California enacts "right to die" legislation

[wisconsinguy]

The euthanasia for being gay article is interesting, but it reminds me of the slippery slope arguments that conservatives have used against gay marriage: "next they'll want to legalize marriage between a man and his child, or between a man and his goat". This gay man would never qualify for euthanasia under the laws being passed in the US. The California law is an example:

- Only adult residents that have a terminal illness that will lead to death within 6 months will qualify.

- Two licensed physicians must verify the patient’s mental competency, diagnosis, and prognosis. If they suspect that a psychiatric or psychological disorder or depression is causing impaired judgment, the patient must undergo an evaluation.

California simply took what the other states that have done with this law, and pretty much used it. Which is fine. They all protect the patient, and allow them the choice. Patients are required to undergo a mental health eval to determine other mental health issues. But, just like any other terminal illness, depression can reach the point in which there is nothing left to try.

[+ quoththeraven]

The posts here all talk of "physical" pain. What of "mental" pain?" In the politics forum, there is a discussion of a young man wanting to be euthanized for being gay:

 

http://www.companyofmen.org/threads/euthanasia-for-being-gay.115106/

 

He is asking for euthanasia because life is unendurable. The article (and maybe he himself, I'd have to go back and reread to be sure) spins this as due to his sexuality, but I agree with whomever suggested that he might be equally as unhappy even if he weren't gay.

 

Yes, guilt and shame about gayness can cause depression, but depression and other similar conditions can exist whether or not there is guilt or shame.

[+ bigjoey]

He is asking for euthanasia because life is unendurable. The article (and maybe he himself, I'd have to go back and reread to be sure) spins this as due to his sexuality, but I agree with whomever suggested that he might be equally as unhappy even if he weren't gay.

 

Yes, guilt and shame about gayness can cause depression, but depression and other similar conditions can exist whether or not there is guilt or shame.

 

 

I think that the man in the article is gay is not relevant. Thousands of people each year commit suicide because of depression; they feel there is no way out of the mental pain they feel but to kill themselves. These people feel real pain; a pain they can not see having an end except through death. In the other thread, I gave a link to a man who is working to help these people. for those who dare not enter the mine fields of the political forum, I post that link here:

 

https://www.notthebrightest.com/taking-the-stigma-fight-to-schools/

 

Unfortunately, many of these suicides are "young" people (some in grade school) who do not have the ability of making a full judgement.

[Guest]

I understand why traditional physicians would oppose Death With Dignity legislation. They have been taught, from day one, that it is their duty to preserve life – at all costs. It would be difficult for them to believe that, when healing is no longer possible, when death is imminent and patients find their suffering unbearable, their role should shift from prolonging life to relieving suffering in accord with the patient’s wishes. I am thankful that some doctors are now learning that they can honor and respect the wishes of someone nearing the end life who says that, for them, the cost will be too high (and I'm not talking about financial costs).

 

I think your analysis seriously mis-characterizes most physicians' discomfort with physician-assisted suicide. Most physicians, including myself, have no difficulty offering treatment which relieves suffering, even if it increases the RISK of death. However, even if we realize that the treatment we are offering may hasten a patient's death, it is not our intent to cause the patient's death. It may seem like only a semantic difference, but I assure you it is not. It is fairly common, for example, for a family to come in explaining that their demented parent wakes up screaming in terror almost every night. There are medications which alleviate this disturbing symptom, but their use is associated with a shorter life-span. In fact, when prescribing this medication, the computer always comes back with a red flag warning "Use in elderly associated with increased risk of death!". So I say to the children/caretakers of the demented parent "There are medications which will relieve this symptom, but statistically, patients who take this do not live as long as those who don't. Is your mother/father the type of person who would want his/her symptoms relieved, or is he/she the type of person who would want life prolonged as long as possible regardless of the consequences?". Usually, the response is to relieve the symptoms, and they come back the next visit explaining how much better the patient is doing.

Another common scenario is the patient who has been on a ventilator for a long time and is clearly not going to get better (often due to cancer). This is often distressing for both the patient and the family. At this point, we might say (particularly if the patient has known wishes or advanced directives) "Your father is not going to get better. We can leave him on the ventilator. However, knowing what we know about Mr. Smith, we can take him off of the ventilator, and relieve his symptoms of shortness of breath with morphine. If we do so, however, he will probably not survive, although he will be made comfortable. Which do you think he would prefer?". In such cases, we provide the morphine and take the patient off of the ventilator. More often than not, the patient expires, but sometimes the patient survives, and we keep the patient comfortable. It is not our intention to kill the patient. Most certainly, if the patient continues breathing, we do not pump the patient up with a mixture of secobarbital and fentanyl in order to try to kill the patient.

So NO, it is not our training that life must be prolonged to the maximal amount at all costs. It is our training to try to follow the patient's wishes as to whether the patient wishes to focus on relief of suffering, or maximizing the chance of life. If relief of suffering puts the patient's life at risk, most physicians don't have a problem with helping the patient. But to provide treatment solely with the intent to kill is not something that I or most other physicians feel is our role.

[Guest]

My points about advanced directives:

1) They may be "on file" but, the physician/surgeon will always go to family and loved ones and ask, "What do you want us to do? Here are the options."

2) I have seen contentious family members put a legal halt to directives. Saying..."This is not what mom wanted. She told me something different last week." Enter of course, if there is money involved with mom's condition.

3) They are only a message board for wishes. They can be halted not just legally, but by someone saying..."That's not what I was told."

4) I choose not to have one. To me, it's a waste of ink. I do have five children, three of which are also nurses, and they are well aware of my choices. I even have my drug of choice dripping into my viens.

One of my nurse kids said: "Don't worry dad, we'll make sure you don't come home so we can take turns changing your diapers!" WG2

 

I'm sorry, but this is incorrect. A patient's written advanced directives trump the patient's representative, regardless of whether or not they have a Durable Power of Attorney for healthcare. It is very rare for the representative, especially those with a DPA, to go against the patient's written wishes. Of course, if the person with the DPA goes against the written directives, the patient certainly chose his representative very poorly. In these cases, the hospital's Ethics Committee usually gets involved. I happen to be a member of ours. In these cases, we explain that we have to follow the wishes of the patient, not the surrogate, when we know what the wishes of the patient are. I can remember only one time when we had to put our foot down and say "I'm sorry, but we have strong written evidence that the patient did not want to continue feeding if he were in a persistent vegetative state, so we will be removing the feeding tube in accordance with the patient's stated wishes. You may go to a judge if you disagree, but the judge has to go by the patient's wishes." That family member did not bother going to a judge.

[wisconsinguy]

I'm sorry, but this is incorrect. A patient's written advanced directives trump the patient's representative, regardless of whether or not they have a Durable Power of Attorney for healthcare. It is very rare for the representative, especially those with a DPA, to go against the patient's written wishes. Of course, if the person with the DPA goes against the written directives, the patient certainly chose his representative very poorly. In these cases, the hospital's Ethics Committee usually gets involved. I happen to be a member of ours. In these cases, we explain that we have to follow the wishes of the patient, not the surrogate, when we know what the wishes of the patient are. I can remember only one time when we had to put our foot down and say "I'm sorry, but we have strong written evidence that the patient did not want to continue feeding if he were in a persistent vegetative state, so we will be removing the feeding tube in accordance with the patient's stated wishes. You may go to a judge if you disagree, but the judge has to go by the patient's wishes." That family member did not bother going to a judge.

The patient does not usually appear in the ER in a vegetative state. The scenario's of a major medical event are numerous. What leads up to that state, can be, and often is convoluted. The decisions that are made by the patient or others on their behalf, may not at the time seem contrary to their wishes. But, and I have seen it many times, the evolution of major medical events can be long. During that time procedures may be performed that may seem in conflict with their directive: "We hope she will only be tube fed for a short time before she can eat again." Enter family and friends, opinions and feelings. I have seen at least three different times in which directives were "put on hold" while progress of the patient was "monitored."