This is often confused with, but is not the same thing as, physician aid-in-dying or euthanasia. People do talk about this in hospitals, and it is appropriate treatment for many patients at the end of life if they are suffering.
The ethical principle of double effect makes this permissible in these contexts. If the aim of the treatment with a benzodiazepine or opiate is to reduce suffering, the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications to achieve the first aim of relieving or preventing suffering.
Suggesting that this is a "workaround" for euthanasia distracts from the fact that this is not available as a treatment for most, if not almost all, dying patients. It is very different from physician aid-in-dying and is not a replacement for these other forms of end of life care.
> what doctors must to is to relieve the pain, nit to prolon
No, doctors implement the patient's wishes. If the patient would like to live as long as possible, even if in pain with an incurable condition, that's the patient's prerogative.
<eyeroll>. It's obvious that doctors don't have to implement any patient desire at all. It must be part of the doctor job description, and sham medicine is obviously not included.
But living longer, even with pain and even if the patient is still going to die, is not considered futile or a sham. (We all have an incurable disease because we all are going to die eventually.) Doctors are of course able to decline to participate, but they must refer you to another doctor.
I was referring to cases where "life" is just "not death", in the sense that "this person is alive just because we are keeping him so" (apart from the elementary support like feeding, cleaning, etc.).
I was not (certainly) referring to cases where the person is conscious and able to make decisions. There is little "palliative sedation" in these cases.
Is there any way suffering at the end of life can be good? Someone I know chose to forgo this treatment as he died from leukemia, so that his mind would not be dulled at the end. I also heard of another lady who resisted this sort of treatment at the end for the same sort of reason. People may value being fully present during their last moments more than they want to avoid pain.
People who wish to forgo sedation at the end of life should be allowed to. Likewise, people who want a quick dignified death should also be allowed to. And everything in between as well. One size does not fit all.
Sure. The gradual physical deterioration and loss of consciousness are OK. But I want to skip the painful parts.
A huge part of enjoying LSD at high dosage was being OK with forgetting who/what I was for a few hours. So maybe dementia will be OK too, as long as I don't stress too much about it. And as long as people around me are also cool.
My 81 year old mother has dementia. It is a terrible disease. She has no short-term memory at all and it makes caring for her extremely difficult. Also, as the disease has progressed, she has gotten into crazy hallucinations and almost hurt herself and my father many times. She puts him into all kinds of bizarre situations when out in public by often screaming for help and telling bystanders she is being kidnapped/held against her will, which makes life for my father a living hell since he already hates cops and government authorities, and now he has to talk to them and explain his situation all the damn time. It's...a...living...hell--for her, for him, and for the entire family and she can't die soon enough because death would be far better than having no ability to be productive and able to care for herself.
However, it sounds like their relationship has become confrontational. And it might help to empathize with her. Perhaps she does have cause to feel held against her will.
Some years ago, we realized that an uncle, who was ~85 years old and living alone, wasn't taking good care of himself. He wasn't eating enough, wasn't keeping himself clean, and just dozed on the couch, watching TV. And one of his feet was gangrenous.
So we invited him to live with us, and he agreed. And we saved the foot. However, my wife is very kind and caring. But she has high standards. So there was much conflict. She argued that, because he had Alzheimer's, and because he was living in our home, he didn't get to choose when to get up, when to eat, when to wash, when to shave, etc, etc.
It got to the point that we hired a big guy who basically forced him to do what she wanted him to. It was horrible. But finally, I convinced my wife to cut him some slack. We let him grow a beard. We let him wash at the sink, rather than showering. We let him watch TV all day, if he wanted, and got him a cat to keep him company. And we made sure that he ate enough, and had proper medical care. We retained the big guy, but he became our uncle's closest friend.
So anyway, whenever I hear horror stories from caregivers, about people with dementia or Alzheimer's, I wonder how it looks from the other side. If for no other reason, because that's the side I'm approaching.
This is a good question, definitely worth thinking about. Also: you only get to live any particular second of your life only once, wouldn't you want to be able to experience it fully?
The key is that it's their choice. A patient who says they want to forgo treatment and experience the suffering should be allowed to. But a patient who says the suffering is unbearable and they want treatment to alleviate it should get it.
I'd second this, even though I'm only a 30 year old, I have done a fair amount of thinking about death. As a result, this is something that I would fight against...suffering or not. Allowing my experience to remain as clear as possible towards the end of my life is of the utmost importance to me. I'm not religious.
> the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications
Talk to opportunistic plaintiff's attorneys about how this works. A doctor knowing they might be doing harm by providing opioids that could cause respiratory failure is opening themselves up for a world of hurt
Who is going to be the plaintiff? I agree that administering x amount of morphine to alleviate pain when 99% of doctors know it's going to kill the person it's practically euthanasia but either the person or the closest kin decide. And the person has the right to be administered pain relievers and not suffer for months because the meds might kill them.
The long lost aunt that didn't even attend the funeral, I guess could try to sue for losing her dearest relative but not sure if she any standing. Any lawyers here? If the children decide for mom, can her brother sue the doctors?
The descendants. You answered that in your second paragraph.
> And the person has the right to be administered pain relievers and not suffer for months because the meds might kill them.
This isn't a right. Your just stating a platitude - If a person were extremely allergic to painkillers, a doctor could not prescribe them, even if the patient was in lots of pain.
>>The descendants. You answered that in your second paragraph.
So everyone of them (descendants) must agree? How far back, 4-10 generations? What if a fourth degree cousin cannot be reached in time, hold up everything or let the closest ones--children and or/ or spouse--decide?
Where are you living that children are allowed to make medical decisions for their dying parent? What legal powers are the hospitals using to follow the wishes of the children? I guess the brother can't sue if those legal powers are in place.
>>Where are you living that children are allowed to make medical decisions for their dying parent?
https://www.nia.nih.gov/health/understanding-healthcare-deci...
"Joseph’s 90-year-old mother, Leilani, was in a coma after having a major stroke. The doctor said damage to Leilani’s brain was widespread and she needed to be put on a breathing machine (ventilator) or she would probably die. The doctor asked Joseph if he wanted that to be done. Joseph remembered how his mother disapproved when an elderly neighbor was put on a similar machine after a stroke. He decided to say no, and his mother died peacefully a few hours later."
"Ali’s father, Wadi, is 80 and has lung cancer, as well as advanced Parkinson’s disease. He is in a nursing facility and doesn’t seem to recognize Ali when he visits. Wadi’s doctor suggested that surgery to remove part of a lung might slow down the course of the cancer and give Wadi more time. But, Ali thought, “What kind of time? What would that time do for Dad?” Ali decided that putting his dad through surgery and recovery was not in Wadi’s best interests. After talking with Wadi’s doctors, Ali believed that surgery would not improve his father’s quality of life but would cause him pain and discomfort.*"
> Where are you living that children are allowed to make medical decisions for their dying parent?
Given the prevalence of mental deterioration and incapacitation in many end of life scenarios, it is very common for children or a spouse to have power of attorney and decision making ability for someone who is near death.
In fact, many people take care of filing a durable power of attorney for medical decisions before it gets that far. I know I’d prefer my children have the ability to end my life if I were suffering.
>>Where are you living that children are allowed to make medical decisions for their dying parent? What legal powers are the hospitals using to follow the wishes of the children?
Child in coma, doctors say it's over. Parents decide to pull plug or not. Never heard of this scenario in USA?
No, fucking horrific. Who's looking after the best interests of the patient?
Also, it doesn't happen like that in all US states where the hospital makes a decision and presents it to the family, who'll need to go to court if they disagree.
> First, in California, Texas, and Virginia the burden is flipped: the families must go to court to stop the clinicians. Moreover, that is a widely recommended approach at the institutional level: announce the plan and give the family time to challenge, but do not seek permission from the court.
When my mother was dying from pneumonia (after it had destroyed her lungs), she had been on a respirator for several weeks and was only getting worse. She also had been unconscious because she had been "fighting" the machine. She had told us that she never wanted to end up that way, but she did not have an advance directive on record. The family made a decision to pull the plug and her doctor administered a large dose of morphine to ease her passing. She went peacefully. We were all very grateful to the doctor for this.
Something I wish was more common is some type of therapy for treating death anxiety. I read somewhere that LSD can reduce the fear of death[0]. I can think of few things I’d like more in life than not being afraid to cease to exist[1] in my deathbed.
I suppose those going through terrible terminal illnesses suffer enough to accept death over the suffering, but I don’t see why one should need to experience such extremes to accept the inevitable.
[0] That’s a big maybe, don’t go around self medicating serious issues based on unsourced comments on unregulated drugs
[1] I know religion or philosopy can sometimes fill this gap, but let’s remember those who are skeptical or didn’t have a lot of time to prepare
I had one parent die from brain cancer in 2011, and another was just diagnosed with a terminal brain tumor, so this is on my mind.
Honestly, I don't think this is a problem specifically for the person with the terminal illness. So much of the difficulty comes from everybody else. American culture does not prepare people to face death, either their own or of loved ones. So a lot of my energy goes in to helping other people manage their feelings at a time when I don't have energy to spare. I want other people to take LSD or do Zen retreats or serve at a hospice or whatever they need to do so they can manage their own death anxiety.
Speaking of which, I strongly recommend the "ring theory of grief" article. The gist is that if bad shit is happening to somebody, you help them rather than imposing on them. It sounds obvious, but I promise that it's unfortunately rare. Here's the article: http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-s...
I'm skeptical that any of those things actually "prepare" people to face death in the first place. Feeling like you're "prepared" weeks, months, or years before the final hours of your self or a loved one does not necessarily translate to those final moments when you are actually going through it.
There's nothing wrong with skepticism. Unless you let it stop you from learning. So I'd say be skeptical, but also be willing to explore.
Personally, I think there's a fair bit of reason to believe that both Zen training and hospice experience are useful to facing one's own death. Cultivating awareness of impermanence is central to Buddhist thought. Zen includes such traditions as composing one's own death poem [1] and specific meditations on death [2].
I also found spending time in a hospice to be useful. Anything unknown is hard to think about and possibly scary. Being in the presence of death made it more real for me. And I'm not alone in this; a hospice program founder has an excellent talk [3] and book [4] on what people can learn from hospice.
It's pretty well documented how terrified western culture is of death relative to others. The Power of Myth by Joseph Campbell is an excellent book which goes into insightful detail on this subject.
Terrified is the wrong word. Western culture simply understands the reality of the situation. Sure, you can delude an entire society with fairy tales and they will feel better about dying...that's not a virtue though.
I don't believe that at all. Western culture is strongly influenced by Christian notions like an eternal soul which has life after death. And American culture has a strong element of the pursuit of eternal youth. Contrast that with the acceptance of the transitory nature of existence that's central to Buddhism. Or even things like the Mexican Day of the Dead, where death is celebrated as a part of life.
>Western culture simply understands the reality of the situation.
You mean not waking up again?
I don't see what is so worrying about that?
If one truly believe there's nothing after this life I'd think one should be very calm?
Edit: to be clear, I'm a Christian, - I just happen to be puzzled by why non-religious people are afraid of death (except for worrying about their loved ones and the pain of dying that is.)
>If one truly believe there's nothing after this life I'd think one should be very calm?
At the very least, most people feel a sense of responsibility towards their loved ones, and knowing they will no longer be around to take care of them is a significant source of stress. That is how it was for my father. And if it ever comes to pass where I am terminal but still lucid, it will be the primary source of my frustration as well.
Is the goal of parents raising children not to prepare them to be adults that can take care of themselves? That's the problem with "helicopter parents", they hold on so selfishly to their role as a parent that they stunt their children's growth and atrophy their capacity for autonomy.
There comes a point in all our lives where we become so old that we become burdensome. If the old never died, there wouldn't be room or resources for new life and ideas to be born and grow. In that sense, it is honorable to meet death, because you are making room for new life.
I spoke of the lifelong bond between parent and child. In healthy relationships, that does not end once the child reaches independence. Rather, it grows into a deeper relationship than before. If, when reading that, your mind goes to solely helicopter parenting, that is on you.
> Self-preservation is a behavior that ensures the survival of an organism. It is almost universal among living organisms. Pain and fear are integral parts of this mechanism.
>If you thought you'd never wake up again, how comfortably would you go to sleep?
If we have no choice but to go to sleep, why would we want to spend those last moments feeling terribly uncomfortable?
If we face the facts that death is a part of life, and that we all must die, what's the practical value in fretting over that fact? (Aside from being wise not to do stupid things that lead to a stupid death)
Excerpting my point out of context like this isn't helpful. I'm responding to the Christian's glib notion that he doesn't understand why atheists worry about dying.
There's no value at all in fretting over death once it's inevitable. There is great value in fretting over possible deaths we can avoid. And regardless, death for atheists is the loss of everything, and loss aversion is a well-studied component of human psychology, so it should be unsurprising even to a Christian that atheists are not particularly jolly about death.
Yes, I understand why atheists are so fearful of death, but also see the illogical and impractical nature of it.
>death for atheists is the loss of everything
Atheist logic should lead to the realization that from an individual standpoint, there is no possibility for the experience of this feared loss, at all. Immediately before the moment of death, you still have it all. Immediately at the moment of death, you have no conscious ability to experience the loss. Therefore the fear is not logical, it's irrational because your "total loss" is something you can never experience.
It's "not logical" only from certain poorly considered priors that have very little to do with how humans work. Emotions aren't supposed to be "logical". Emotions are part of the biological machinery that keeps meat-machines alive and active in the world.
>Emotions are part of the biological machinery that keeps meat-machines alive and active in the world.
Not all emotions are valuable, some are indeed quite harmful and anti social.
Which brings us back full circle to the original point of this comment chain: that western society is extremely emotional about the subject of death relative to other societies. This tendendency leads to unecessary suffering and the prolonging of life at all costs.
The US has come very far from its founding mantra; "Give me liberty, or give me death!" has seemingly been reversed to "anything but death"
> I'm responding to the Christian's glib notion that he doesn't understand why atheists worry about dying
I'm not glib.
It's an honest question. This puzzles me.
Also I'm Reitan, not "the Christian" and while you don't owe me much respect, some degree of politeness so you don't call me glib is expected here AFAIK.
It seems like I've struck a nerve though and for that I apologise, I just hoped for an answer.
I'm of two minds about this. Like most everyone, of course, I have this fear. I ponder the ways it is not adaptive. I find it lessens over time as I consider this.
First of all, I don't "hypothesize" anything - I am just pointing out what seems to be the obvious answer to "what happens when you die?". When the brain is damaged or undergoes chemical changes, we know that consciousness seems to disappear. There is no strong evidence to think this is different upon the death of any organism.
Second, I find your puzzlement with the fear of nonexistence utterly incoherent. Humans are born with the desire to live. We don't want to stop existing. Stating the obvious truth that one can't experience things when they are dead is completely void of content - the point is that we fear our eternal end WHILE we are alive because we'd like to continue on and be healthy again.
>When the brain is damaged or undergoes chemical changes, we know that consciousness seems to disappear. There is no strong evidence to think this is different upon the death of any organism.
People often have dreams under such circumstances, and there are many who have died and been resusitated that report having wild experiences inbetween.
>we fear our eternal end WHILE we are alive
Again, you're mythologizing/hypothesizing here with your use of the word "eternal".
But yes, when confronted with immediate life threatening situations, all animals including humans have a natural fight or flight instinct. However, not all humans (and seemingly no animals) have such existential dread like you do of a future of eternal nonexistence. Your fear is a result of your materialist reductionist mythology.
The simple fact of this discussion is: no one knows what death is truly like, so we can only extrapolate, hypothesize, and mythologize.
That physical damage to the brain results in loss or impairment of consciousness, and that there is absolutely no evidence that total biological death would entail anything but the cessation of this consciousness.
[EDIT: I want to be clear - I am NOT saying that it could never be the case that some form of "being" exists outside of what appears to us as a finite biological existence, I am merely pointing out that we have no evidence of this kind of existence, aside from vague spiritual feelings and experiences which are difficult to evaluate, so the skeptical position is the most honest one for the time being.]
>no evidence that total biological death would entail anything but
You seem very certain of your hypothesis. Is there anything that science has had a harder time defining, quantifying, or understanding than the nature of consciousness as it relates to reality? With that in mind it would seem more in keeping with the spirit of science to remain agnostic ("I don't know"), rather than atheistic ("I know")
>Those who raise questions about the God hypothesis and the soul hypothesis are by no means all atheists. An atheist is someone who is certain that God does not exist, someone who has compelling evidence against the existence of God. I know of no such compelling evidence. Because God can be relegated to remote times and places and to ultimate causes, we would have to know a great deal more about the universe than we do to be sure that no such God exists. To be certain of the existence of God and to be certain of the nonexistence of God seem to me to be the confident extremes in a subject so riddled with doubt and uncertainty as to inspire very little confidence indeed.
I just went through this with my grandmother. She decided she didn't want any more care in the hospital, so they morphined her up to the point that she never woke up again and she essentially starved and dehydrated to death, over about a five day period. The whole thing was disturbing to me.
If that treatment plan disturbs you, have you made your advanced directive plan so that the same thing doesn't happen to you? You could be hit by a bus tomorrow and unable to talk / write your desires down. What would you want if you found yourself in a hospital bed without a decent shot of getting out of it?
This is a very important point, whichever choice you make in advance. My father was in a similar situation after a large stroke, a decline into pneumonia, and was clearly not going to survive. He'd made his wishes clear in advance so we felt untroubled by this course of action. The fact that he essentially starved and dehydrated to death was what we knew he wanted given the other options. He was under constant medical supervision to make sure it was as painless as possible, rather than struggling on through what he would have thought was a pointlessly drawn-out and painful death. Make sure the people close to you know what you want. You may not get a chance to express your wishes at the time, and taking the burden of that choice off the people you leave behind will be greatly appreciated, however awkward and difficult the initial conversation is.
> If that treatment plan disturbs you, have you made your advanced directive plan so that the same thing doesn't happen to you?
OPs statement as I read it, their grandmother fully chose the best option she thought she had at the time and it disturbed OP, so not sure of the point about pre-choosing.
I guess perhaps to say, they would prefer not to be killed just because there isn't a decent shot? I'd prefer a hospital system that didn't do that, but I guess until we get one maybe it might be needed.
And as always, rather than planing for death, what about planning for life.
Work on the thing in your life that might cause the issue in the first place. Planning for death is giving up in some regard.
I'm in my 40s and have a full estate plan including a will & trust, technical recovery how-to's, and my advanced care directives documented. If I get hit by a bus tomorrow, I don't want a) my estate drained for bullshit care that won't fix me, b) or the people caring for me and executing my post-death instructions burdened unnecessarily. If I am a vegetable and the spark that makes me, me is gone, pull the plug. If I don't have the mental ability to ask for food or water, pull the plug. If I am in so much pain I am out of my mind, bring on the opiates and large doses please.
I haven't given up and I have no plans to die any time soon. I just realized I had too much money to die without a will and I don't want to live like a vegetable. It's all my choice, not a hospital system. You don't like these decisions, you do you and document your own plan.
Death happens to us all. If you don't like how somebody else did their death, document your own preferences. If you want to live unable to lift a spoon to mouth, unable to walk, confined to a bed, not knowing what year it is, that's okay. Just hope you don't marry somebody like me without an advanced care plan! I would pull your plug under those circumstances. I'd cry, but I would do it if I didn't know what you wanted. Sounds like you wouldn't want that...
Ignoring a 100% guaranteed thing in your future because it's uncomfortable to think and talk about is irresponsible in some regard.
My mom went through the same in hospice. She refused any food or water. Given that she was in the later stages of Alzheimer’s I thought it was a pretty impressive feat, euthanasia would have been so much more humane.
Humane to who? Ending one person’s life kills you a little on the inside, too. I have had to put three dogs to “sleep” and the fourth will come sooner than I want. I am not a better person because of it.
Having been legally required to make the decision of when to withdraw care for three different relatives, I think this is nonsense.
When someone is going to die, there is no good way, no good time. But there are worse ways and times. As technology gives us more power to extend life of body, we are forced to considered what that means, and how to use that power wisely.
Three times I have had to decide when somebody's life ended. I think their are practical differences between deciding to withdraw care and choosing more active measures. But I think there is no moral difference. Either way, somebody vulnerable has placed their life in your hands. Either way, your only real choice is when to give up hope, and how much suffering they endure between that point and death.
I honestly don't give a fuck whether you're a better person for it. Or whether I am. It's not about us. The important question is whether you have done the best you can for the person. And "best" here, I think means something like "in accordance with their informed preferences, or as best as we can guess".
To that end, I strongly encourage everybody to get their families together and have real discussions about this. The Five Wishes framework is one good option. [1] The best thing my mom ever did for me was to have a frank conversation with me and my brother about her end-of-life preferences well before she was sick. Don't make your loved ones guess. And don't put yourself in the position of having to guess for them.
Personally, if I end up with something gruesome and terminal, I aim to die well before things get awful. Like Brittany Maynard, [2] I'd much rather go out on my terms than suffer pointlessly until my body fails, consuming absurd amounts of medical effort. Others can do differently, of course, but there's no way I'd want a doctor who frets they're going to die "a little on the inside" by following my advance care directive.
I have gone through exactly this with my dad, where he was in an unbelivable amounts of pain and eventually was being given so much morphine he wasn't conscious at all in his final 4 days. So we just kept vigil next to his bed at the hospital 24/7, and there was absolutely nothing dignified about it, we were literally sitting next to my dad who was slowly starving do death. It was so disturbing I still have issues because of it. My dad might have chosen euthanasia, or he might not have done - but not giving him that choice in the first place(euthanasia is illegal here) and instead going towards sedating someone to a point where there is no dignity to speak about is horrendous to me.
I don’t expect it to be somehow advantageous to me, it is about lessening the suffering of another being. Plus my mom had stated for years that she wanted euthanasia if it got to that point, but it was not a legal option.
Will repeat myself for a third time. You feel that way after tending to end of life for your 4 dogs. Imagine how it must feel for your carer when it comes time for your end of life. Get an advanced directive documented, make it legal, and take the burden off other people to guess what your preferences would be. In a way, it is a kindness to your future carer. That way if your carer disagrees with your preferences or finds it a hard burden, they can point to something you wrote and be able to comfort themselves with "that's the way he wanted it."
As wpietri said, it isn't about you. It's about them.
It's actually harder in some ways with pets because they can't talk and tell you detailed preferences for how they want to go when it's their time. All you have is the general guideline that, if their condition can't be treated and they are going to have to die, you want to minimize their suffering. I've had to do it with four cats, and we have two dogs now whose time will come eventually. It's not easy, but it's not like you have a choice; you made the choice when you took them into your life in the first place.
And don't forget that making the choice to let them into your life adds a lot more to your life than whatever the pain of having to put them to sleep takes away. Our two dogs are both rescues; we have given them many years of happy life (and many more to come) that they would otherwise not have had at all. And they have given us a lot of happiness in return. That will always be there whatever comes.
> Ending one person’s life kills you a little on the inside, too.
Are you saying this in a metaphysical sense?
Secondly, if you don't want to put your dogs to sleep, no one is forcing you to do so, just refuse it and allow them to live in pain till they die of old age. It's not the choice I would make, but then I don't have your views on euthanasia.
I went through the same a few years ago with hospice. She had emphysema and real trouble breathing. She was mentally checked out after a few days in the hospital and opted for hospice. They started morphine and for a couple of hours she was able to breathe and felt great. She even said maybe she could get out of there - she fully expected to die.
Well after that she passed out, didn't wake up again, and died. Bothers me greatly to this day and I wish I had been there for the whole thing to challenge some of the decisions made that my parents didn't contest.
Gotta respect their decision. I mean, I see my father falling apart and if he made the decision idk if I'd contest it. He's not able to really go out, has trouble breathing, etc. Staring at the same 4 walls all day until you die naturally isn't the best way to go out. A little bit of you dies mentally every day going through that until you're just old, depressed, and unable to function. Why put them through that misery if they don't want to essentially rot in a bed or chair.
Don't feel guilty about this, or as if you and your brothers should have done something differently. It wasn't your choice to make-- it was hers and your parents'. They may have understood her condition and wishes differently, and had conversations you weren't a part of. In the moment, you guys didn't challenge the hard decisions your parents were making, and instead showed support. Which is doing something in its own right. Moreover, morphine can give a pleasant high, and combined with patient's own adrenaline surge around the times they're the sickest-- can make very sick people look much better. Consciousness/lucidity waxes and wanes a lot in sick people.
Will repeat myself. If you disagree with your parents' decisions, have you documented your own advanced directive plan? If you don't agree with what they decided for your grandparent, highly likely you would not agree with their decisions if they had to make them for you. You could be hit by a bus tomorrow and unable to talk / write your desires down. What would you want if you found yourself in a hospital bed without a decent shot of getting out of it?
Get it documented, make it legal, and if you don't trust your parents, then declare somebody else able to make medical decisions for you.
That's different from what I've heard from friends, they had to wait for their parent's hearts to stop. One sat with his father until three in the morning before it finally happened. I've not heard it's taken as many as five days though.
This was in the Netherlands by the way, before euthanasia was legalized.
My experience mirrors yours. I've had relatives receive doses in the scale of things stop working within 24 hours. But at that point, they didn't have very long left anyway, so maybe it's different practises, and maybe it's about how healthy the body is when the process is initiated.
But that was her life and frankly, I'd want that too. IMO, when your time has come--and it does come at some point--there's no reason to suffer. A few extra days of horrible pain is not life, it's torture. Why would you want your family to see you in that position?
From what I've read, starvation isn't actually that terrible.
For example: [1], quoting:
> Instead of feeling pain, the patient experienced the characteristic sense of euphoria that accompanies a complete lack of food and water. She was cogent for weeks, chatting with her caregivers in the nursing home and writing letters to family and friends. As her organs finally failed, she slipped painlessly into a coma and died.
> “What my patients have told me over the last 25 years is that when they stop eating and drinking, there’s nothing unpleasant about it — in fact it can be quite blissful and euphoric,” said Dr. Perry G. Fine, vice president of medical affairs at the National Hospice and Palliative Care Organization in Arlington, Va. “It’s a very smooth, graceful and elegant way to go.”
Patients under sedation don’t feel pain from starving or dehydration. If they were conscious the pain from their own illness would be considerably worse.
Patients under general anesthesia don’t, sedation is less certain. For obvious reasons, there’s no corpus or research into the issue, so it’s left to supposition. Remember that “sedation” and “unconscious” are not necessarily the same.
>Whether palliative sedation truly ends suffering is not knowable, although doctors perceive indications that it does. “You might be able to tell if their blood pressure goes up. Same with their pulse,” said Nancy Crumpacker, a retired oncologist in Oregon. “And you read their faces. If they are still bothered somehow, it will show in their facial expression.”
If she wasn't conscious and didn't feel any pain I don't see how it's "worse" than any other method of death. The whole purpose is to make the patient not suffer.
I don't think she specifically requested morphine, just that she no longer be treated. I'm honestly not sure how the decision-making process worked. It was kinda odd to me because no one said that she was going to be completely knocked out for the rest of her few days. If I had known exactly how it was going to work, I would have asked to talk to her more before they initiated the process. But I got there the day after she requested the cessation of care and she was out, never to be conscious again. She was then moved to hospice with a locked-up morphine machine and we all sat there for several days, watching her die.
I watched this in action with my father's death. My mother had a long nursing career and had a talk with the doctor that lasted about 15 minutes (it was 20 years ago), after that a large morphine dose was added to his IV. Within 5 minutes I watched my dad stop breathing.
My Dad was in his early sixties, morbidly obese, this condition was aggrevated by his lifelong fear of doctors. Dad needed hip replacements but wouldn't consider it because of his medical phobia. This caused his lack of mobility which caused urinary track infections from his dificulty moving to a toilet chair.
He was in the hospital for chronic UTI's when my mom made the decision. He was lucent and not at all ready to die.
Mom has passed too and it feels cathartic to say this.
In my opinion the medical profession know quite well how to run the system. My mom spent most of her career in a terminal cancer hospital. I was an active opiate addict at the time, so my opinion wasn't solicited.
A few years ago my 90 year old grandma had a stroke in her sleep and the doctors told us she'd never really have any more quality of life and what's usually done is just pull out the sugar drip and basically wait for her to (for lack of better word) starve to death.
After a day or two with no food or water she'd drift in and out of consciousness. It was amazing how she would even refuse my offer of wetting her lips with a sponge.
During a time I was alone with her, her breathing became so heavy, this rattling sound. I asked a nurse "can't you give her something" and he gave her a shot of morphine and a few min later the breathing stopped and that was that. It was quite a humbling experience.
When my dad was dying it took 4 days after he became unresponsive. They administered morphine all along but not enough in one dose to be fatal.
The rattling came on day 2-3, then quieted down.
The strange(?) thing was that he lost consciousness and became unresponsive shortly after my brother arrived at the hospital. My brother was the last of the immediate, local family to arrive. My dad acknowledged his presence and in a few minutes was unconscious.
Then on the fourth day he passed shortly after his grandkids arrived from the airport.
This has been a thing-everyone-knows-but-no-one-talks-about in hospitals for a long time.
And honestly, I wish it would stay that way. Because while I support the right of terminal patients to die at the time of their choosing and avoid pointless agony, opponents of euthanasia do have a good point– which is not appreciated nearly often enough– that state-sanctioned euthanasia opens the door for family members to start pressuring people to die when they don't really want to. This is a thing that happens more than anyone wants to admit in areas where it is legal.
Deliberate ambiguity, where euthanasia is allowed but we all pretend it's not, is the best way to square this circle. Doctors have implicitly understood this for a while, hence this practice. Unfortunately, most people hate ambiguity in their laws, which I understand and think is a good priniple in general, but I wish they'd look more carefully and see that the benefits outweigh the costs here.
> state-sanctioned euthanasia opens the door for family members to start pressuring people to die when they don't really want to
Everything I've ever read - or heard - from doctors, is the exact opposite - that family members more often than not want herculean and unintentionally inhumane efforts made to keep a suffering family member alive for just a little bit longer.
That may be the usual case but that is not all cases. It does happen that people wish for there parents to die. You see it all over this thread. What no one can say here is that some people also wish for them to die so they can take their payout or stop paying for care.
Euthanasia in practice but not in name is also easier to reconcile with various codes of ethics (especially religious ones) for the patient or his family. Suicide is taboo, large palliative doses of morphine are not.
I tend to disagree with that argument because I think the slippery slope issue can be mitigated sufficiently with proper procedures (waiting periods, psychiatrist interviews, etc.). However, it is a valid argument that must be addressed, is appropriately formulated and entirely on topic, so I'm confused as to why it was downvoted.
I suppose the question is whether deliberate ambiguity actually creates more scope for the pressuring by family members, because there isn't an established protocol with checks and balances for the patient to agree to die (and in practice any consent they give to "increased medication" may be uninformed or nonexistent).
Choosing to "euthanize" yourself is something that is so predominately chosen in fits of mental illness that society has probably made the right choice in banning it outright. Further, I think there's a strong argument that other people shouldn't be allowed to add any weight to the idea of killing you...
As someone else brought up, there can be disagreements between family and an individual about when the right time for them to die is in both directions. Even in America this can be observed with things like life support for the very elderly, an intervention that is sometimes necessary for continued life but not considered euthanasia to forego. You won't have to dig very deep to find a doctor that has seen families argue about this.
So, if you say "only I can make the decision," then mental illness becomes a lot more deadly than it has to be. If you say, "other people can weigh in," then what do you do when they want you to die more than you do (and start pressuring you, and you're old, and already depressed...)? This leaves us at our current state, which is "nobody gets to make the decision."
You’re so worried about making the wrong choice, yet you advocate for a situation where the law makes a blanket one-size-fits-all choice that’s inevitably going to be the wrong one sometimes.
You (rightly) worry about a situation where someone is pressured into dying, or chooses to die because their brain is broken. But what about situations where someone is suffering horribly with no relief to come, and they want to end it, and their family agrees, and their doctors, but everyone is prevented from carrying out their wishes because of a blanket ban?
Quite. By the same token, if I took my healthy dog into my vet to have it euthanized, I am sure my vet would refuse to do so, and probably inform the relevant authority.
Actually that happens often enough that it has a name: convenience euthanasia. I believe most vets will try to find alternatives before they go through with it, but some physically healthy animals are definitely put down due to behavioral issues.
Some vets will do it but not most according to my vet and vet tech friends. (Anecdotes, unfortunately.)
They find even the proper application of euthanasia terribly emotionally draining though. It's being confronted by the feelings of the human family that is the worst for them.
In some countries (like NL) assisted suicide is only allowed when certain criteria is met, such a terminal illness with no chance of improvement, etc.
Having seen some of my grandparents slowly fade with dementia, I'm sad they didn't have the choice to end it on their terms. Whether they would have chosen to do so I don't know.
But the individual freedom to end your own pointless suffering seems very reasonable to me.
Dementia is a good example - how far gone can someone be before they are no longer able to request death? At present, you cannot be diagnosed until you have already suffered enough decline to have seen a doctor about it. Most people think the difference between suicide and euthanasia is that euthanasia is requested with a "sound mind," but the cases where euthanasia seems the most opportune are those where no sound mind is available.
Exactly. Even if you try to make the decision ahead of time with a sound mind, where do you draw the line? And even if the line is drawn, what happens if you change your mind later but you're in the late stages? Which "you" gets precedence?
Perhaps you would plan ahead with a "living will" if those are available to you that states in the event that you are determined to no longer be capable of managing your affairs that you be euthanized.
I am planning to set one up soon though I will hopefully have a few more decades ahead of me. It will specifically state that in the event I can no longer manage my affairs I wish to be transported to the nearest locale in which I can have my life ended.
> It will specifically state that in the event I can no longer manage my affairs I wish to be transported to the nearest locale in which I can have my life ended.
Ha ha, "manage my affairs"... maybe give yourself a slightly longer rope :)
My grandmother sure can't do her own taxes, but she has no illness - she's just old, and world has changed around her.
Assuming you have well behaved kids, you'll likely stop managing your affairs long before you loose your health.
Nothing is every perfect -- neither is dying slowly.
But we have reasonable legal frameworks for refusing treatment already (even in cases of dementia, where a guardian makes the decision). We can build reasonable frameworks for making assisted suicide decisions too.
And should these frameworks have flaws we can improve them.
I won't outline a proposal here, but it's not rocket science to require a paper signed while of sound mind, and then giving a guardian permission to pull the plug later. It's not rocket science to limit it to people with fatal conditions, etc.
> This leaves us at our current state, which is "nobody gets to make the decision."
Except that is not our current state. Our current state is that a bizarre legal process makes the decision, and that process is different in every state.
Any time you have uncertainty, you necessarily have both type I and type II errors. You can tweak your decision criteria so that you get more of one or more of the other, but you can never eliminate errors entirely. The fundamental problem we have is that we can't agree which is worse: having someone die before their time, or having someone live past it.
One thing that would help is to recognize that our choice of terminology is hurting us: we talk about "saving lives" but in fact there is no such thing as "saving" a life, only extending one. Once you look at it that way you realize almost immediately that if you're going to allocated resources to extending a life, it probably makes more sense to, say, allocate those resources to a 20-year-old rather than a 95-year-old.
>in fact there is no such thing as "saving" a life, only extending one.
Most of the objection to euthanasia is focused on the case where you are administering deadly medications to a person that can survive on their own. Ending life support is another debate, although one that shares many properties and players with euthanasia.
Yeah, that's actually another thing that I think is messing us up, this idea that "letting nature take its course" is somehow better in and of itself than intervention. If you know that the outcome of "letting nature take its course" is going to be a bucketful of pain, and you have the option to eliminate that pain with a low-cost intervention, and you choose not to intervene, then IMHO that pain is on you every bit as much as if you'd actively tortured the person. (All this is assuming that the subject consents, of course. Some people might choose to experience the pain. I can respect that.)
On the other hand, I really don't see the salient difference between euthanizing someone and sedating them until they die of starvation and dehydration. Once you start to intervene with the intent of producing a painless death, why not just get it over with?
But what is "life support" in a hospital? Do providing food and water count? Would it be ok to also remove those forms of life support to allow one to finally die if it's their wish? Stop providing heat to their room?
If so, why so? Why is that form of induced death better or worse than administering a drug? If not, why not? It's clearly a form of hospital administered life support just like a breathing machine.
I don't have the answer, but it's not a cut and dry question. Like most things around life and conscienceness it's complicated.
>society has probably made the right choice in banning it outright
If you're equating society with government, you're not correct in every case. Assisted suicide is legal in some jurisdictions. California is mentioned in the article, but another example: https://en.wikipedia.org/wiki/Euthanasia_in_Canada
> This leaves us at our current state, which is "nobody gets to make the decision."
Someone always decides what's right, either yourself or your family or the state (usually via law).
You opt in favour of state and conveniently ignore the will of the people who would choose family or "they themselves" because law is not a person and therefore it can decide.
This is not what actually happens in practice. There are a number of states with "Death with dignity" laws. Read up: https://www.deathwithdignity.org/faqs/
The website you linked does not address the situation described in the comment above - where family members disagree with an individual about the time of death, and pressure them in to making a different decision than they would otherwise. (If it does, I missed it. For this reason it's often helpful to reprint your quote in the comment that contains the link.)
Again, this can already be seen happening in life-support cases. I won't say "ask any doctor," because I haven't asked every doctor, but it's not too hard to find first-hand accounts.
Nothing strange about it. Most legal systems attach far greater value to a human life than that of a dog, so the checks and balances around taking such a life are commensurably greater.
And "workaround" seems a strangely lightweight term to use in this context. It's not an engineering problem you're faced with here. It's an ethical issue.
I would be thrilled by the possibility of having an implant which requires a timed confirmation (every 6 months or so) and if there is no, it would pour poison in the bloodstream.
I am terrified by the possibility of not being capable to end my life when I want to, either because I am too disabled, or senile to the point of forgetting to do that.
I think it should always be left up to the patient, what they wish to do, and doctors should support it. If it gets to that point, I would very much like to spend my last days stoned and comfortable, and die peacefully. But if I have a terminal illness or I am in great pain, I very much want that choice of when to go.
End of life decision-making vis-a-vis the doctrine of double effect[0]. This section addresses specifically some of the claims made in the posted article.
Best choice is to follow the wishes of the person who’s in the heat of the battle. Be cognizant that those wishes may change as the illness progresses. Do it as being of maximal service to the loved one.
I've been trying to receive "euthanasia" for myself. I suffer gender dysphoria. I think it's a shame how society can discriminate a person with an illness compared to another group with a different illness; when it comes to receiving what is considered a medical treatment for ending pain. The terminology for who qualifies & receives euthanasia is flexible in the jurisdictions that offer it by terminology but people will warp their own perception around who they view should have a right to qualify to die by personal opinions without understanding the pain of another. Society doesn't help some people and euthanasia can be a real solution for the current system until real help evolves; where euthanasia can be less thought about.
I am not sure if this will help you, but to bring some perspective, this is very much a rational position on public health. Given that gender dysphoria is not actually a terminal illness it is probably not a good idea to offer euthanasia for it - there is a not-insignificant chance you will fully recover.
Suicide rates are much lower in areas where people have less access to things that can end their life (e.g. https://www.hsph.harvard.edu/news/magazine/guns-and-suicide/), statistically speaking many people do make it through. By offering euthanasia to people who would otherwise survive, those people will lose their shot at life beyond their condition.
Public health policy has to be driven from the net benefits to all and not at the individual case level.
Gender dysphoria is an actual terminal illness depending on the person. Many people end up dead because of it. My ability, desire, or whatever to eat diminished years ago because of it and my health continues to get poor with also lack of sleep. Similar to other illnesses where the body shuts down in the functions of having good health. I've been seeing several doctors for several years and continue to do so with trying to voice my right for euthanasia the past several months. Currently people take a diagnosis and have their opinion glazed over by success stories of people fitting the diagnosis. It's sad when people then refuse to acknowledge the ones who have a different reality with the same diagnosis. I think this happens a lot in the medical community.
To you what would make Gender Dysphoria a candidate for Euthanasia? The illness you listed is the same to some with Gender Dysphoria. I’ve known people with my illness who have committed suicide and they all communicated it’s like living in hell and feeling robbed of life. I think it comes down to your own perception being discriminatory based on your own personal opinion with disregarding pain not experienced of a certain life with an illness that people can’t imagine because it’s psychological.
My personal inclination is that anyone of sound enough mind to carefully consider the topic ought to be able to opt for physician-assisted suicide after a short waiting/consulting period as an essential element of agency over their own life.
That's beside the point in that the current medical practice and legal environment doesn't support that position broadly, so with respect to medical indication, the fact that some people die from a given condition does not seem to be a workable threshold for supporting euthanasia as a treatment.
Some people don't die from an illness that is considered a terminal illness and which receives euthanasia in the current medical practice. I can think of a few people who have survived certain types of cancer. Also it really depends on where a person is located right now. I could obtain euthanasia if I were to fly to Switzerland. I haven't considered doing that just yet and I don't necessarily find it the same as receiving the treatment in my birth country. There has already been a case where a person suffering Gender Dysphoria received euthanasia (not my country) and someone obtained euthanasia from traumatic rape throughout childhood (again not my country).
I'm on the current medical treatment I can afford. I wouldn't combine the word effective in that sentence. I've given it enough time to decide the treatment is unacceptable in making the pain be bearable. I'm at a point where it's euthanasia or suicide and which is the case for people seeking euthanasia. Some people have more pain than others with the same illness classification and depending on how life transpired. It shouldn't be an outsider limiting others scenario.
I’m sorry you’re going through so much suffering. I personally don’t think anyone experiencing mental anguish should commit suicide before giving “drugs of abuse” a try. These drugs are so popular and addictive precisely because they’re so good at making you feel better. They’re a last resort, but I think they’re a better last resort than suicide.
Here’s a link to a recent Reddit comment where I discussed this idea, along with suggestions of drugs to try:
Have you tried psychedelics? They’ve been reported as being effective at setting the world straight for many people. Probably need to do a good deal of research first, and conventional medical information sources will probably be unhelpful.
> I've been trying to receive "euthanasia" for myself. I suffer gender dysphoria.
I'm sorry to read that you want to die, but I hope very much that you continue to fail. You are valuable, you make the world better by being in it and it will be worse when you do die. Yes, you have a mental condition, but that is no reason to hate yourself: you deserve love, not hate. Life is tough for everyone, some more than others, but it's also full of joy & beauty, and you're part of that joy & beauty.
This is often confused with, but is not the same thing as, physician aid-in-dying or euthanasia. People do talk about this in hospitals, and it is appropriate treatment for many patients at the end of life if they are suffering.
The ethical principle of double effect makes this permissible in these contexts. If the aim of the treatment with a benzodiazepine or opiate is to reduce suffering, the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications to achieve the first aim of relieving or preventing suffering.
Suggesting that this is a "workaround" for euthanasia distracts from the fact that this is not available as a treatment for most, if not almost all, dying patients. It is very different from physician aid-in-dying and is not a replacement for these other forms of end of life care.