Posted by: medicblog999 | June 27, 2009

A human choice?

euthanasiaI had a job a little while back that made me question some things but also re-affirmed a strong belief I have….that of allowing euthanasia in this country.

Now, I know that some people hold strong views on this subject (me included), but in this day of pointing fingers at bloggers etc, let me re-state that this is just my own personal opinion. We are all allowed to have views and opinions on things and it just so happened that what I experienced made me think about all of this stuff again.

I was crewed on a 2 person ambulance and we were sent to a local hospital to transfer a female patient from one ward, to a local hospice for palliative care. The information on the MDT told us that she was a DNR (do not resuscitate) patient but then also informed us that she was on ‘suicide watch’!

I looked at my mate and we both thought the same thing….If she is dying anyway, why go to the extremes of having someone watch a patient 24hrs a day to ensure that she doesn’t do anything to shorten or end her life?

I know its not as simple as that, and that in the eyes of the law, the hospital and the staff on the ward would be responsible for the patients well being whilst in their care and therefore would be indirectly culpable for allowing the patient to commit suicide.

We arrived on the ward and were met by the nurse in charge who proceeded to tell me that the patient (lets call her Val) had tried a number of times over the last 3 days to hang herself or choke herself with various cords, oxygen tubing, belts etc. She was now being sent to a palliative care unit for continuation of her care.

The nurses had drawn up a number of sedatives and managed to persuade Val to take them ‘to make her journey more comfortable’

We moved her onto the trolley and off into the ambulance.

It doesn’t take a doctor to understand her rationale for wanting to die.

She was fed up with the pain that she had, and she never got any significant relief. She was dying anyway, and she didn’t want to go through a painful drawn out death. She wanted some control back in her life, she was sick of being a patient and wanted to decide herself, what her fate was and when she was going to die. She had been told there was no further treatment for her and she knew that it was unlikely that she was going to get back home again. The only family she had was a brother who lived further down the country and couldn’t get up to see her due to his own ill health.

But……she was on suicide watch. She had a security guard sitting outside he door, constantly watching her. No one was going to give her any chance to finish what she had tried a number of times over the days before.

Whilst we were in the vehicle the sedation quickly took hold off her and she became disorientated and started pulling at the sheets covering her. Her eyes were open but there didn’t seem to be any one there. Her breathing became a little wheezy and her oxygen saturations dropped from 91% to 84%so I started a salbutamol neb to try and ease any discomfort that she may be having. I know she was DNR, but trying to maintain patient comfort is seperate from performing heroic measures to maintain life.

All the way to the hospital, I was thinking that this was far from a dignified and peaceful death. No doubt the hospice where she was going would be able to palliate her symptoms far better than an acute medical ward, but ultimately, its just delaying the inevitable.

When I was a nurse, I started my career in an oncology (cancer) ward, and also worked in a local hospice. I have the upmost respect for what nurses in the cancer specialities can do and I know that there is a movement against euthanasia and for good palliation and control of symptoms to allow patients to have a peaceful death. BUT……it isn’t always possible. Despite everyones best efforts, not all death can be peaceful. I have seen a number of patients apparently struggle right up to their last breath. Surely there has to be a better way for these patients and their families.

I would hate to see a member of my family go through an end of life event like that. I don’t see it as a cop-out to seek euthanasia as I think it takes a great deal of courage and support to make the decision to end your own life.

We don’t let animals suffer like this do we?

As for Val, I hope that she does find peace and I hope her remaining days are not filled with further attempts to end her life. It just doesn’t seem right or fair.

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Responses

  1. Very hard one! I totally agree with euthanaesia but it would be a mine field to try and control. I believe that people with a terminal illness should be given the right to end their suffering, however it will never be straight forward. With the introduction of human rights people will argue that the likes of mental illness and say for example copd could be classed as terminal illness, however long it will take to lead to death. I can understand why the government will not consider this as a humane form of intervention.

  2. I don’t agree with euthanasia. However, in a lot of cases, I wish that there was a humane way to let someone slip away and avoid the painful parts of their inevitable death. Yes, that is contradictory.

    I don’t believe that it should be up to the “powers that be” to decide whether someone lives or dies in that ultimate capacity, whether they do now or not. Also, if someone is conscious and alert… well then I don’t think that they are 100% qualified to make the decision either. We’re all dying, we’re all going to go through a lot of pain as we progress through life.

    I’ve seen the end of a lot of people’s lives as well, and it’s hard. I’ve considered changing my opinions on euthanasia a number of times. It’s a tough issue. If I get whacked on the job today, I’ll as someone “upstairs” if I make it there.

  3. It can be hard to climb into the mindset of our clients, those in terminal situations especially. We ran on a woman the other night (an hour after Bubba) who was screaming she couldn’t get out of bed.
    The son told us she is newly bedridden, terminal cancer and slowly wasting away. She told us clearly and concisely that she could no longer live the life she wanted and wanted to die as soon as possible.
    Who am I to stand in her way? She should be given the option of living her life her way.
    We put cats down, we put dogs down. We shoot horses to put them out of their misery (not US EMS but us as a whole, follow me) but when grandma gets old and sick we forcibly feed her and drug her beyond consciousness to “ease the suffering.”

    Euthanasia should be regulated like medicine and available to those who request it. Just like in Soylent Green.

  4. I have to say that I agree with the above statements, however I’m a fairly religious man. I believe that there is only one who decides when humans live or die. We don’t get to make those decisions for a reason, even if we don’t understand what the reason is.

    Think about it this way, the end-of-life care that we give these patients costs a lot of money and resources. We could use those monies and resources elsewhere, right? So let’s save all that time, effort, and cash and just prescribe a euthanasia coctail to anyone who 2 oncologists concur is going to die. Or to anyone who’s cardiologist decides that is never going to get their heart transplant. Or to anyone who’s schizophrenia makes them likely to freeze to death on the street…

    Think of how much better society would be if we just decided that the above was the right thing to do. Am I right? Guys? Hello? …

    (for those who do not know, the above two paragraphs were rhetorical, don’t flame me, Interwebs)

    But I’ve been there too. I’ve seen the pain, the suffering, the anguish caused by prolonging life against all hope. It hurts me to look at it but EMS forces me to do so. I too, consider euthanasia a caring, compassionate act in some cases because, as a religious man, I believe that there’s something better awaiting us after this life.

    However, I know a slippery slope when I see one. I have also seen how human nature corrupts even the most noble of ideals, and I don’t really want “the powers that be” to decide the fate of the helpless in that way.

    I’ve said it before, it’s above my pay grade.

  5. I remember an episode of “Futurama” (the short-lived adult cartoon creation of Matt Groening that I liked, but not enough others did apparently) where when people reached the age of 107 they had to be warehoused by the “Sunset Squad”.

    It’s because I watch cartoons rather than mature shows. Comedy over drama, 100% for me.

    I’m not saying that I disagree with euthanasia because I think that it is black-and-white-always morally wrong. I disagree with it because of the questions it raises and the unknowns. Proponents always bring forth the “Informed consent of the patient” statement. However, in the case of the 2 oncologists and the cancer patient, how many of them fight on until their family has to take over the role of the (In the US) Power of Attorney for Health Care? What then? There are plenty of examples of situations where the patient’s informed consent could not be secured. I would imagine that these cases also are those where the suffering would be the greatest as well. What then? Does the spouse make the decision to euthanize? The children? The physician? The state?

    I guess that there could be a question asked of everyone facing a terminal disease as to when they want to give up and whack themselves. It actually was a common thing where I grew up for old people facing horrble illnesses to go to the back of the barn with a shotgun once diagnosed with terminal cancer. I’ve personally attended many to make the pronouncement. Should the question be asked beforehand? What if the patient has an indomitable spirit and wants to fight on to the bitter end? What then? It would, logically be more expensive then for the healthcare payers (Medicare/Medicaid/private Insurance in the US and the NHS in the UK) to cover stronger willed patients than people who gave up early. I can see protocols and flowcharts being devised…

    I would think that the above statements are unpalatable to some in the audience. Unfortunately these are real considerations that must be faced in this debate.

    I again say that I would ultimately disagree with euthanasia because of these questions being unanswerable by man. Patients will continue to suffer because of these questions, I know… but I believe the alternative to be much worse.


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