What's the difference between assisted suicide and end-of-life sedation?

My husband has fought a long courageous battle (18 months)with pancreatic cancer. Up until a shortness of breath on 11/17/17, he was doing pretty well following treatment. He went through all chemo/radiation like a trooper but after hospital admittance, he continued to eat, sit & with physical therapy, he was taking steps again & due to come home on 11/24. However, his nurse didn't and/or chose not to come to his aid when he got up himself, fell & hit his head. He rang the nurse's station, bed alarm going off but no one came. He kept asking that the bedside toilet be kept by his bed but instead, it was placed dirty in the bathroom. He didn't want to lie in his feces for hours! He was sitting up & eating prior to the fall. The staff insisted fall mats were on place but, I was there every day...they were never ever there! After head trauma, he was sent to larger hospital. He was sent home on 11/28 with hospice. He never ate, drank, or walked again after the fall & now I sit mostly alone & watch him die! I've told everyone that this is hell, minus the fire. I've renamed myself Ms. Kevorkian. I believe this is a form of torture, especially being by his side 24/7. He has possibly a week of "life" left, while I'm watching him deteriorate more each passing. Assisted suicide? Maybe. The guilt will follow me forever!

"Euthanasia was once more practiced than historical records will admit to ."

The person who wrote this would obviously likely to believe it's true, but then how would she know if history doesn't record it? Here-say?

And Socrates' death by hemlock? He was sentenced to death by the government of Athens. It's not like he chose to commit suicide. If someone were choosing suicide it seems they would choose a less painful method than one causing emesis (vomiting), salivation (drooling), mydriasis (excessive dilation of the pupils), tachycardia (heart palpitations), bradycardia (abnormally slow heartbeat), fasciculations (muscle twitches all over the body), tremor, and seizures.

Euthanasia should be allowed in this corrupt country known as the US of A!

Me too CM but then you know my views on this

Yes, Jude - it's about intent. Pain relief or sedatives may be given for the purpose of relieving pain or preventing suffering. If as an incidental effect a treatment *may* shorten life, it is still an acceptable risk because the fixed intent is the relief of pain, not the shortening of life.

If a treatment definitely would shorten life, as in kill someone, you can't do that: no matter what the suffering it would prevent nor how effectively that treatment (e.g. brick, plastic bag, pillow over the face, massive overdose) would do the job. Which is why they spend all that time calculating precise dosages and restricting patients' control of the dosage instead of just whacking in a heap of morphine.

I still have high hopes that the Brompton Cocktail will make a comeback in my lifetime. If you're going to go anyway, high as a kite on morphine, heroin and cocaine - Champagne optional? - sounds good to me.

End of life care is fraught with a lot of difficulties. I think a lot of the issues come from the Hippocratic oath - I always thought that first do no harm was part of it but apparently not

They have to respect scientific knowledge and share it

They are obliged to treat the sick not over treat them or stop treating them.

They must recognise that warmth, sympathy, and understanding may outweigh surgery or drugs.

They must recognise their limits and refer where necessary

They must keep a patients information private

They have to take special care in matters of life and death.

To quote: If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humility and awareness of my own frailty. Above all, I must not play at God.

They must treat the person not the data about the person

They must act to precent disease

and a couple of others

So theoretically they do have the right knowingly to give medication which will result in a speedier death BUT only if they deem it necessary or appropriate for that individual person and as long as it conforms to the knowledge they have about that person.... I THINK

@countrymouse - thank you! I'm listening now.

Dr Gawande is giving this year's Reith Lectures, too - I think two of four of them have already been broadcast, but they should be quite easy to find and download from the BBC website. Very interesting speaker.

Also, I can't recommend this book enough - Being Mortal Atul Gawande. Excellent history regarding health care in this country beginning with the proliferation of hospitals that began after WWII.

Also, explain Hospice very nicely.

http://hospicefoundation.org/End-of-Life-Support-and-Resources/Coping-with-Terminal-Illness/Hospice-Services

I was wrong in some of my answers in my post. Sorry :(

Wow there are some really great answers here! Honestly when my mother was in hospice care in September, it was not easy at all. You are riddled with guilt and you feel like you are just starving them to death. I thank God they are not in pain though. My father thought the doctor would give him a shot to die, he wanted it over with NOW! Personally when a person is that ill, we should let them go.

The thought that the nurse who administers the injection has committed murder may be true but I think they have to deal with that themselves and see if it presents a moral issue to them much like those who perform abortions have to. I've been through both scenarios and all I can say is I have been thankful for those people being there when they were needed.

Ziggie - my condolences. You are not one of those 'America's Religious Right'...you are a person who believes and has faith in God, as I do. And there are many more of us out there than not. We're just not vociferous about our faith and practice it quietly.

Hospice allows the patient the palliative care without the drugs necessary to keep the body alive any longer. It's more of a natural death, i.e., no drugs to keep the heart working means you die naturally, the way nature intended.

For instance, my mom takes insulin along with a pill for diabetes, a cholesterol drug, a BP drug, and anti psychotics, along with stuff to make her sleep. She's also on a strict diet, no potassium, no fat, no carbohydrates, etc., etc. All that keeps her body alive. However, her brain is not functioning.

I've been told by the psychiatrists that I should start thinking about quality of life versus quantity, which to me, sounds a lot like assisting in her death. But the reality is it means just allowing her to die as she normally would without the drugs.

At least, that's what it means to me. Am I withholding drugs?

No. I don't feel it's my place to do so.

That's just me. She's not in pain either physically or mentally (at least she says absolutely nothing about it, although I see she can't see, hear, or get into bed by herself). I'm starting to allow the sweets she wants because I'm beginning to think that at her age, 91, she should be able to have something half way decent to eat that would make her happy.

Am I happy?

Nope. But it's the trade-off for taking her into my home.

I believe that hospice allows the patient to die on the natural timetable. Sometimes man keeps man alive beyond the will of God. Keeping patients alive with machines for the mere fact of a breathing body is not life. My mom was on hospice care. Her diagnosis was "failure to thrive" and dementia.She was not on a bunch of drugs either. I got to love her, enjoy her, spend time with her as I was her caregiver. I would not trade that time for anything for all the world. She quit eating and drinking on a Tuesday, passed away on Sunday Her body told her it was time to go .Hospice kept her comfortable during the death process. She was home with me. Was it hard to watch that process? You bet, I'm still grieving, I want her here with me, but alas, she passed exactly on God's timetable. And I'm one of those "America's narrowminded religious right"

It's like saying "The surgery was a success but the patient died of complications" or that "the chemo killed the cancer but the patient died of kidney failure". Medical interventions don't know when to stop. You have the right to choose. You can say no to more torture.
Euthanasia was once more practiced than historical records will admit to . Nurses would just take a long long time to attempt resuscitation. Midwives would smother defective newborns, and report them as stillborn. Socrates was given a cup of poison hemlock in 399BC. By the standards of ancient Greece, it was extremely humane. It is nothing new.

Thanks for all the interesting answers.So much to think about!

re: NotDeadYet and similar organizations, I don't really consider myelf to be supportive because I've always thought :'Nobody is trying to kill YOU people~ This is for patients that are requesting it for themselves"
I do give them credit for their strength and voice though, and think they should continue the fight.
I always thought I'd vote yes or for assisted suicide if we had an opportunity to vote. I hate to see people suffer and think they should have the choice. However, I'm slowly changing my mind. I do think the slippery slope arguement has some value. Greedy family or insurance companies are sure to take advantage. They already do through hospice.
Assisted suicide is what it is. The person knows they will be dead. Hospice should be renamed "Comfort Care With the Possibility of Euthanasia." That way everyone who signs up knows that oversedation is a possibility, and can clearly refuse while they're still able to think clearly.

:-o

Oh. My. God.

Did they also send her contact details for recommended undertakers?

You have to wonder who is thinking these things through.

Yeah, ethically speaking we would say that the difference is in the intent. In other words, keeping someone comfortable with whatever dose of medication is needed is one thing - you decide it is worth possibly hastening death in order to relieve suffering, but you don't deliberately give an overdose. For assisted suicide the direct intent is to induce death.

The line gets blurred by giving high dose opioids and sedatives around the clock, which probably is going to accumulate in someone ill and/or elderly and poorly metabolizing, which is the default for some hospice protocols. I think you have to pick a hospice that lets you stay in charge. I did not let them do that to my mom, but I was glad there was morphine available at the very end when she was having a really bad angina attack and was really in distress...

I also am on the side of NotDeadYet.org and others who fear, rightfully, that legal euthanasia would become a recommendation for people that healthcare economists if not doctors and nurses find bothersome or burdensome, or just think have a poor QOL evenb though the person themself might rate their QOL as pretty good - lets face it, funerals are way cheaper than critical care stays or cancer care and there will be pressure on people to just get it over with. There was a horrible case in Oregon not too many years ago where a young woman was denied an "experimental' cancer drug (it wasn't - good literature indicated it had a strong chance of working) but received a note in the mail that assisted suicide would be covered due to the new law.

Not offensive at all, it's an extremely interesting question.

I think it shifts the focus from what is happening with the patient to what, exactly, the people caring for the patient are doing. Are they, or are they not, killing the person? To be guilty of murder, you have to act with intent, knowing that your action will kill. If you do so to relieve suffering, the intent may have a merciful motivation but it is still intent to kill, therefore still murder.

Where it gets really interesting is the question of whether sedation, by suppressing respiration and other functions, hastens the death of the patient. If you relieve somebody's symptoms using a technique which you know will shorten your patient's life, how do you justify that?

We justify these things on pragmatic grounds, on grounds of expediency, on grounds of what we expect suffering human beings to tolerate. So do I! - so would I! - I'm not accusing anyone of anything.

At the moment in the UK we've got growing momentum behind legislation to protect people from prosecution in cases of assisted suicide. It hasn't happened yet, I don't suppose it will any time soon. For what it's worth, I'm against changing the law. I feel that if people act under duress, and out of humane pity, to help another to end his life, then let them tell a jury so, and let a jury acquit them; but they must still be held to account by the criminal law. Once the law permits assisted suicide, people will stop examining what exactly has gone on and euthanasia will slowly cease to be voluntary.

There is a case for that too, of course; only far fewer people are willing to make it!

In my mind, assisted suicide means that you decide to end it all on a particular day. In hospice, you choose not to fight the disease process any longer and let "nature" takes its course, albeit while limited the attendant pain and anxiety. The difference is subtle and has to do with not determining yourself when the end will be, while still controlling pain. For many people, this is an important ethical and sometimes religious difference. I WILL agree to Hospice when the time comes: I would never agree to assisted suicide on my mother's behalf.

imo , there is no difference except one method takes longer and contains terminology thats more acceptable to americas narrowminded , religious right .
i dont mean to sound bitter but ive worked for the public for 25 years and i will turn and run from most professing christians . everything that comes out of their lips has some kind of self serving spin to it .

No offense taken here. I think it's cultural and religion based. Attitudes change, and some countries (and now a few US states) are offering alternatives.