Tuesday, February 01, 2005
Dead Wrong
The January 26th issue of JAMA has a review of the book "Physician-Assisted Dying: The Case for palliative Care and Patient Choice."
The 2 editors of the book are both advocates for physician-assisted dying and the book is slanted in support of their cause.
An excerpt:
A substantial majority of citizens believe that competent, terminally ill patients should have the option of receiving medication that patients could self-administer to bring about a humane and peaceful death if pain and suffering becomes intolerable...
The authors go on to conclude that physicians also support assisting patients in dying and, in fact, do already in an "underneath the table" way. The authors believe that laws should be changed to legitimize this practice.
I am a nurse practitioner that specializes in the care of the elderly. I have worked in this capacity for the past 10 years and I am very familiar with the issues surrounding the dying patient. I would like to give my opinion about the euthanasia craze that is sweeping the nation(s).
Dying is a difficult (obviously) process for everyone involved. There is no manual that lays out the various points to be met for a proper death. Most of the time what happens is that patient is no longer competent to make their own healthcare decisions. At that point a "Power of Attorney" is designated (usually a family member) and the POA makes the medical decisions.
Suddenly there comes a point when there is a choice to be made that will affect whether the patient continues to live or not. For example, a confused patient is no longer able to swallow. What is usually done is that a tube is placed in the stomach in which to feed the patient. Some POA's (and sometimes the patients themselves) refuse to have the tube placed. At that point there are some other options:
-They can continue to eat until they aspirate food/fluid into the lungs and get pneumonia ,which may or may not be treated depending on the POA's decision.
-They don't eat but have I.V. fluids administered to maintain hydration status until the effects of malnutrition (again, usually infection) cause death.
-No food or fluids are given and the patient thirsts to death (though acute renal failure is usually the real cause of death). Proper pain control is given when needed to keep the patient comfortable throughout.
Now none of these are euthanasia. In each case a decision is being made to extended care in some way, or not. No where is a drug given to end life. BTW I do not like option #3 and lobby against this to the POA. Thankfully that option is, by far, the most rare, and no patient making their own healthcare decisions has ever decided for that option either, which is telling.
Are most physicians practicing euthanasia? Not that I've witnessed. If a physician was found to be outright administering drugs to kill patients, whether the patient/POA was for it or not, they would be thrown in jail. The assertion by the authors is ludicrous.
Some may ask what is the difference between the above processes and simply killing the patient with a lethal dose of a drug. There are some stark differences:
-Not stopping the dying process when something could be done, and actually killing the patient by an active intervention is as different as flying a plane and falling out of one. We are all going to die. I believe a person should have the power to say "enough!" when it comes to interventions to prolong life. I don't believe a person has the right to say "I want to die now, you make it so!" That is a different creature altogether. If a person cannot see this then I don't no how to frame it so they will.
-This idea is considered quaint today, but the Healthcare industry is founded on the principle of life. If healthcare is again annexed into being also a vehicle for the extinction of life (like with abortion) it moves further from it's roots, it's reason for being. This will affect all parts of the industry. I see it now. Many little Gods running around deciding independently who has quality of life and should receive care, and who doesn't. Life is viewed on a continuum from least to most quality. Very dangerous stuff!
This post is getting too long, so I'll stop here.
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The 2 editors of the book are both advocates for physician-assisted dying and the book is slanted in support of their cause.
An excerpt:
A substantial majority of citizens believe that competent, terminally ill patients should have the option of receiving medication that patients could self-administer to bring about a humane and peaceful death if pain and suffering becomes intolerable...
The authors go on to conclude that physicians also support assisting patients in dying and, in fact, do already in an "underneath the table" way. The authors believe that laws should be changed to legitimize this practice.
I am a nurse practitioner that specializes in the care of the elderly. I have worked in this capacity for the past 10 years and I am very familiar with the issues surrounding the dying patient. I would like to give my opinion about the euthanasia craze that is sweeping the nation(s).
Dying is a difficult (obviously) process for everyone involved. There is no manual that lays out the various points to be met for a proper death. Most of the time what happens is that patient is no longer competent to make their own healthcare decisions. At that point a "Power of Attorney" is designated (usually a family member) and the POA makes the medical decisions.
Suddenly there comes a point when there is a choice to be made that will affect whether the patient continues to live or not. For example, a confused patient is no longer able to swallow. What is usually done is that a tube is placed in the stomach in which to feed the patient. Some POA's (and sometimes the patients themselves) refuse to have the tube placed. At that point there are some other options:
-They can continue to eat until they aspirate food/fluid into the lungs and get pneumonia ,which may or may not be treated depending on the POA's decision.
-They don't eat but have I.V. fluids administered to maintain hydration status until the effects of malnutrition (again, usually infection) cause death.
-No food or fluids are given and the patient thirsts to death (though acute renal failure is usually the real cause of death). Proper pain control is given when needed to keep the patient comfortable throughout.
Now none of these are euthanasia. In each case a decision is being made to extended care in some way, or not. No where is a drug given to end life. BTW I do not like option #3 and lobby against this to the POA. Thankfully that option is, by far, the most rare, and no patient making their own healthcare decisions has ever decided for that option either, which is telling.
Are most physicians practicing euthanasia? Not that I've witnessed. If a physician was found to be outright administering drugs to kill patients, whether the patient/POA was for it or not, they would be thrown in jail. The assertion by the authors is ludicrous.
Some may ask what is the difference between the above processes and simply killing the patient with a lethal dose of a drug. There are some stark differences:
-Not stopping the dying process when something could be done, and actually killing the patient by an active intervention is as different as flying a plane and falling out of one. We are all going to die. I believe a person should have the power to say "enough!" when it comes to interventions to prolong life. I don't believe a person has the right to say "I want to die now, you make it so!" That is a different creature altogether. If a person cannot see this then I don't no how to frame it so they will.
-This idea is considered quaint today, but the Healthcare industry is founded on the principle of life. If healthcare is again annexed into being also a vehicle for the extinction of life (like with abortion) it moves further from it's roots, it's reason for being. This will affect all parts of the industry. I see it now. Many little Gods running around deciding independently who has quality of life and should receive care, and who doesn't. Life is viewed on a continuum from least to most quality. Very dangerous stuff!
This post is getting too long, so I'll stop here.
# posted by Joe Florida @ 11:12 AM 
