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I'm not saying burden in the sense that the person is "annoying" or a waste of time... I'm speaking of the emotional burden I, as an impaired elderly person, would have on my family and friends.

A member of my family was so affected by alzheimers and dementia that they repeatedly asked the whereabouts of their spouse, during the funeral of said spouse, and for months afterwards. How much joy do you think was in their life, having to be told every day of their death, or that the strangers invading their home were actually their children? I can't speak for the family member, but I know I'd rather be dead.

I'm fully aware that I'm bound to grow old, and possibly be affected by some age-related disease. If I can't enjoy my life, or if I inflict pain on my family, I would prefer to die sooner than later.

   

In the end, I think it should be up to that person whether or not they should die or not. If they can't/are unable to make the decision, then (as old as this saying is getting) err on the side of life, and as a society, see to it that they live.

   

So in the case of coma victims, should there be something associated with euthanasia similar to organ donor, or DNR 'registration'?

   

Not sure what you mean there.

   

As with organ donors, or "do not resusitate" patients, have a "euthanize if severely incapacitated" option.

   

Only if the patient made that choice.

   

Obviously...

   

Well, it would have been made before the fact, but it would be up to each individual to make up their own mind, as with organ donation.

Actually, I think I'm an organ donor without my expressed consent

   

Why obviously? Do you think everyone who has gone into a coma knew that they were going to?

   

No, but obviously if somone has a EISI bracelet or whatever they made the choice, just like a DNR patient made the choice for DNR.

   

hahahaha... just googled EISI to figure out what the heck you were talking about....

   

Doctors don't always follow this request. My grandmother, a retired nurse, had that order and even had it posted in her room. Yet, when she suffered a heart attack, the doctor disregarded that request. She lingered a further three days in constant pain until she died.

There is an odd twist to this story, my aunt, who my grandmother hadn't heard from since 1980, returned to Canada from Australia in 2003(She'd been there since '72). Even when my grandmother passed away, we didn't hear from her, even though she had been contacted.

Her husband had just passed away from a sudden illness and she decided to return home, not telling her children or grandchildren why. She just showed up at my parent's place. Three months later she died in the exact same room and the exact same bed that my grandmother had passed away in just three years ealier. It turns out she had come home to die, but didn't tell anyone she was dying.

   

Family members make the call on DNR orders when the patient is unable to and haven't made any plans for this. Making a decision like this is very hard on the family. It's very import that your families know what you want done if you become incapacitated. It's also important that you know what your family members want done if they become incapacitated.

Sad but true story #1: A woman with dementia also suffered from diabetes. The diabetes stopped blood flowing into her feet so her feet started to rot. The doctors wanted to amputate her feet but her family refused to give permission even though they could see and smell the rotting of her feet and were told how much pain she was in. She spent the last few months of her life in extreme pain, with rotting, fetid feet, unable to walk, and not having any lucid moments at all because she was on very potent painkillers. Even the nursing staff wanted nothing to do with her because her rotting feet stank so much. She died with absolutely no dignity.

Sad but true story #2: The wife of an old man with Alzhiemer's passes away. His family refuses to tell him what has happened to his wife because he will forget 5 minutes after he is told and then will want to know where his wife is forcing the family to tell him again and have him go through all the emotion again of finding out his wife has died only to forget in another 5 minutes and then want to know where his wife is......Anyways, he is told that she is in the hospital because she is ill, furthermore, they don't take him to the funeral. Since his wife has passed away there is no one home to care for him anymore so he must be put in a nursing home(his children have children of their own and fulltime jobs making it too difficult to care for him in his condition). Since the topic of going to a nursing home has been discussed with him before, his family knows that he will freak out and refuse to go. Here comes the saddest part....to get him to go into the nursing home his family tells him they are taking him to visit his wife in the hospital!

I'd like to know that I can chose the timing of my death and not have to go through what many people have gone through.

I don't consider that I have a life if I can't get some enjoyment out of it and my family or friends are saddened to see the state I'm living in because I am no longer me.

If I'm to be strapped into a chair so I can't wander and do harm to myself or others, if I must sit in my own shit till it's diaper change time, if I must eat pureed everything because I have forgotten that I must chew my food and if I no longer remember or recognize my loved ones please end my living because my life ended long ago.

   

That is the absolutely most dangerous question you can ask in a country with socialized medical care! When the government medical bureaucracy starts having to decide between saving their jobs or saving people's lives you're going to be in serious trouble!

Now you've headed down the road where people will be executed (let's call it what it is, shall we?) instead of providing life-saving care for the diseases that are readily, but expensively cured.

You're thinking the issue will concern 80 year old Alzheimer's patients but it will rapidly be applied to Down's Syndrome patients at birth because a Down's Syndrome afflicted individual will be far more expensive to attend to over their lifespan with the chronic illnesses associated with Down's than an Alzheimer's patient who is expected to die within five years of early onset.

And then we can start talking about eight year old girls with leukemia who can be cured, but only at a huge expense.

Oh, and little Timmy with the tumor next to his brain stem? You may as well go pick out a casket after the oncologist confirms the diagnosis because the two to three million dollars he will likely require to remove the tumor would be better spent on ergonomic chairs and walnut paneling for the Health Canada's nice new local office.

From http://www.pregnantpause.org/euth/nazieuth.htm comes the following points to ponder:

Lessons from History:
Euthanasia in Nazi Germany
by PJ King

Present day death proponents of the "right-to-die" movement disavow any analogy between what they are selling and what happened in Nazi Germany in the 1930's. And, if one does not examine the facts too closely, there appears to be none. After all, Hitler was bent on exterminating the Jews, even though he destroyed a few thousand others before he found his focus. His was a dictatorship, not a democratic nation. His agenda was political, not moral. He fed on hate, not compassion. And one could add to the list.
However, if we look back to German society of the twenties and thirties, we find a civilized culture not so unlike our own. As a nation, Germany took pride in its art, its culture, and its science. People engaged in business, went shopping, enjoyed their families, followed the news. Genocide did not seem a likely development. But the seeds had already sprouted, though few foresaw into what kind of twisting vines they would soon grow.

In 1920 was published a book titled The Permission to Destroy Life Unworthy of Life, by Alfred Hoche, M.D., a professor of psychiatry at the University of Freiburg, and Karl Binding, a professor of law from the University of Leipzig. They argued in their book that patients who ask for "death assistance" should, under very carefully controlled conditions, be able to obtain it from a physician. The conditions were spelled out, and included the submission of the request to a panel of three experts, the right of the patient to withdraw his request at any time, and the legal protection of the physicians who would help him terminate his life. Binding and Hoche explained how death assistance was congruent with the highest medical ethics and was essentially a compassionate solution to a painful problem.

Death assistance, according to the authors, was not to be limited to those who were able or even willing to ask for it. They would have such mercy extended as well to "empty shells of human beings" such as those with brain damage, some psychiatric conditions, and mental retardation, if by scientific criteria the "impossibility of improvement of a mentally dead person" could be proven. The benefits to society would be great, they said, as money previously devoted to the care of "meaningless life" would be channeled to those who most needed it, the socially and physically fit. Germans needed only to learn to evaluate the relative value of life in different individuals.

An opinion poll conducted in 1920 revealed that 73% of the parents and guardians of severely disabled children surveyed would approve of allowing physicians to end the lives of disabled children such as their own. Newspapers, journal articles, and movies joined in shaping the opinion of the German public. The Ministry of Justice described the proposal as one that would make it "possible for physicians to end the tortures of incurable patients, upon request, in the interests of true humanity" (reported in the N.Y. Times, 10/8/33, p. 1, col. 2). And the savings would redound to the German people if money was no longer thrown away on the disabled, the incurable, and "those on the threshold of old age."

A 1936 novel written by Helmut Unger, M.D., further assisted the German people in accepting the unthinkable. Dr. Unger told the story of a physician whose wife was disabled by multiple sclerosis. She asks him to help her die, and he complies. At his trial he pleads with the jurors to understand his honorable motive: "Would you, if you were a cripple, want to vegetate forever?" The jury acquit him in the novel. The book was subsequently made into a movie which, according to research by the SS Security Service, was "favorably received and discussed," even though some Germans were concerned about possible abuses.

With the public now assenting, the question turned from "whether" to "by whom" and "under what circumstances."

The first known case of the application of this now-acceptable proposal concerned "Baby Knauer." The child's father requested of Adolph Hitler himself that his son be allowed death because he was blind, retarded, and missing an arm and a leg. Surely, in his condition, he would be better off dead. Hitler turned the case over to his personal physician, Karl Brandt, and in 1938 the request was granted.

Over the next few months, a committee set out to establish practical means by which such "mercy deaths" could be granted to other children who had no prospect for meaningful life. The hospital at Eglfing-Haar, under the direction of Hermann Pfannmuller, M.D., slowly starved many of the disabled children in its care until they died of "natural causes." Other institutions followed suit, some depriving its small patients of heat rather than food. Medical personnel who were uncomfortable with what they were asked to do were told this was not killing: they were simply withholding treatment and "letting nature take its course."

Over time Pfannmuller set up Hungerhauser (starvation houses) for the elderly. By the end of 1941, euthanasia was simply "normal hospital routine."

In the meantime, no law had been passed permitting euthanasia. Rather, at the end of 1939, Hitler signed this letter:


"Reichleader Bouhler and Dr. Med. Brandt are responsibly commissioned to extend the authority of physicians to be designated by name so that a mercy death may be granted to patients who, according to human judgment, are incurably ill according to the most critical evaluation of the state of their disease."

Interestingly, physicians were not ordered to participate, but merely permitted to if they so wished. It was to be a private matter between the doctor and his patient (or the family if the patient was unable to speak for himself).
Brandt, testifying at his trial in Nuremburg after the war, insisted:


"The underlying motive was the desire to help individuals who could not help themselves and were thus prolonging their lives in torment. ... To quote Hippocrates today is to proclaim that invalids and persons in great pain should never be given poison. But any modern doctor who makes so rhetorical a declaration without qualification is either a liar or a hypocrite. ... I never intended anything more than or believed I was doing anything but abbreviating the tortured existence of such unhappy creatures."

Brandt's only regret was that the dead patients' relatives may have been caused pain. Yet he justified even that: "I am convinced that today they have overcome their distress and personally believe that the dead members of their families were given a happy release from their sufferings." (A. Mitcherlich & F. Mielke, The Death Doctors, pp. 264-265.)
Decide for yourselves whether parallels can be drawn between Germany in the thirties and forties and the world scene in the nineties.

   

I am a nurse/social worker and I manage a home hospice programme. Half of our demographics involve mostly people with very low income, mostly living in rooms, rooming houses; about one-quarter are AIDS-related in the downtown core and another quarter provides respite care for families/primary caregivers for profoundly disabled people.

1)It is not uncommon for the dying person to have an "out"...a stash of pills or a plan in place if things get too rough. In most cases, they never use the Out, but there is comfort in knowing they have options.
Quite often when people say they don't want to die in pain, what they are really saying is the equivalent of "Don't let me die alone in the dark; abandoned." We do very good work with physical pain management and some people do ask to be "snowed", meaning they are given enough meds to keep them in a twilight so they won't be conscious of their dying (whether or not this is happening anyway on a subconscious level is another discussion).
For our hospice people, we do our damndest to be sure we are there for the end. Sometimes it's more to support family/friends so they don't feel they are doing this alone and sometimes there are no family/friends and we are the sole support system.
We also have an extensive network of volunteers and care-team options, all of which require massive amounts of time and money to train and nurture. (You have to scrounge for facilities so you have a place where you can teach Practical Caregiving Skills. In my case, I have a deal with a local university's school of nursing--they let us use their "nursing lab" which has 20+ beds and caregiving supplies, wheelchairs etc---but in exchange I have to find the time to present two Ethics workshops a year for them!


2)Suicide is still very much a reality. Although the politically-correct term now appears to be "self-deliverance". I have seen suicide primarily with people fearing dementia or neurological breakdown. Sometimes the dying does not happen that easily and, in some instances, the attempt fails entirely.

Now, here's the sticky part: If you read books like "Final Exit", they give you recipes for various means of suicide, but most people miss the fine print. Ideally, you should have one or two people on stand-by who will be willing to either gently hold a pillow over your face or wrap a plastic bag around your head.
The ?founder of The Hemlock Society, Derek Humphry, rather too enthusiastically describes how it was necessary for him to do this for several loved ones.

For the most part, nurses and doctors are focussed on supporting Life...even in hospice work, we don't see it as taking care of the dying, but rather supporting life until death happens. That isn't just semantics either; imagine if you were the dying person and had to look forward to daily support from hang-dog people reminding you of your impending demise.

I lived in San Francisco in the 80's, in the middle of the AIDS holocaust and over 13,000 people died in that city alone. I was working as a trauma nurse, but volunteered with a Quaker group to take care of people who were sick and dying with AIDS.......and, BTW, gives you a whole new appreciation for our socialized medicine. At that time, I never had the occasion to be present during an assisted suicide, but I felt supportive of the decision made and believed in my heart it should be that person's right to choose. Had I been asked, I probably would have naively agreed to participate.

Then, somewhere along the line, I got to the nitty-gritty about what it means to "assist". Right now, at this moment in time, I do not think I could stop the life of another human being. Perhaps, in time, I will change my mind or will be confronted with a situation where there are no other options and I can make my peace with it.......but right here, right now, no.

There have been a couple of comments on this thread that would seem to put the onus on the medical people to find a way to peacefully end a person's life. Neither doctors nor nurses took an oath to kill......"First do no harm" or "Harm none" are pretty much what we committed to.

If we, as a society, are going to sanction assisted suicide or euthanesia, we are going to need to take a long hard look at who is going to be doing that and how they will do it and how they will work out the criteria. And human beings being who they are, there will be some major screw-ups. I don't have the constitution that could reconcile myself with being part of that kind of screw-up. At the very least, I would probably have to give up nursing.

This is such a hard topic - and for the most part I agree with Constantinople. I wonder who will volunteer that they have a big enough ego to be willing to decide the hows and whens.

It is not fair to put the entire responsibility for ending someone's life on people who live with the philosophy that where there is life, there is hope.

In my job, I can promise to do my best by you, to be there for you, to use all of my skills to ensure that you do not "suffer". But I would ask that you take what you see in movies and what you read about in theory with a grain of salt---the reality is much more complicated and intricate.

Aanii.

   

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