Physician Assisted Suicide

[TWR]

I read an article in the Sunday Houston Chronicle regarding this.  California has recently passed a law allowing this. I believe there are 3 other states that have allowed this.  2 on the west coast and 1 in New England.  Having worked in medicine for 31 years and have had family members pass in excruciating discomfort not to mention the financial drain.  If you can, try to read the article, Houston Chronicle, July 9, 2017  "Physician Assisted Suicide". 

[CAAdmission]

When this goes nationwide, it's only a matter of time until people start saying "Granny, your quality of life is not too good, and you are a bit of a burden on the family. You should think about assisted suicide."

[rev ronin]

9 minutes ago, CJAdmission said:

When this goes nationwide, it's only a matter of time until people start saying "Granny, your quality of life is not too good, and you are a bit of a burden on the family. You should think about assisted suicide."

I have seen assertions that insurance companies have already been suggesting that doctors have a conversation with terminal patients about whether assisted suicide is right for them.  No indication that this is widespread in America... yet.

 

ETA: https://www.google.com/search?q=assisted+suicide+insurance+companies&ie=utf-8&oe=utf-8

Looks like the reports appear to be primarily in religious- and conservative publications.

[Cideous]

5 minutes ago, CJAdmission said:

When this goes nationwide, it's only a matter of time until people start saying "Granny, your quality of life is not too good, and you are a bit of a burden on the family. You should think about assisted suicide."

 

That's a bunch of crap just like the "death panel" argument R's made.  The only death panel now is a bill sitting on the Senate floor which is why it has 17% support among Americans and can't even pass R's.

 

And for the record, Physician Assisted suicide has been around for a long time.  Enough Morphine to stop the pain and you stop the breathing as well.  A kindness to end dismal suffering.

[CAAdmission]

It's far from crap. It is the only inevitable conclusion.

If you think there are no people caring for elderly relatives that find them to be a financial burden and would be happy to do away with them, you're either remarkably naive or working in Beverly Hills.

 

[Zach]

We should be encouraging end of life conversations. I just wish it wasn't the insurance companies doing it. We spend far too much money in the last 6 months of life. 

There should be dignity in dying. If someone wants to go who is suffering from a terminal illness, they should be allowed to. And I think it's important that we explore the moral dimensions when properly defining and evaluating suicide. Physician assisted suicide is not the same as suicide because someone was bullied to death at school.

12 minutes ago, CJAdmission said:

It's far from crap. It is the only inevitable conclusion.

If you think there are no people caring for elderly relatives that find them to be a financial burden and would be happy to do away with them, you're either remarkably naive or working in Beverly Hills.

We are talking about "physician assisted" suicide, CJ. Not the family taking grandma out back behind the shed. It's probably another thing that physicians don't need on their plates, but they are the gatekeepers. 

----

But as a legal point, I do wonder the difference between physician assisted suicide and a patient who chooses to cease treatment. We just had a girl in Wisconsin choose to end her treatments after attending prom. Is the only distinction a positive versus a negative action? 

[LKPAC]

56 minutes ago, Cideous said:

That's a bunch of crap just like the "death panel" argument R's made.  The only death panel now is a bill sitting on the Senate floor which is why it has 17% support among Americans and can't even pass R's.

And for the record, Physician Assisted suicide has been around for a long time.  Enough Morphine to stop the pain and you stop the breathing as well.  A kindness to end dismal suffering.

wow.  

If you don't believe that some families might pressure Grandma into "assisted suicide" then that is naive.  Ever worked an ER on a Friday before a holiday weekend?  Ever heard of Grandma dumping?  Bring granny to the ER on Friday night, say the magic words about weakness, chest pain, whatever, and she spends Labor Day weekend in the hospital so you can go out of town.  It happens.  Do most families do this?  No, but a few do.  And a few would pressure Grandma into assisted suicide.

And I don't equate pain control with assisted suicide.  Helping a person die with reduced pain is a worthy goal, even if it might hasten the end.

 

[Marinejiujitsu]

I've had some attending almost drive me to physician assistant suicide [emoji19]

Sent from my SAMSUNG-SM-G935A using Tapatalk

[Maynard]

2 hours ago, CJAdmission said:

When this goes nationwide, it's only a matter of time until people start saying "Granny, your quality of life is not too good, and you are a bit of a burden on the family. You should think about assisted suicide."

Perhaps, but it is still Grandma's decision whether she lives or dies. The alternative is that it's not Grandma's decision at all.

 

I for one, don't want the government to ever be able to tell me I have to die a long, horrible, agonizing death even though a peaceful and dignified one is readily available. If you ever have to face a long, horrible, agonizing death and you prefer to go out the hard way then more power to you. It is your right to make that decision for yourself. But it's not your right to make that decision for me or anyone else.

[Joelseff]

2 hours ago, Marinejiujitsu said:

I've had some attending almost drive me to physician assistant suicide

Sent from my SAMSUNG-SM-G935A using Tapatalk
 

Hahaha When I read the Thread title that's what I thought it said!

[anewconvert]

4 hours ago, LKPAC said:

wow.  

If you don't believe that some families might pressure Grandma into "assisted suicide" then that is naive.  Ever worked an ER on a Friday before a holiday weekend?  Ever heard of Grandma dumping?  Bring granny to the ER on Friday night, say the magic words about weakness, chest pain, whatever, and she spends Labor Day weekend in the hospital so you can go out of town.  It happens.  Do most families do this?  No, but a few do.  And a few would pressure Grandma into assisted suicide.

And I don't equate pain control with assisted suicide.  Helping a person die with reduced pain is a worthy goal, even if it might hasten the end.

 

Grandma doesn't just get to choose. As physician assisted suicide is practiced in this country and many (all??) Western European countries it is a process. One that requires a terminal illness with no reasonable hope of survival, that take months from its first discussion to writing the prescription, and that requires two or more physicians to sign off on the decision after both agree that the decision is being made without duress and the patient is capable of making this decision on their own. 

 

And then, frequently the script is written for the medication and either never filled or never taken, because it isn't about dying but about having control...

 

There is a discussion to be had on the matter: inclusion of non-terminal illness or mental health diagnoses that are treatable but miserable for the patient.  Defining "terminal".  The role of community or religious leaders in the process (or not). 

 

 

or we could play the slippery slope game and talk about eventualities that have been thought through and have no evidence supporting their position.........

[rev ronin]

anewconvert, do you practice in a state that has legalized physician-assisted suicide?  I do.  I'm curious to hear if the disconnect between your statements and my experience is practice-based, or whether you're just talking about the theoretical safeguards rather than how they're actually instantiated by busy physicians...

[CAAdmission]

2 hours ago, anewconvert said:

or we could play the slippery slope game and talk about eventualities that have been thought through and have no evidence supporting their position.........

This isn't a "slippery slope" game - its more of a "just the tip" game.

Coercion - subtle or overt - can occur. Not good.

[anewconvert]

11 hours ago, CJAdmission said:

This isn't a "slippery slope" game - its more of a "just the tip" game.

Coercion - subtle or overt - can occur. Not good.

Yeah... that is called a slippery slope. It's a logical fallacy for a reason. 

 

 

There are checks in place to mitigate coercion. Coercion is still a non-zero concern, but it is mitigated. If we hestitated to treat the needs of our patients because of every non-zero risk we'd sit around hemming and hawing all day long. Instead we take steps to mitigate risk, and then weigh then benefit against the risk. 

[Cideous]

17 hours ago, CJAdmission said:

It's far from crap. It is the only inevitable conclusion.

If you think there are no people caring for elderly relatives that find them to be a financial burden and would be happy to do away with them, you're either remarkably naive or working in Beverly Hills.

 

 

What's naive is thinking that we need a law forcing people to die long painful agonizing deaths.  That's not freedom.  Freedom is the right to choose how you want to go out without having to stick a gun in your mouth.  Like the other posters said, if you want to go out the hard way or force a loved one too, then good luck with that.  I for one have no interest in suffering for weeks in front of my kids and then for good measure, bankrupting them because I'm intent of delaying the inevitable.  BUT....like I said, if that's for you?  Good on ya.  Just don't force others to suffer with you.

This is exactly why the assisted suicide bill was passed in CA.  And you know what?  A certain percentage of the people who were given the lethal combo pills after going through an extensive qualification process, didn't use them.  However, they also reported that just by having the cocktail provided them and their family immense peace in their final weeks.  The "throw grandma from the train" argument is quickly becoming tiresome as the public's view on this issue is changing.  Rapidly at that.  

Btw...I'm in Texas, not Beverly Hills.  Not exactly a bastion of liberalism......

[TWR]

Interesting and varied responses to this topic.  Some pro, some not, some defensive.  As I get older (73), I realize that the light gets a little dimmer at the end of the tunnel.  I am retired from PA life but stay active in the profession from the sidelines.  I am in good health, stay mentally and physically active daily.  (If you don't use it you lose it mentality).  I have the living will, directives etc.  BUT if I am diagnosed at some time with a terminal, incurable disease, at some point, I would like to have the right to end my life rather than suffer.  I am 100% about quality of life at least mine.  That being said, the statistics show that less than 50% of sedative prescriptions written to end one's life are actually used.  All of this is IMHO.

[Boatswain2PA]

20 minutes ago, Cideous said:

 

What's naive is thinking that we need a law forcing people to die long painful agonizing deaths.  That's not freedom.  Freedom is the right to choose how you want to go out without having to stick a gun in your mouth.  Like the other posters said, if you want to go out the hard way or force a loved one too, then good luck with that.  I for one have no interest in suffering for weeks in front of my kids and then for good measure, bankrupting them because I'm intent of delaying the inevitable.  BUT....like I said, if that's for you?  Good on ya.  Just don't force others to suffer with you.

This is exactly why the assisted suicide bill was passed in CA.  And you know what?  A certain percentage of the people who were given the lethal combo pills after going through an extensive qualification process, didn't use them.  However, they also reported that just by having the cocktail provided them and their family immense peace in their final weeks.  The "throw grandma from the train" argument is quickly becoming tiresome as the public's view on this issue is changing.  Rapidly at that.  

Btw...I'm in Texas, not Beverly Hills.  Not exactly a bastion of liberalism......

There is no law "forcing people to die long painful agonizing deaths."  This is simply inaccurate.

We are healers.  For those we cannot heal, it is incumbent upon us to ameliorate the pain of living, and the pain of death.  

But we should never be the intentional cause of someone's death.

If you don't want to "bankrupt your kids" as you die of a terminal illness then don't go into the ICU.  Stay home with hospice and take your roxenol.  

You're in Texas.....Austin??

[d2305]

Seconal anyone?

[sas5814]

I have seen enough slow, horrible death to make me pro assisted suicide. I once had to discuss with an ALS patient I was caring for in the nursing home what the likely progression of his disease would be. His last question was "what will kill me?" It was the hardest, most painful discussion I have ever had and the fear rolling off of him was palpable.

[Boatswain2PA]

Those hard, painful discussions are part of practicing medicine.  You helped him understand his disease, understand that he was going to die, and understand what was likely going to take his life. And I'm sure you did everything you could to make sure he died in a dignified manner....without prescribing him a medication for the sole purpose of taking his life.

We are healers.

[sas5814]

Assisted suicide isn't just for the purpose of taking a life, though that is what it does, any more than giving Lisinipril is just for the purpose of lowering blood pressure. In the first case it would be to ameliorate suffering and fear and give someone some control over their life and death and  dignity. In the latter it is to improve their health and by extension the quality and quantity of their lives. It sounds like a semantics argument and  I guess, to a degree, it is but I think you'll get my point.

It isn't something I could imagine participating in without a thoughtful long multi-diciplinary process that always left the control with the patient. I have seen to many painful, ugly deaths of people in agony and fear to not at least give the concept some real thought. It is probably moot for me because I'll be dead before it comes to Texas but it is a conversation worth having.

[CAAdmission]

50 minutes ago, sas5814 said:

It isn't something I could imagine participating in without a thoughtful long multi-diciplinary process that always left the control with the patient. I have seen to many painful, ugly deaths of people in agony and fear to not at least give the concept some real thought.

It sounds like your experience has been colored by seeing the consequences of very poor patient management.

[CAAdmission]

On 7/10/2017 at 2:51 PM, Cideous said:

And for the record, Physician Assisted suicide has been around for a long time.  Enough Morphine to stop the pain and you stop the breathing as well.  A kindness to end dismal suffering.

If your contention here is correct, then you have no grounds for concern. The system is working.

[sas5814]

32 minutes ago, CJAdmission said:

It sounds like your experience has been colored by seeing the consequences of very poor patient management.

Would that it was that simple. If every circumstance could be anticipated and every pain ameliorated then your point would be valid. Having spent a good chunk of my career where resources are scarce the kind of intense management you allude to just isn't there. I have seen excellent end of life care and I have seen things get out of control for the patient before resources have been brought to bear. I have seen people waste away slowly and miserably from different things after losing control of their body functions and their dignity is lost and no medicine ends their mental and psychological suffering. 

It is too complicated an issue to believe that all end of life care is or will be perfect.

[Jdabrowski]

For those against Physician Assisted suicide, how much of your decision is based on religious beliefs? Not trying to stir the pot but this is an interesting topic to read. Having worked with hospice I can see the validity of physician assisted suicide is certain situations like ALS patients and others of course.