Posted on 03/26/2008 6:08:06 AM PDT by wagglebee
Editor's note: The following commentary from Alex Schadenberg comes in response to a study in the Netherlands which found that 1,800 people - 7.1 percent of all deaths in the Netherlands in 2005 - were drugged into so-called continuous deep sedation shortly before dying. This compares with 5.6 percent of cases in 2001. At the same time, the use of euthanasia fell from 2.6 percent of all deaths to 1.7 percent, representing a decrease of 1,200 cases.
The question of the use of deep sedation in the Netherlands as the alternative form of euthanasia is an important question.
In the case of deep sedation, a person is usually sedated and then fluids and food are withdrawn, resulting in an intentional death by dehydration or "slow euthanasia."
Intentionally killing someone by injection (or as Dignitas Clinic in Switzerland now does, with a plastic bag and helium) usually takes several minutes and usually not more than one hour.
To intentionally kill someone by dehydration usually takes 10 - 14 days.
The problem with the moral assessment of deep sedation is that not all acts of deep sedation are related to decisions to intentionally kill the person. Sometimes a person is very near to death and experiencing intractable pain. The person is sedated and dies within a few days. This is not euthanasia, but in fact good palliative care.
Deep sedation can also be used in other cases when someone is not near to death but also experiencing intractable pain. These people can be sedated for several days. Fluids and food, however, should be continued, and after the short period of time the person comes out of the sedated state. These people are sometimes relaxed from their time of sedation and can be effectively treated for pain and symptom management without re-sedating them.
The point is: deep sedation can be used as a form of "slow euthanasia" or it can be effectively used as a form of good palliative care.
We must point out that when deep sedation is used as a form of euthanasia, this is an abuse of medical ethics. Such sedation is often an imposed death, whereby the family is not informed that the reason for the deep sedation is to cause the death of their family member.
Like all acts of euthanasia, deep sedation can be abused and is a direct threat to the lives of the most vulnerable people in our society who are not given the care and respect that is due a human person.
I don't think ANYBODY is suggesting that pain medication be withdrawn.
It is not uncommon for patients to die of too much morphine because their doctors often have to increase dosages as the pain gets greater and their tolerance to the morphine increases. However, this is VERY DIFFERENT from a doctor INTENTIONALLY administering a high enough dose with the sole purpose of killing the patient.
The court date (as it stands now) is April 2nd and it seems fairly certain that the judge will allow the mother to remove Lauren’s feeding tube. The question becomes if and how quickly an appeals judge will act.
Jim Robinson had to pull a thread about Lauren not long ago because of some revolting comments that were made. Yes, she is a heroin addict and yes she overdosed while pregnant; however, this is not a reason to kill her as some FReepers suggested.
At one point, about a week before his death, my husband said, “If you want to do the euthanasia thing, it’s alright with me...” and I realized that he was not getting the pain relief he needed. I said, “No, God will come for you when He decides, but I want to have you with me until then, and I will help you feel as good as possible.”
Interestingly, what the hospice nurse recommended was adding beer. He really enjoyed those last few beers, and we made sure always to have one within reach, with a straw, and to offer it. I don’t know why I didn’t think of it sooner, and I do reproach myself a bit for that...
As long as the decisions are left to flawed human beings, the result will range from merciful palliative care to coldly murderous expedience. I don't see any way around it.
Teach your children well; choose your physicians carefully.
My father passed away in October 2007 from a massive hemorrhagic stroke. As I watched him die over a 30 hour period, he demonstrated some vegetative signs suggestive of pain. Although I knew he couldn’t be in pain, my step-mother kept asking the nurses for him to have morphine for his pain. I just shrugged and let them give it.
Rob had two fentanyl patches, and sublingual morphine after he couldn’t swallow anymore. He was allowed to have as much as he wanted, and oddly enough, his O2 sats were in the 90s even on the last day.
Morphine does depress respiration, but it also eases the sensation of air hunger, or the feeling of shortness of breath.
In cases of relief vs respiration depression, I say, relieve the pain. Coma does not always follow, each person is different. I think people have a choice, and it’s my personal opinion that when people lapse into the final coma, it’s their “real” death, the person has likely taken the hand of a loving God and left the premises, no matter if the body lives on a few hours. Just my opinion.
Narcotics/analgesics/sedation questions in terminal cases always require two things: an accurate assessment of what the pain/discomfort situation is and what the practical options are; and decision-makers (patient, family, and practitioners) who are clear about taking aggressive steps to eliminate the pain and not the patient.
Even if the pain medication shortens the overall life expectancy in a terminal patient, this is an ethical choice as long as additional steps are not taken to intentionally kill the patient.
The most important thing is not a Living Will, but an actual personal decision-maker (family member with power of attorney) present at every point to insist on excellent palliative care. Here's a good resource for ethical considerations in terminal care.. God bless you.
All of us will eventually be terminal cases, won’t we? So, again, my concern is: Do not legislate palliative care! Let it be case by case.
I agree and I have no doubt when my time comes I will reach a point where I just don't want to fight it anymore -- this is how it has always been and how God intends it to be. However, this MUST be the patient's choice or a trusted family member, it CANNOT be left to the discretion of a "well meaning" doctor or hospital employee who may not value the sanctity of human life.
That’s quite a thread. :(
I'm sorry; I wasn't clear. I didn't mean denying pain meds altogether, but simply not giving enough to fully alleviate pain.
Oh Judith, I hope you can find a way to let that go. You did the best you could with the information you had. But maybe there are always wishes and regrets? Perhaps we love so much that we can't fully let them go.
Being human stinks sometimes.
I think we should all hope to die at home, surrounded by family who love us. Dying in a hospital, while not always avoidable, invariably leads to missteps that burn the heart, later.
I know, as a hospital nurse who occasionally took care of terminal patients, I did my best to explain the dying process and possible treatments to patients and families, according to the level of information they requested.
Dignity, cleanliness, comfort, and love: in terminal illness, these are paramount. Emotional comfort makes physical pain less, definitely. More difficult in a NH or hospital, but possible.
I understood you, and surely wagglebee did too.
I was worried the beer, interacting with the pain meds, would kill him. The hospice nurse reassured me it wouldn’t, and she was right. He honestly didn’t care if it did, for his part.
In every death, there is sorrow and regret. Nothing goes perfectly; in every wedding, there is an “incident” or two, in every birth, something not perfectly done...same with death. The great significance, though, is that with death there are no “do-overs” and few chances to say, “I’m sorry, I won’t do it again...”
Yes they are. As the culture of death so often does, they have now largely succeeded in changing the meaning of the word "dignity" as it relates to life and death.
Dignity is a part of a person's character, not their appearance. When our Lord was beaten, bloodied, mocked and nailed to the Cross, He did not look "dignified" yet He possessed more "dignity" than any of us ever will; in contrast, when Hitler dressed in his finest uniform and committed suicide he probably looked dignified but he didn't possess an ounce of dignity. If we have not lived lives of dignity there is nothing we can do to change that in our last moments and if we have lived a life of dignity it won't matter one bit to our loved ones or God how we look and act in the end.
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