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View Diary: Death with Dignity Law Brings No Dignity to Some (272 comments)

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  •  Procure your own drugs early (49+ / 0-)

    if you have terminal cancer.

    They can't bust you when you're dead.

    This case is sad but typical. The doctor should be busted for providing inadequate pain relief apart from the assisted suicide issue. Pancreatic cancer is a brutal way to go. It would be far better for this gentleman to have been killed by an accidental OD of pain meds than to die in misery.

    "It's the planet, stupid."

    by FishOutofWater on Sun May 10, 2009 at 06:37:10 PM PDT

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    •  Why the dichotomy? Don't we do nuance? (4+ / 0-)

      I just looked up the Catholic teaching,   which is conservative but probably better thought out than the teachings of preachers leaving most "Bible colleges".  Euthanasia is prohibited.  The withdrawal of food and water is not prohibited, provided that the food and water would do the patient no good.  (In practice, feed Terri Schiavo, but should Stephen Wallace request withdrawal of food and water, that's okay.)  Palliative treatment that may indirectly shorten life is permitted (and usually does not, anyway.)

      According to Pope Pius XII:

      "Normally one is held to use only ordinary means—according to the circumstances of persons, places, times and culture—that is to say, means that do not involve any grave burden for oneself or another. A stricter obligation would be too burdensome for most people and would render the attainment of the higher, more important good too difficult. Life, health, all temporal activities are in fact subordinated to spiritual ends."

      So, what on earth kept the doctor from prescribing unusually high, but non-lethal doses of painkillers?  It would let the poor man die in his sleep.  

      2009: Year of the Donkey. Let's not screw it up.

      by Yamaneko2 on Sun May 10, 2009 at 07:15:50 PM PDT

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      •  the problem is less about availability of suicide (4+ / 0-)

        but with the poor medical care, and conversely the "heroic" style of care at the end of natural life for some, that drives people to desire suicide as an alternative. The US system is particularly poor when it comes to palliative care--to give an example close to home for me, my husband currently takes fentanyl and morphine for a very serious chronic back pain caused by injury. In the US he was told to manage the same issue using Tylenol 3, and accused of "drug-seeking behaviour" when he begged for something more effective. The result for him was increased disability, as due to extreme pain he couldn't take part in even gentle exercise. I would encourage people to re-read the many sad human stories posted and ask themselves, was suicide the only solution? Or could good palliative care, and understanding when it's time to stop the heroic measures and assist people to prepare for the end, have effected a good outcome?
        I am strongly opposed to euthanasia laws because as a disability activist I know where these can lead. We seem to have been trained to fear "dependency" (even though this is a normal part of human life), and the factors mentioned earlier play no small part in this. If you can't be sure that your needs will be met should you become dependent it is frightening indeed!
        This can have some truly tragic consequences--just recently, an otherwise healthy young man who had become a paraplegic here in the UK went to Switzerland to end his "intolerable" life; I have met others with the same injury who have attained a great quality of life because they have had counselling and (crucially) practical help. It's natural to experience that kind of catastrophic injury as a personal tragedy but it isn't the end of the world--unless you choose to make it so. The Dignitas clinic has also said they are willing to end the lives of people who have mental illness, or who are not even ill but want to "accompany" a terminally ill spouse to the other side! The Dutch experience of legalised euthanasia has also shown that attitudes towards disability among doctors cause them to make some very negative decisions abut the value of the lives of disabled infants.
        There are also costs to family and friends of suicide, even if when people have been prepared in advance to what has been planned. I believe (but obviously we don't know this for sure) that increased prevalence of assisted suicide is likely to increase societal beliefs that people have a duty to die when they cost too much or need assistance.
        I should be clear that I have no objection to palliative care that increases risk of death, or stopping unwanted "heroic" care--in fact, I made the decision to stop my former mother-in-law's oxygen when doctors told us there was no hope of reviving her following a massive heart failure. She had been oxygen tank-dependent for over 20 years and the heart failure had been so catastrophic that she could not breathe on her own, so this led to her death within about two minutes. This was based on her own express wishes, which had been written down earlier and discussed with us, and having had it explained to us that she could not recover.

        Political Compass says: -8.88, -8.67
        "We never sold out cos no one would buy."--J Neo Marvin

        by expatyank on Sun May 10, 2009 at 11:04:43 PM PDT

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        •  feeding tubes (2+ / 0-)
          Recommended by:
          Creosote, offred

          I would think long and hard before I allowed or encouraged anyone in my family getting a feeding tube inserted.

          There are worst things than dying.

          •  Alternative not so hot either (1+ / 0-)
            Recommended by:
            deminmarineland

            My aunt had a devastating stroke last year.  She was not likely to have a good recovery.  Her family was torn on what to do.  In the end, she came home and had hospice care until she died.  No tubes.   Basically that meant she starved to death in about ten days, while everyone watched.  Like Terry Schiavo.  I thought it was horrible.  It wasn't my decision, but her sister, who is my mom, had a stroke two years ago, bad but not as bad as my aunt's, and we all take turns caring for her.  It's actually been a blessing and a grace for us all.  I wrote about it last December:  http://www.dailykos.com/...

          •  Thank god I'm not in your family (1+ / 0-)
            Recommended by:
            deminmarineland

            There are thousands of people out there who LIVE because they use feeding tubes.

          •  Well, (0+ / 0-)

            Feeding tubes aren't the devil.  My dad had a feeding tube for about 2 months for an operation on his jaw that prevented him from eating normally.  So that was a good thing.  I met a man a few years ago who had a feeding tube because he had some form of cancer which prevented him from eating in the more common way.  Some people would say perhaps he should have starved himself to death, but he enjoyed doing other things besides eating with his mouth for the next couple of years.

            God knows I need a crutch at times To help this gimpy soul of mine along But not a Burning Truth That we must kill each other over.-Ric Masten

            by deminmarineland on Mon May 11, 2009 at 07:39:57 AM PDT

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            •  yep, at a school I visited recently (1+ / 0-)
              Recommended by:
              dancewater

              there were many children who have feeding tubes because of medical conditions. There was also a lot of laughter, smiles, and playing.
              That said, I know that rough insertion and poor understanding of how to increase comfort with these can lead to some pretty wretched results. The "food" that goes down 'em isn't so nice either! (Hubby used to be a nurse's aide and showed me the daily "steak in a sack" as they used to call it--the regular menu du jour only pureed. Ugh. Luckily, when you're tube fed you can't taste it.)

              Political Compass says: -8.88, -8.67
              "We never sold out cos no one would buy."--J Neo Marvin

              by expatyank on Mon May 11, 2009 at 11:28:37 AM PDT

              [ Parent ]

      •  The DEA. (1+ / 0-)
        Recommended by:
        dancewater

        They've prosecuted doctors in the past for such things. Essentially, if you go over a threshold in your prescriptions of opiates (whatever the threshold might be), they come down on you like a box of hammers.

        That's what keeps doctors from prescribing.

        •  Thus my bloodymindedness on this. (0+ / 0-)

          To offer a patient and her family only two choices:  euthanasia and extreme agony, is monstrous.  On a policy level, it is tempting to oppose euthanasia in order to encourage the development of palliative care.  Such a blanket prohibition, though, is cruel in the case of a terminal patient in intense pain if no palliation is available.  

          FWIW, The February 1, 2008 issue of Pediatrics   points to insufficient palliation in end-of-life care for children.

          Maybe it's just that given the choice of blinding pain, painkillers to the point of being stoned and euthanasia, I'd choose the middle option.

          2009: Year of the Donkey. Let's not screw it up.

          by Yamaneko2 on Tue May 12, 2009 at 12:03:41 AM PDT

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    •  I hope this isn't out of line (1+ / 0-)
      Recommended by:
      linkage

      but exactly what drugs (or combo of drugs) would successfully end a life?

      "Earth provides enough to satisfy every man's need, but not every man's greed." - Gandhi

      by DoubleT on Sun May 10, 2009 at 07:32:59 PM PDT

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    •  I have to wonder about pain relief too (23+ / 0-)

      My mother died of cancer and it would have been quite painful the last few weeks, but her painkiller dosages were continually increased until she was completely comatose the last week of more.

      Even without assisted suicide, no one needs to spend their last days in agony.

      Je suis Marxiste, tendance Groucho

      by badger on Sun May 10, 2009 at 07:34:47 PM PDT

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      •  I read an article about five years back (12+ / 0-)

        about how because of DEA prosecutions, Doctors are actually afraid to provide adequate pain relief to patients.

        I am sorry, I don't have links but that may have something to do with it?

        Perhaps someone else can speak more to this, I am not an authority by any means.

        •  I've heard that too (2+ / 0-)
          Recommended by:
          rowanleigh, Puddytat

          but I don't know if it's true - it wouldn't surprise me. As a lot of people have commented below, this was hospice care, and they seem to have no problem with pain relief.

          Je suis Marxiste, tendance Groucho

          by badger on Sun May 10, 2009 at 08:54:35 PM PDT

          [ Parent ]

        •  here we go (11+ / 0-)

          linkage:

          http://content.nejm.org/...

          webpage lists a 2006 date.

          Excerpt:

          Two cases in California highlight the legal consequences of physicians' undertreatment of pain, providing a counterweight to the fear of legal vulnerability for the prescribing of controlled substances.5 In 2001, in Bergman v. Chin, a jury found that a dying patient had received inadequate pain management and convicted the treating physician under the state's elder-abuse statute, awarding the patient's family $1.5 million. In 2003, in Tomlinson v. Bayberry Care Center, charges of inadequate pain management were brought successfully against both the treating physician and the patient's nursing home. Both cases demonstrate that, in addition to representing an unacceptably poor quality of care, the undertreatment of pain may carry legal risks and consequences.

          Nevertheless, physicians continue to believe that regulatory oversight translates into a high risk of disciplinary action for prescribing opioids and other controlled substances.

          The page than goes on to address the concerns on regulatory oversight.

        •  It's definitely an issue that (5+ / 0-)

          chronic pain patients not in hospice have run into.

          The precise syndrome I have has improper nerve signalling to the pain sensors; I can move and discover my light cotton blouse is painful as wearing sandpaper, and ordinary daily life hurts. I get out of bed as though I had been beaten the day before. Like many others, I really only find relief with opiates, though I don't need a heavy dose. It causes muscle spasms, and sometimes a muscle relaxant is needed to cope with them.  My sleep process has been disrupted; I take Ambien so that I get something like normal sleep. It has aggravated the ADD I already had, to the point that lifestyle coping strategies just aren't enough. It has turned up my normal responses to small daily worries and stresses, and so now that I have PTSD about the dentist (fairly so; the last one sprained my jaw for me) I have an anti-anxiety drug for that and similar high-anxiety situations.

          So I absolutely understand why my doctor won't give me Ritalin. I'm already on tramadol, skelaxin, ambien, and have a prn valium prescription. (sigh)

      •  Mine also, but we really had to push Hospice and (9+ / 0-)

        the Doctor to keep on top of the pain. Once she was on a Morphine pump, she slipped into a coma for a couple of days. We're in Oregon, and could have done Death with Dignity, but Hospice assured us they could control the pain, which took a lot of pushing to connect with Drs, Pharma, and Hospice. Hospice will advise on Death with dignity, as well as the hospital social worker and cancer society. Lethal dose? We could have done it with pills we had prior to hospice, but once hospice comes in they supply meds by the week, so you don't have a "lethal" supply.

        •  Is hospice different from state to state? (2+ / 0-)
          Recommended by:
          dancewater, sallym

          When we had hospice for my MIL, they provided us with a box of morphine in many forms. pills, chewables, liquid, suppositories etc.  They gave us a hug and went home for the weekend saying, "now you can do no harm."

          We didn't need the morphine as she went pretty peacefully with pneumonia.  I appreciated hospice, however, for the care after death, it was much better than having to call the sheriff's department to report a death at home.

          God knows I need a crutch at times To help this gimpy soul of mine along But not a Burning Truth That we must kill each other over.-Ric Masten

          by deminmarineland on Mon May 11, 2009 at 07:49:26 AM PDT

          [ Parent ]

    •  But they can bust someone (5+ / 0-)

      who may have helped you along in any way.

    •  I have my "check out" kit ready to go. When the (1+ / 0-)
      Recommended by:
      AllisonInSeattle

      time comes, and it will, I will first try to obtain relief via the Oregon "death with dignity" law. If, for any reason that fails, my backup will be ready anytime I am ready to go.  

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