Unseen euthanasia
Discussion
I'm talking about end of life care at home when someone is in extreme pain. Such as my father three weeks ago. With a morphine syringe driver in place and a fentanyl patch he was still crying out in pain. We called out a district nurse late at night who administered diamorphine and something to relax him.
Within the hour he passed away peacefully. I feel it was the painkillers that saw him off and not the cancer and I am very grateful for the district nurse who attended. Anyone else had a similar experience?
Within the hour he passed away peacefully. I feel it was the painkillers that saw him off and not the cancer and I am very grateful for the district nurse who attended. Anyone else had a similar experience?
I've heard it spoken about several times in the cancer ward where my dad goes, although never actually heard of it or seen it first hand. But common consensus seems that if a patient is dying and in pain, they are given a dosage that will relieve them of the pain, regardless of whether it finishes them off or not.
They are very sensitive and brave people, and I admire them immensely - I'm glad you approved of the nurses actions.
They are very sensitive and brave people, and I admire them immensely - I'm glad you approved of the nurses actions.
I'm so sorry for your loss. I wish you long life.
Palliative care nurses are trained to prioritise freedom from pain and distress in a person's final hours: they cannot and would never act with the *primary* intention of causing death, but giving enough of the good stuff to achieve that relief of pain and panic will often a) decrease the drive to breathe and b) also generally remove a load of agitation that is sometimes masking a very exhausted person running out of their last little bit of energy. And of course they know that, and they do what they do because who wouldn't choose 2 hours - or fifteen minutes - serenity post diamorphine over 24 or 48 hours of awfulness?
The primary/secondary thing is the principle of double effect: doing things with the intention of shortening life is illegal, doing things when they are the only way to relieve pain and distress, even when you know that they will also shorten life, is fine.
Palliative care nurses are trained to prioritise freedom from pain and distress in a person's final hours: they cannot and would never act with the *primary* intention of causing death, but giving enough of the good stuff to achieve that relief of pain and panic will often a) decrease the drive to breathe and b) also generally remove a load of agitation that is sometimes masking a very exhausted person running out of their last little bit of energy. And of course they know that, and they do what they do because who wouldn't choose 2 hours - or fifteen minutes - serenity post diamorphine over 24 or 48 hours of awfulness?
The primary/secondary thing is the principle of double effect: doing things with the intention of shortening life is illegal, doing things when they are the only way to relieve pain and distress, even when you know that they will also shorten life, is fine.
My father died of cancer in a hospice. Over the two weeks he was there, I think they gradually upped his does of painkillers, until in the last couple of days he was barely and then fully unconscious. We were with him, went around the corner for lunch, had just ordered and the phone rang. He'd gone. Where the situation is hopeless and the patient is in significant pain, it has to be the most humane treatment.
When my wife was in the hospice for her final days, while she was still lucid (she was dying of liver cancer, and the poisons that build up quickly prevent you from being 'all there' so to speak) I talked to her and we agreed that pain relief was the most important thing and when she was no longer able to express herself I would interpret any attempt to communicate as a request for more morphine. I talked to the nurses and they agreed that this would be an appropriate approach. I sincerely hope that it was the morphine that finished her off and not the cancer or the liver failure but I will never know, and I do not wish to. There is no dignity in death and when it is inevitable my experience has made me of the mind that it is best done quickly and painlessly.
It's a contentious subject of course but my belief is that nobody who has had to watch one of their loved ones die a slow, lingering and painful death would ever be against euthanasia. It angered me that I was not able to provide the same service to my wife as I was to my pet cat.
It's a contentious subject of course but my belief is that nobody who has had to watch one of their loved ones die a slow, lingering and painful death would ever be against euthanasia. It angered me that I was not able to provide the same service to my wife as I was to my pet cat.
Zod said:
My father died of cancer in a hospice. Over the two weeks he was there, I think they gradually upped his does of painkillers, until in the last couple of days he was barely and then fully unconscious. We were with him, went around the corner for lunch, had just ordered and the phone rang. He'd gone. Where the situation is hopeless and the patient is in significant pain, it has to be the most humane treatment.
Almost identical situation to my dad. Although a really tiny part of me didn't like the idea of someone being in control of his death (esp without consultation) the vast majority of me was grateful and thought it was absolutely the correct thing to do when someone has reached end of life.
Morphine is a CVS/Resp depressive and is always a little risky to give - when someone is clearly day's away from dying and in pain or distress it's even more of a risk (or a benefit) to give it and its given knowingly which I'm grateful for.
I went to see my grandad in the hospice and he was in his last hours, same thing, my mum said a nurse gave him a dose of something and he slipped away not very long after, I was glad as he was in a lot of pain, and it isnt like he was going to make a recovery, he was wracked with cancer and had lost all lucidity but could still feel and react to pain.
I think sometimes it goes on too far, we offer this service to our pets, but not other humans because if it is legal, with the best of intentions it gets misused.
I think it is best to just let the palliative care folk get on with it, maybe its kind of an unwritten rule, something that technically the legal profession could turn into a case and then set a precedent that everyone has to have smaller doses and take it literally to the death, a little bit of assistance to let them stop the natural instinct to fight seems the kindest, but not when its a fit 78 year old but the wife wants to move and a new Evoque
I think sometimes it goes on too far, we offer this service to our pets, but not other humans because if it is legal, with the best of intentions it gets misused.
I think it is best to just let the palliative care folk get on with it, maybe its kind of an unwritten rule, something that technically the legal profession could turn into a case and then set a precedent that everyone has to have smaller doses and take it literally to the death, a little bit of assistance to let them stop the natural instinct to fight seems the kindest, but not when its a fit 78 year old but the wife wants to move and a new Evoque
I recall one of the specialist cancer nurses giving my g/father "something to make him more comfortable" when he was being cared for at home. He passed away a few hours later.
Contrarily, look at the pioneering prosthetics Prof Noel Fitzpatrick makes for animals, and we've people wearing prosthetics on stumps when they could be an integral/joined body part. It's nucking futs!
TooMany2cvs said:
It's just a pity that they can't be more open and honest about it.
If you treated a pet the way you're meant to treat humans, it'd be cruel.
True, but it's a legal minefield for the medical profession.If you treated a pet the way you're meant to treat humans, it'd be cruel.
Contrarily, look at the pioneering prosthetics Prof Noel Fitzpatrick makes for animals, and we've people wearing prosthetics on stumps when they could be an integral/joined body part. It's nucking futs!
TooMany2cvs said:
It's just a pity that they can't be more open and honest about it.
If you treated a pet the way you're meant to treat humans, it'd be cruel.
Agreed.If you treated a pet the way you're meant to treat humans, it'd be cruel.
Quite a few years ago, my partner's father died of leukaemi. We're fairly certain, and grateful, that his passing may well have been accelerated slightly by his care team. It ended months of watching someone who was always physically imposing seeming to shrink slightly every visit and eventually not be able to sit up on his own, let alone get out of bed.
We also had to watch my father deteriorate with very severe Alzheimer's, seeing him spend the last year of his life in a secure care home (as he became violent and wandered), not recognising anyone at all, even his wife of 50 years, was horrendous and not a dignified way for him to leave us.
The medics in these situation have to navigate a very fine line and death can be a secondary effect.
The pain can be keeping people alive. It causes the release of beneficial hormones and compounds that can be keeping people alive when at the very edge of survival, by removing the pain these are reduced. We should not forget that pain is an important biological signalling mechanism.
The pain can be keeping people alive. It causes the release of beneficial hormones and compounds that can be keeping people alive when at the very edge of survival, by removing the pain these are reduced. We should not forget that pain is an important biological signalling mechanism.
When my father was in hospital with the final stages of Parkinson's, after two weeks unresponsive they stopped feeding him. After another weeks it was deemed that his water-logged, friable skin would be making him uncomfortable so they stopped his fluids. He took another six days to die.
I had an interesting discussion with the Registrar, who agreed that it was crazy that it was legal to starve him to death but not to give him a helping hand on the last step of his terminal journey. I empathised with him in the legal predicament he was bound by.
I had an interesting discussion with the Registrar, who agreed that it was crazy that it was legal to starve him to death but not to give him a helping hand on the last step of his terminal journey. I empathised with him in the legal predicament he was bound by.
4x4Tyke said:
The pain can be keeping people alive. It causes the release of beneficial hormones and compounds that can be keeping people alive when at the very edge of survival, by removing the pain these are reduced. We should not forget that pain is an important biological signalling mechanism.
The medics in these situation have to navigate a very fine line.
But in all the cases above, every patient was days (or hours) from death, with presumably a minute possibility of recovery, so surely it’s the most humane option? The medics in these situation have to navigate a very fine line.
Nobody is saying that we should end someone’s life when there’s a good chance of survival, but when it comes to the point where we’re keeping someone alive (but not living) for the longest possible time, then I think it’s the best choice.
Chebble said:
But in all the cases above, every patient was days (or hours) from death, with presumably a minute possibility of recovery, so surely it’s the most humane option?
Nobody is saying that we should end someone’s life when there’s a good chance of survival, but when it comes to the point where we’re keeping someone alive (but not living) for the longest possible time, then I think it’s the best choice.
Unfortunately there are lot of people out there who want to keep their dying relatives alive as long as possible. The person suffering cannot communicate and the family want everything done in order to prolong it - tests, medications, interventions, etc, because they are selfish and cannot let go. If they caught wind of what was going on, or if euthanasia became a thing in the UK, the media would have a field day with all the arguments going on.Nobody is saying that we should end someone’s life when there’s a good chance of survival, but when it comes to the point where we’re keeping someone alive (but not living) for the longest possible time, then I think it’s the best choice.
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