This may be off tangent but what about situations (like in movies) where a spy or soldier will kill an injured friendly to avoid the suffering of capture and torture? Is this generally considered acceptable by society? If so, why is the type of suffering avoidance okay but not from a disease like cancer?

quote:

Originally posted by 12131:
Maybe it’s because of Hippocrates’ “do no harm”.

So, it seems that there are actually two cases of harm: 1) allowing the patient to suffer, 2) assisted death. The oath is saying that #2 should be followed as the worser of the two harms?

When does the patient get a voice in his course of treatment - if there are options, shouldn't the patient get to influence? Including the denial of treatment (ie - I don't want to do chemo). Why wouldn't this be considered harming the patient?

Not challenging you, 12131. Just wondering out loud. I'm in favor of the avoidance of suffering, my call.

My former pastor said we have more compassion for our animals than we do for our elderly.
Rod

If one keeps the patient suffering, more $$ for the medical industry.

I recall at my first "free" Medicare physical, I was asked if I had a medical directive - it's about the $$.

It’s become politicized bullshit. The AMA in the US officially opposes assisted suicide in good part because of the “do no harm” or healing aspect of medicine. Yet they’re fully onboard with abortion as a basic “human right”, not just a tool to be used in limited situations as a last resort. Seems pretty contradictory to me that ending a life in the womb at the whim of the uterus holder is ok, but helping someone who is in great pain at the end of their life pass with dignity is not.

^^^ AMA endorses a lot of bullshit. Two off the top of my head:

Your doctor asking if you have guns at routine appointments

Recommends the mRNA COVID jab for healthy adults, healthy pregnant women, and children 6 to 23 months

---

Ego is the anesthesia that deadens the pain of stupidity

DISCLAIMER: These are the author's own personal views and do not represent the views of the author's employer.

quote:

Originally posted by tatortodd:

Your doctor asking if you have guns at routine appointments

"Some, but not nearly enough."

Florida medical folks seem to be pretty cool about this.

My first visit with a urologist to discuss my high PSA, I had not thought about my gun. When he asked me to drop my pants I tried to hide the holstered pistol. He leaned over my shoulder to look at it and said, "What's that -- a SIG? I carry an H&K."

The AME (Aviation Medical Examiner) I used to go to, liked to show me his P226.

Cardiologist's nurse asked me to open my shirt so that she could stick the EKG leads on me. I tried to hide my pistol, nurse said "Don't worry about it. We all carry in my family."

Damn. If that happened around here, they'd call in an active shooter event. Free country vs fascist country - all the difference in the world.

I don’t have breast cancer, but have a high risk condition, so have been a member of a BC org’s discussion board for many years. One member who had been stage IV for years spoke to New Mexico’s legislature a couple of times as an advocate for Death with Dignity before it was finally passed. She was eloquent. She died not long after. We will never know, but I hope she was able to avail herself of the option. I see no compassion in allowing people to howl with pain like wounded animals and I can’t believe God wants that for us either when there are other options. I agree with the others that it is criminal to treat our animals better than we treat humans.

As another said, the resistance to assisted death is abuse of the process.

But I want that right for myself.

But had I chose to exercise that right at a time when I wanted to, it turns out to be premature. It would have been a permanent solution to a temporary problem. I’m enjoying life so much so now that I truly am ready to die at any moment.

So one guideline could be: is the assisted death the solution to a permanent problem? And is the problem centered around the personal suffering of the patient? I’ll even allow the discussion involving the patient whether their wish is to spend their assets for medical care versus leaving it for their survivors.

I think we tend to look at things with the clear cut exemplar in our minds and basing our position on that exemplar rather than searching for the gray case in the shadows where the issues are most murky. It is these cases around which policy must be designed for and take into account on where the guardrails must be placed.

quote:

Originally posted by konata88:

quote:

Originally posted by 12131:
Maybe it’s because of Hippocrates’ “do no harm”.

So, it seems that there are actually two cases of harm: 1) allowing the patient to suffer, 2) assisted death. The oath is saying that #2 should be followed as the worser of the two harms?

When does the patient get a voice in his course of treatment - if there are options, shouldn't the patient get to influence? Including the denial of treatment (ie - I don't want to do chemo). Why wouldn't this be considered harming the patient?

Not challenging you, 12131. Just wondering out loud. I'm in favor of the avoidance of suffering, my call.

The physician is obligated to lay out the diagnosis and treatment options that explain risks and benefits, and which potentially has the best possible outcome. The patient always has the right to accept or refuse the recommended plan. It’s called informed consent. The mentally competent patient has the right to leave against medical advice (AMA), and the doc cannot stop him.

Now, talking specifically about PAE, the patient can request it, but what do you suggest the doc do in a state where PAE is not legal? He cannot carry out the patient’s wish, unless he’s willing to lose his medical license. The patient then has two options. Travels to a state that allows PAE, or goes home and does it himself. And, no one can stop him from doing either.

This message has been edited. Last edited by: 12131,

I don't disagree. But I'm wondering about all of this w/o the confines of a legal system.

Perhaps one question to ask in parallel, aside from government and those who abide by the Hippocratic oath, is does religion allow it? Christianity, Judaism, Shintoism, Hinduism. At least two seem to forbid it? If religion / God accepted it, perhaps gov / doc would as well?

What's the original basis behind the prohibition?

Seems like religion seems to be one historical influence, especially for areas where the oath was not introduced (or perhaps a different form?). Perhaps religion and the oath where both were common?

Ignoring the oath, if one were atheist, then is PAE more accepted? Again, just historically / philosophically, not in the context of modern legal systems.

quote:

Originally posted by Fly-Sig:
Having good legal directive documents is important. You can, for example, direct that food and water be withheld. Other specifics such as no antibiotics or other medications not needed for pain control or comfort can be directed.

The important thing is that the document be properly executed and easily available to your designated representative. Your illness could come on suddenly. The hospital or care facility will not withhold life prolonging medical care without that document.

Be sure your designees are listed, with alternates in case one or more are unavailable. If the primary person isn't immediately available, the facility probably will not stop treatment or start hospice until they are contacted.

And be sure to have a long conversation with your designated representatives so that they know exactly what your directives are and are willing to follow through on your wishes. Also, let them know how to get access with the paperwork.

The decision to off oneself is personal. Don't ask others - especially the medical community which is supposed to preserve life - to facilitate or do it for you.

I didnt have an opinion on the matter until I witnessed my grandfather, on his deathbed, asking the nurses if the medicine they were preparing to administer were going to help him "get in to heaven". This was a lucid man who knew what time it was and had one final request. He fought for a few more days then went on.

I admired my mother's courage in her deathbed pain. Liver cancer had spread so far that no options were available. Her last few weeks were perhaps "typical" with acceptance, last conversations, and finally a short time with intensive pain medicine removing her ability to converse. That specific pain medication can, I believe, result in death, and the difference between pain relief and death dosages seems fairly small. We were very careful to have professional staff visit and administer the prescribed medication.

I don't think my mother wanted her death to be any sooner than her courage and her body would allow. She fought not to be alive, but to be a witness to those around her. She visited others and shared her lifelong faith from a wheelchair. But, in time, the body just gave out, thankfully while she slept.

Experiencing all this first hand, I can say that it would be very difficult for my family to opt for PAE. The courage to choose to die is, as best I can tell, the highest one can have. I believe that some have the extraordinary courage to endure the pain also, in part to spare the family the emotions of the decision to die.

The complexity is of course who makes the decision, when, and how to be certain that decision remains valid. We might all say early in our lives "I don't want to live if..." and fill in the blank with some horrible condition. We can look at the experiences we have with our pets, and know with more certainty at observed end of life pain that mercy is admirable and PAE is appropriate. Can we be as certain with our own lives as we are with our pets? In many cases, I'm sure we can.

I hope that we as a nominally moral society somehow navigate the rocky course from the storm-tossed ocean to a peaceful harbor.

I have turned off pacemakers and defibrillators to keep them from interfering with a natural death. No problem. I assisted with a case once in a patient with ALS who decided to hasten things along. I have regretted ever since that I helped with that.

The larger issue is what happens when the decision is being made not by the patient or a designated person with power of attorney for health care, but a physician or other person claiming to be doing what is best for society?

What about Canada where people are encouraged to have euthanasia if they’re depressed? Or the Netherlands? Slippery slope long left behind.

I could write a whole book on the potentials for abuse and misunderstanding involved in end of life care. In California everyone admitted to a hospital is asked whether they would want to be kept alive in the event of cardiac arrest. The patient is thinking “Yeah, I don’t want to end up a vegetable.” The medical system understands that as “If he has an episode of ventricular fibrillation we’re not going to shock him.”

The few would spoil it for the many,
As so often they do.

Like any processes that involve money, there is always potential for abuses, and there should be safeguards against them. But, the decision should always be the patient’s, or that of their designated decision maker. The physician’s role should always be to assist. That’s why it’s called physician assisted euthanasia, not physician decided euthanasia.

A doctor's job is not to prolong life, it is to help the patient meet their medical needs, to include minimizing suffering.

Unfortunately, the modern philosophy seems to be that our individual goal is to have the longest life. People who take big risks are considered weird or foolish. Not that long ago, they were admired for their spirit of adventure, or their bravery. Astronauts through the Apollo program were admired, but 10 years later the public demanded perfect safety. Same with mountaineers, sky divers (ok, they've always been crazy), and race car drivers. Dying prior to a natural cause at a very advanced age is considered wasteful.

Doctors seem to still be quite willing to advise ending treatment and going into hospice. Family pressures though are to eek out every additional hour of life at any cost.