constraints do you try to place on the procedure?
Supplies of the toxin have to be kept safer than Fort Knox. The procedure can be requested through a living will (preferably in writing, folks) by the patient himself; if the patient hasn’t expressed his opinion one way or another and can not, the family can request it. The procedure to determine that a patient can not express his opinion and is not likely to be able to “come back” takes between minutes (for explosive trauma) and weeks (for slower acting conditions), not frikkin’ years. The definition of family includes friends and roommates when no relative below the 5th grade can be found (that is, spouse/children/parents first, then siblings/adult grandchildren/grandparents, then uncles/adult nephews, then cousins - within each grade, in the order written).

What constraints do you work hardest to keep off the table?
That only if there is a written living will can it be done. That it can be done by the doctor’s decision, if so much as a single person gave a shit about the patient.

Do you foresee unintended consequences if all your recommendations are put into effect? What, in particular, do you fear?
Unintended, no, but I imagine there will be doctors who won’t perform the procedure (Spain is big on “conscientious objection” for controversial procedures). There is a risk of the toxin ending up in altogether the wrong hands. And of course, the actual implementations will always be ugly.

EvilTOJ, it’s not about “me killing myself.” It’s about “me getting myself killed when I can’t move enough to do it” and about “my family being able to ask for a fast death for me when I’m in a Schiavo situation, rather than for starvation.”

14

Wrong. Senility/alzheimers MUST be included. I am planning on offing myself before I lose myself. I am not going to be a drooling idiot stuck in a bed in diapers. I am not costing my family and society hundreds of thousands of dollars to keep my corpse breathing if I am not home in my head… i also dont give a shit if it is legal or not. I understand bleeding out in a warm tub of water is reasonably painless and the mess is self contained in the tub. I dont want to leave a mess. I will also take advantage of planning my death to close out online accounts and say good bye properly. I have my wake planned [music list and invitee list] and I am donating my body to science so the students can get a good giggle in at my poor corpse followed by a cremation and disposal by dumping the contents of the box on the family plot.

15

This is not a practice that I believe we, as a society, should support. People who want to die by their own hands can die by their own hands - if they really want to, it’s basically impossible to stop them anyway. But don’t ask me, a nurse who vowed to do no harm, to destroy the body of a still functioning human being. If you wanted to state in a living will that you wished to be euthanized once you were unable to, say, speak or once you were bedridden, I could support that. But I DEFINITLY don’t want any Joe off the street in my office looking to die because life dealt him a crap hand.

16

I see your point. Would you agree there is a difference between medically assisted suicide and suicide on your own? I don’t like that there are laws between me and killing myself, as EvilTOJ says. I mean, what if I am twenty…and also have some kind of horrid disease? What’s to say I can’t make that decision?

I agree on the Alzheimer’s too. Flowers for Algernon was a horror novel for me. Slowly losing your intelligence like that…

Honestly, why CAN’T humans make the choice to go, when they want, with dignity? I don’t understand the hangup. And part of the compassion of being a health provider is also understanding when to let go. However, I agree with you that it would be difficult to mandate.

BUT there should be provisos. If I have Alzheimer’s and am still aware and cut my wrists and leave a living will - “do not resuscitate, I want to die”, will anyone really listen? I don’t know.

And yes, I agree everyone should have a living will. But not everyone has the money to get one made! And there’s laziness, and don’t talk to me about fear - my mother is afraid the State will get all her money (sure as hell isn’t coming to me! ;)) but will she make a will? :smack:

17

Also, not everybody has ever been to the point of being able to make a living will. A minor can’t make one, but if he’s old enough, he can make his wishes known to his parents.

And some people don’t want to think about it in the level of detail required for a living will (tracheotomy - yes or no?) but at the same time anybody who knows them knows whether they’d rather last than live or die than last.

18

Sure there’s a difference. It’s physically and psychologically devastating to feel suicidal, a challenge to find a sure fire method, and, much as I hate to put it like this, an act that requires a great deal of courage to complete. I’m sure it would feel nice to die without that on your shoulders. But how is it fair to put it on mine? Can you agree that there is a difference between asking me to end the life of a woman in the final stages of ovarian cancer and asking me to end the life of a twenty two year old who just lost her first boyfriend?

I would need more specifics on the horrid disease to express an opinion on that. Are you terminal? In constant pain? Have no quality of life? I get where you’re coming from, but I can’t put a good picture in my head.

Because it’s not a self contained act. Doctors order it, nurses perform it, family mourn it and wonder what they could have done. No matter how you look at it, suicide is not a positive. In some cases, it’s more a positive than not committing suicide, but I believe those are extreme and, generally, terminal cases.

I don’t think they will, but that’s a legal issue beyond my scope as a nurse. Likely, some medical personnel would and some wouldn’t.

Living wills don’t have to cost much. You don’t have to hire an attorney to draft it for you - just asked my lawyer friend and it turns out there are kits that companies will send you for free. As for fear and laziness, I’m afraid that there’s not much to be done about that. But like the person who is fearful and lazy about looking for a job, sending in their taxes, and paying bills. There are consequences for everything.

19

No death is self-contained, whether it be by euthanasia, suicide, disease, or accident. Doctors give orders (for the toxin, for medications, for surgery, etc.), nurses perform those orders as appropriate, and when the patient dies, the family mourns and wonders what they could have done (“What if I hadn’t lent him the car keys?” “What if I hadn’t gotten sick while I was pregnant with her?” “What if I’d pushed him to see a doctor sooner?”).

With the possible exception of the person with no family, who dies unnoticed in the desert, every person’s death involves someone else, if only the people who have to deal with the body afterward. I’m not satisfied that euthanasia-by-request or assisted suicide is necessarily more disturbing to a family than is watching their loved one suffer, knowing that death is inevitable anyway.

I don’t agree that suicide is not a positive “no matter how you look at it,” unless you are arguing that no death is ever positive.

20

Did you even read my post, I specifically stated alzheimers/senility. I did not mention anything about a crappy life. I would have to off myself now if that was the case, I am physically handicapped, out of work, not likely to ever be employable again in this economy, and have multiple health issues. I just laid out almost $5000 as my copays so far this year, and the year isn’t over yet. I just don’t want to check out until I am losing my mind and self. When my self is almost gone, then I am going to check out.