Bioethics Discussion Blog: Does End-of-Life, Hospice, Comfort Care Represent "Murder, Euthanasia, Killing"?

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Monday, April 16, 2012

Does End-of-Life, Hospice, Comfort Care Represent "Murder, Euthanasia, Killing"?

Surprisingly, after over 30 years of hospice care available for those who are terminally ill, the public and even physicians have interpreted end-of-life care, hospice and comfort care patient treatment as "murder, euthanasia and killing", Palliative medicine, treatment to relieve pain and discomfort, in patients who have no further treatment to resolve their disease is an established certified sub-specialty and yet physicians who perform this specialty are working under a cloud of such misperceptions. Read about this issue in Amednews (American Medical Association News).

Do you look at treatment by physicians, with the terminally ill patient's consent, to relieve the pain and suffering "murder, euthanasia or killing" just because the patient's life might be ended a bit sooner than if they were left untreated? Or might you look at pain unrelieved by the treatment of a doctor as "torture"? ..Maurice.

37 Comments:

At Monday, April 16, 2012 4:06:00 PM, Anonymous Anonymous said...

'Do you look at treatment by physicians, with the terminally ill patient's consent, to relieve the pain and suffering "murder, euthanasia or killing" just because the patient's life might be ended a bit sooner than if they were left untreated?'
NO!!!
Or might you look at pain unrelieved by the treatment of a doctor as "torture"?
If treatment is available, and withheld, YES.
I don't see this as a complicated question at all. It is unfortunate that denial, but patients/family members and at times physicians, denies appropriate treatments to patients. We are often kinder to animals.
TAM

 
At Monday, April 16, 2012 7:54:00 PM, Blogger Maurice Bernstein, M.D. said...

"Or might you look at pain unrelieved by the treatment of a doctor as 'torture'?
If treatment is available, and withheld, YES."

Torture is the intentional infliction of pain or suffering. What if the pain and suffering is inflicted by the disease and the treatment of the physician does not relieve the symptom without causing the death of the patient? Does this interpretation relieve the doctor of being accused of torture for not providing the treatment?

What I am getting at is that the public and even doctors loosely use the words "murder", "euthanasia" and "killing" along with "torture". They are all serious accusations to be applied to the way a terminally ill and suffering patient is treated by others. Surely, attention to the full and specific definitions of these expressions is of importance before their use. Their inappropriate use may literally affect how the public looks at ways to provide comfort to those terminally ill patients in need. ..Maurice.

 
At Tuesday, April 17, 2012 5:30:00 AM, Anonymous Anonymous said...

I believe (you can correct me if I am wrong please) that it is considered legal and ethical to attempt to treat pain in a terminal patient, even if that treatment might shorten their life.
So if that is what the patient wants, and that treatment is withheld, I find it - if not "torture" - wrong, and cruel. I'd probably be angry enough to just use the word torture myself. Whoever is withholding the available treatment is making a deliberate choice, which is causing continued pain. I suppose one can pick a different word, to soften it, but the patient won't feel any less pain.
I have had this happen to a family member, for a time, so am not entirely objective about the topic.
TAM

 
At Tuesday, April 17, 2012 8:19:00 AM, Blogger Maurice Bernstein, M.D. said...

And TAM, it is understandable that those who describe a shared empathy regarding a painful experience may express their feelings beyond the terms' dictionary meanings. ..Maurice.

 
At Friday, April 20, 2012 9:22:00 AM, Blogger Hexanchus said...

Tam,

I agree with Dr. B - by definition, the act of torture is the intentional infliction of severe physical or psychological pain to punish, coerce or afford sadistic pleasure.

However, the definition of torture also includes a."anguish of mind or body" and b."something that causes agony or pain". So while the physician may not be technically torturing the patient, the patient can still be tortured by pain.

To address the original question, I do not believe that providing adequate medication to control pain in a terminal patient, even if it may hasten death, is murder, killing or even remotely unethical. If that is what the patient wants, then that is what the patient should get....of course I live in a state with a "death with dignity" law that I fully support, so my feelings go a ways beyond that point.

Let's be real. Doctors recommend treatments that have inherent tradeoffs all the time. Almost any treatment has some inherent form of adverse risk, some of which are fatal. When a patient is at the point you can no longer treat the disease, what is left to treat? The pain. As long as the physician is up front with the patient (or their representative) and tells them that the side effects of adequately controlling the pain cause death to occur sooner, and the patient is OK with that, then I see no problem with it.

 
At Saturday, May 19, 2012 11:43:00 AM, Anonymous Anonymous said...

You know what? You WON'T believe it until it actually happens to YOUR loved one. Do not be so quick as to discount these accounts. The scenarios sound like science fiction, but this IS DEFINITELY happening! Too much MORPHINE. My dad was not terminal BY ANY STRETCH OF THE IMAGINATION until hospice came on the scene. Who pushed us into hospice? His medical insurance plan, that's who! Over and over and over again. Made it sound all rosey and wonderful. Do you know that hospice gets paid by Medicare...a flat fee??? My dad was dead in six weeks...and that's only because his constitution NOT to die made him hang on that long. This was after the hospice doctor (hospice company -- or "palliative care" as they like to be called -- barf! -- owned by the doctor) -- debilitated him day after day with psychotrophic drugs (and btw, did you know that's illegal????) The last day of my dad's life, a "closer" "nurse" from hospice came in (not his normal nurse -- and with questionable credentials) and he was dead in an hour!! My sister and I were appalled and had a postmortem toxicology lab performed, and guess what, present were TOXIC levels of MORPHINE and OPIATES -- even though we had stressed written and verbal instructions, time and time again, for NO MORPHINE or OPIATES!! They did what they wanted to do without regard to anything other than their mission. If you will take the time to google HOSPICE KILLS...MORPHINE DEATH...ELDERLY EUTHANASIA...read the stories and be informed. Better yet, read Ron Panzer's book (you can download it for free) called Stealth Euthanasia: Health Care Tyranny in America. I am not promo'ing this book...it is just an extremely informative book. Believe me, I've seen more and more of these stories on the internet in the past two years, we lived it, and it IS TRUE!!

 
At Friday, June 01, 2012 7:37:00 PM, Anonymous HRN said...

I absolutely agree with end of life care. It is in no way euthanasia!! We do not allow our pets to suffer! Rather "put them out of their misery," but many people in this country seem to have no problem watching their, so called, "loved ones" suffer. There are many different forms of suffering! Pain is an obvious form, but what about a complete change in a persons "quality of life?" If a person is terminally ill, they may not be in pain at the onset of illness, but I promise, as the person continues to slowly deteriorate, there will be pain. If not from the disease, then from the immobility! Our bodies were created to be upright and mobile! When they're not, it hurts! For years, I took care of people in ICU's. When you're there for a temporary condition, like surgery, that's one thing, but when a person is near death, and the family, or doctors, won't allow the natural progression of death to happen, it's awful! The indignity of having a tube placed in every opening of your body, then, having new holes made for more tubes; machines and medications making you breathe, making you have a blood pressure...it can go on and on! I would bet that most people, if asked, would state, "I do not want to live that way!" Because there is no quality of life there! It's inhumane! The last response I read, on 5/19/12, made me feel saddened. Not because her father had died, but because she seems in total denial of the truth! She'd rather "blame" someone, anyone, than face the fact that her father was dying. She stated, "My dad was not terminal by any stretch of the imagination." Yet, he was on Hospice!!! There are absolute criteria a person has to meet to even qualify to be on Hospice! And it took 6 weeks for him to pass. That's a long time for a Hospice patient. I say that, because most people, or their doctors, wait till the last minute to call on Hospice! I hope she finds peace, and realizes that Hospice did not "kill" her dad, nature simply did what nature does. We are human! We are born to die! From our first breath, we are nearer to death! Is it sad? Yes! Has anyone beat death? Not even Jesus Christ himself! I often find when a family member continues to stay in denial over someones death, there is some kind of underlying guilt. This is usually shown by blaming others for what has happened. Because as long as you can blame everyone else, you never have to look at yourself and own up to the unresolved issues between yourself and the person that has died. I know I went off topic, but words like hers could hurt so many people who have found absolute comfort and peace by using Hospice or end of life care. It comes down to quality vs. quantity! Last thought - what good is quantity without quality???

 
At Sunday, June 03, 2012 11:28:00 AM, Anonymous Anonymous said...

Apparently you are an "RN." You, of all people, must know (or do you?) that it takes absolutely nothing nowdays except a signature from a so-called "doctor" of a health plan for your loved one to be placed into hospice (OR having the insurance company AND the hospice organization HOUND you constantly -- even when you've repeatedly told them not to). Ask yourself this question: Who is benefiting?? Why, it's the insurance company and Medicare -- and let's not forget the hospice organization. I don't care what you believe, NO ONE in this world has the right to take another person's life (AND totally disable them with psychotropic drugs first, as was the case here, btw) to the point of being "terminal"!! Sorry, the term euthanasia DOES apply here, no matter how you personally define it or qualify it for your own conscience. Who made you or anyone else God??? I am far from being in denial...my family just so happened to live this nightmare. I know the facts, I lived them, continue to do so now every day of my life, and the facts unequivocably point to elder euthanasia in this instance, madame! Get your head out of the sand!

 
At Monday, June 18, 2012 10:33:00 AM, Anonymous Anonymous said...

Some very disturbing comments about hospice care
here and a lack of understanding as to the exact role
hospice provides. It's always blame the physicians,
hospice and the nurses.

PT

 
At Wednesday, June 27, 2012 2:17:00 PM, Anonymous Anonymous said...

I have not seen on any web site I've visited the question of Hospice "selling" their patients. My dad was offered
"free cremation" by the Hospice people in the form of a "body donation" pamphlet from another company. Once signed and turned in, he was dead from morphine within the week. (he was NOT in pain) When his ashes were returned from the facility that he donated his body to, there was almost nothing left. I BELIEVE Hospice gets a kick back for finding and supplying "donors" so bone can be sold to be used for "cadaver bone grafts" and/or more. Anyone have such an experience? Free cremation offered through Hospice? Toms girl

 
At Sunday, July 01, 2012 7:12:00 PM, Anonymous Anonymous said...

Anonymous, with all due respect to your father,often the
only bone remnants left within the ashes are teeth. The
temperature of cremation is not designed to reduce long
bones,ribs and vertebrae to ashes. A crushing machine
often is used to grind long bones to rubble and removed
from the final assay.

PT

 
At Tuesday, August 14, 2012 6:34:00 PM, Blogger Maurice Bernstein, M.D. said...

Robin wrote the following today to this thread but since the hospice was virtually specifically named, I decided out of fairness to the hospice to edit out the identification in view of the accusation. Nevertheless, the concerns of the writer is very important and should be discussed. ..Maurice.



The Hospice killed my father. That's right. They killed him. Would he have died from the cancer anyway? Maybe. But we all have a point of death, right? That certainly doesn't mean someone should "speed it along." If that is allowed, then I should be allowed to shoot whom I choose, because, after all...they will die eventually anyway.
When my father arrived at hospice, he wanted to come home with me. I should have put him in the car and taken him. He was in good spirits and was eating. I stayed with him all 13 days until his death. I fed him every day and even went to the kitchen and got him more soup one evening. The doctor took me aside the next day and said, "You are just feeding the cancer. You should stop doing this." Those were the doctor's exact words. Everyone there was very "nice" but if I did things outside of their agenda, they made me feel very uncomfortable. Their agenda was clearly laid out in their pamphlets (with a few omitted details). The pamphlet told the stages of death that come as a direct result of a lack of fluids to the body. The pamphlet tells you to expect the patient's urine bag to grow very dark, a blueness around the knees, feet, and extremeties from the death process. It went on and on but nothing was mentioned about the morphine induced coma the place puts the patient in. My father didn't ask for morphine and I didn't know that's what he was getting in his IV until day 4. They conveniently would administer the drug when I was out to lunch with my daughter each day. I'd return and dad would be asleep. Surprisingly, I couldn't waken him. When he did awake, he'd display the symptoms of an addict, crying for pain meds...but he didn't act like this when he arrived.
Hospice did nothing for him as far as food and drink. They placed a meal plate on his bedside tray right after knocking him out with morphine, then took it away.
Finally, one day while I was at lunch he slipped into a morphine induced coma and slowly died. It took about a week for his body to completely shut down. Dad was a fighter. Hospice kills.
I would never wish this on anyone and I am still haunted by the fact that I wish I would have told the doctor to step aside and took my father out of there.
They didn't want him to go home with me because they wanted his insurance money. Besides that, dad died at 3 am and I had a 10 year old daughter with me who was sleeping. As soon as he had no pulse, they told me to get out. I couldn't even let my daughter sleep til morning.
Robin

 
At Tuesday, January 08, 2013 8:51:00 PM, Blogger SweetAngelSong7 said...

It has been some time since my Mother died at a Hospice Care Facility. She died 8/17/2012 in a drug-induced stupor. The question presented is undoubtedly an ethical one and at very least requires some amount of knowledge and considerable thought to fully understand the magnitude of what is being asked. To provide an answer to the question as to whether voluntary euthanasia is an acceptable treatment “of last resort” surely invokes various responses depending on personal values and personal experiences. With regards to this type of aggressive treatment to ease a terminal patient’s pain even if it hastens death a “bit sooner” introduces a very real and valid concern. Therefore, Doctors must be forthright about providing adequate information to the patient and the patient’s family. It is anyone’s guess if “Palliative Sedation” may shorten a person’s life; however, research does indicate that “imminent death” can be mistaken by hours, days, or even weeks. Great consideration must then be given to the time frame in which “Palliative Sedation” to coma should become a valid option of treatment. My question for you my friend is this: Should a Terminal Patient ever be placed into a drug-induced coma without the Patient’s Consent or the Consent of the Patient’s Advocate? Morally, there will always be people on both sides of this issue but believe me when I tell you that this procedure is being used on terminal patients without “Patient Consent” or the Consent of the Health Care Surrogate. This very thing happened to my Mother and is still happening to others today. There was No Consent given for “Palliative Sedation” to coma. The lethal combination of Morphine, Ativan, and Haldol surely contributed if not caused her immediate death. Even after requests were made to “back off” the medications, these requests were ignored. My Mother was alert and responsive when she entered the Care Facility and in less than 4 days she was reduced to less than human, put in a drug-induced coma, unable to speak or voice her objection, unable to communicate at all. After a private autopsy was performed it was revealed there was a lethal amount of Morphine still in her system even after three days following her death. Also revealed was the fact she had bacterial pneumonia. My Mother’s pain level was on an average around a 4 or 5. She had not yet reached the threshold of “intolerable pain” and yet the Doctor took it upon himself to induce her to a coma using the combo of drugs. In my opinion the mistake was made by the Doctor who declared her to be “imminently dying” so he took it upon himself to medicate her to a coma, denying food and water, as we helplessly watched her die a most horrific death. I personally believe this type of treatment should only be given to patients under limited circumstances with “full written consent” and that the family must fully understand what will happen to their loved one. We have left too much up to conjecture as to whether a patient is “imminently dying” and we must implement stronger guidelines and consent procedures before resorting to the use of “Palliative Sedation” to coma leading to the death of the terminal patient. My Mother needed medical attention for pneumonia not increasing dosages of Morphine and other drugs to bring her to a comatose state, unable to eat or drink, unable to voice her objection, and if the patient does not die of their “underlying illness”, they will die from dehydration or like my Mother, pneumonia… surely this is not humane… this is playing God and is rightly coined non-voluntary “euthanasia”!

 
At Thursday, February 28, 2013 9:45:00 AM, Anonymous Anonymous said...

I believe that all people have a right to die with dignity and to be free of pain in the process. That said, there are serious problems inherent in home hospice care that need to be addressed. My father was enrolled in home hospice for "failure to thrive." He did not have cancer, He was not in pain. He had chronic heart disease. Records show that he agreed to be enrolled in hospice care because the alternative given to him by his internist was either hospice at home, or a SNF. My dad wanted to be at home. He was dead 18 days later with an accumulative overdose of morphine.
The people entrusted with giving him morphine were his wife, and her boyfriend who was 30 years younger than my dad. My dad was not aware of the affair that had been going on for years and we learned of it only after his death. Records reveal that in the first 14 days, he was given only 10ml of morphine. On day 15, records reveal that he was refusing to take the morphine stating very clearly to a hospice nurse who came to check on him, “I am not in pain. Get away from me. Get out of my house.” On day 16 hospice records reveal that my father was fighting back and the “caregivers” were able to get him “under control” with morphine and the nurse said “it is the family, not the patient who decides what he needs.” This is in direct contravention of well established law. Every person has the right to refuse medication. Within 30 hours of death, 35ml of liquid morphine disappeared – completely unaccounted for. Within 11 hours of death, the wife was caught lying to hospice workers about the missing morphine told hospice that she had tampered with the morphine by watering it down. Instead of removing my father, the patient, from this dangerous and suspicious situation, hospice prescribed another vial of morphine and my father died hours later.
Bank accounts were drained, insurance policies forged, and assets missing – all accomplished during the 18 days he was in hospice.
While the reasons for enrolling in hospice vary between individuals, the fact that hospice patients are an extremely vulnerable class of people applies uniformly. This is especially true if the patient is also an elder. In a case where an elder hospice patient is receiving home hospice care, and the people responsible for administering morphine are not objective medical personnel, and especially if those same people serve in any way to benefit from the patient’s death, there is fertile ground for abuse.

 
At Thursday, February 28, 2013 10:39:00 AM, Blogger Maurice Bernstein, M.D. said...

It is sad to read life experiences regarding a family member's death in a hospice situation which leaves a remnants of uncertainty and anger in place of comfort knowing that the patient's participation in hospice and the final event was that of both physical and mental comfort. What can be done about these bad experiences? I would say to the families not to withhold the concerns but to speak up to the appropriate parties, whether it be the patient's physician, manager of the hospice program or lawyers or even law enforcement if a crime is suspected. If not the family, there may be no one else to speak. ..Maurice.

 
At Sunday, July 21, 2013 4:47:00 PM, Blogger GC said...

my dad is dying a slow, miserable, tortured death from an obstructive form of cancer that is not painful. he, however, is in agony, with hiccups lasting hours, acid reflux that cannot be controlled, and is not eating or drinking, nor does he want artificial nutrition or fluids. he has been in psychological agony for over a week now, begging to not have to endure this slow, tortuous death. even the death with dignity act cannot help him, as the 2 week lockout period is still only a week in.

he wants to be unconscious, but our hospice "team" is only concerned about physical pain, which he does not have. so that's the other side of this torture story. I would love for some kind nurse or doctor to give him enough morphine to die; but no one will. he keeps asking how much longer til he can drink the death with dignity cocktail, but there is no dignity left for him. and hospice acts as if they do not care.

 
At Tuesday, November 19, 2013 11:24:00 PM, Anonymous Anonymous said...

My brother loved life he was not ready to die. He was only 58 years young, he had cancer but was not in any pain, was of sound mind and enjoyed his family. "Someone" wanted him dead in less than 6 months. Hospice + Morphine = DEATH. This is wrong, this is not Christian. To every thing there is a season, and a time to every purpose under the heaven: 2, a time to be born, and a time to die; Ecclesiastes 3:1-10 CC

 
At Friday, November 22, 2013 1:16:00 PM, Blogger coup de grace said...

Anonymous 11-19-13. I am so sorry for your loss. I truly feel your pain, to all the others who mourn the life of loved ones I extend my condolences as well. I too have experienced the loss of a parent while under the care of hospice attended to at home. This loss was over a year ago and I am still grieving that death. I myself am a Registered Nurse and had no idea that hospice had become a "culture of death" governed at the national level by the combined forces of pro euthanasia organizations. I have spent the last 18 mos researching this organization and its mission in society and the legislative arm of it's philosophy and ideals, Compassion & Choice is attempting to steer society under the disguise of "Right to Die", end of life choice and now physician assisted suicide. It has NEVER been about any of individual rights, it has been about what the PRO EUTHANASIA advocate organizations have been wanting for a long time. They have finally cleverly and stealthly entered into mainstream healthcare. Hospice is marketing itself as compassionate care for those with terminal illness and at end of life. My suggestion to anyone wanting to enjoy life up until the moment of death stay away from Hospice, its goal is to make sure your are dead within 6 mos if you are allowed to last that long even. Do the research, the avg. length of time under hospice care is 49 days. There is a re-certification reason for that time frame and the next stealth target time frame is before the 6 mos is up or else they can be charged with Medicare Fraud. It's time to wake up and admit to ourselves, "if it walks like a duck and quacks like a duck it is a duck!" Stay away from Hospice services unless you are sure you don't want to be alive in 6 mos or less. When you really think about it, other than killing what did their services really provide that could not have been provided by under other care options. Let us remember, Death does not need Hospice, Hospice needs death. Death is no different today than it has always been. The need for Hospice based on Pain management is a smokescreen for murder, pain management can be easily achieved today without killing the person. That is not pain management that is murder. Hospice needs to be prosecuted for what they are doing, medicare/medicaid does not pay them to kill people, it pays them to provide comfort at end of life, killing a person is a poor excuse for comfort care. It will take only one person capturing on camera what they are doing to make them sit up and take notice that their euthanasia scheme has been exposed. If society wanted euthanasia legal, society would demand it. Society is not demanding euthanasia. Compassion & Choice is but they are calling it a Right and a Choice and comfort care. Who's choice I ask? jbj

 
At Thursday, January 09, 2014 11:29:00 AM, Anonymous Anonymous said...

I am a registered nurse: HOSPICE IS MURDER. Who the hell decides what should be the desired "quality of life" and where is that line to be drawn? A retarded child has a quality of life many would not choose. So does a bereaved widow. So does a decorated vet with missing limbs. MOST of the people I have watched be MURDERED by Hospice were NOT ACTIVELY DYING, it was just cheaper for the HMO or insurance to kill them off, and they were killed by starvation and intentional dehydration and morphine. If you are against abortion, you SHOULD be against hospice as well: a life is a life, yu do NOT get to pick and choose! Your name is not GOD, MD.

 
At Thursday, January 16, 2014 7:21:00 AM, Anonymous Anonymous said...

The same thing happened to my 93 year old Father. They told my Mom to give my dad hadol crush it and put it under his tongue. Then 0.5 morphine this was at 10:00. My dad was complaining of more pain and mom called nurse again and she said he must of been a heavy drinker. Then she said give him 2 siringes of morphine at the same time. No one came from hospice to help my Mom and Dad. So sad my Mom had no idea what morphine would do to him. They never explained any of the meds to give him. Why did hospice help them. They wanted to end his life. All the next day no one ever came out until 2:30 the next day. I called as soon as I got to my parents they said they would call back when some one could come out. He was out and not the same as every day visit. He usually up and ready to eat breakfast. Loved to see his family. It broke my heart to read all these post. I am certain that hospice did end his life early. I don't see how they can live with knowing what they did to him. Be ware of who you trust with your love one! I know they will not touch my Mom. I hope other people read up before you trust hospice. I called them and gave them a piece of my mind. They said they were sorry the nurse didn't come out she should had come and helped Mom. Also they may have given him too much morphine. I told them sorry doesn't bring him back. But when you sign up just remember you turning them over to hospice.

 
At Thursday, January 16, 2014 12:29:00 PM, Blogger Maurice Bernstein, M.D. said...

The last comment was identified shortly after the comment was published as written by MH. ..Maurice.

 
At Thursday, January 16, 2014 6:15:00 PM, Anonymous Anonymous said...

I am surprised by the experiences described here by those who had family members die while on hospice care. My experience with hospice, both as a former hospice employee and as someone who had a family member die at home while on hospice, is quite different.

When I worked in hospice care we had a good number of patients who lived way beyond the 6 month time frame because their illness did not follow the expected course for whatever reason. In fact, many patients actually got better for a period of time because they were home and were receiving regular care from a team that included multiple disciplines to address the physical needs of the patient and the emotional & spiritual needs of the patient and family. Pain medication, as well as other types of medications, were used only as needed, and the patient and/or family was well aware of what was prescribed and how and when to administer it.

I recently lost a loved one to end stage dementia, and we had hospice at home for him. We had to accept that this was the stage he was in and that further hospitalizations were not beneficial. He was confused, but was still able to protest at the tests and treatments that were being given to him, so the answer became clear that the best treatment for him was comfort care at home. The hospice nurse was absolutely wonderful, and spent a great deal of time educating those who cared for him on what medications to use, for what reason, when, and how much. As I saw with the hospice patients I worked with years ago, my family member "improved" for a period of time once we got the comfort care underway. He was given small amounts of Ativan and morphine when he became agitated and uncomfortable, but was still able to interact with the people who came to see him and listen to the music that he loved all his life. There were a few times when it looked like he was on his way out, but the hospice nurse never advised or recommended to increase any meds unless there were specific symptoms that needed to be addressed. He rallied a couple of times before starting the final journey to the end of this life, and it was a very peaceful end.

Providing someone with comfort care and pain management, both at the end of life and for treatment of chronic conditions that involve pain, is absolutely necessary, humane, and ethical. It can be very difficult to accept when someone is at the end of their life span, whether it be due to end stage cancer, dementia, liver disease, or whatever condition, but if you can do that it is very possible for the dying person AND their loved ones to experience the peaceful death that we all hope for when it is our time. JMS

 
At Wednesday, January 29, 2014 2:07:00 AM, Anonymous Anonymous said...

My mom was killed by what staff would like to call euthanasia. In reality it was murder. It started with haldol adivan etc cocktails. She survived since she was a very healthy person despite her age. She went to the hospital for a minor surgery that went fine. She got a skin fungal infection that eventually went sepsis from no treatment and the wrong treatment. She was treated with antibiotics instead of continuing the fungal meds that had helped her. Between sedatives that she was sensitive to and non treatment and deadly poisonous treatment they managed to murder her. The doctors decided that because of her age the fungal meds would be a waste on her even though they had saved her life and would have saved her had they been continued like they were supposed to be. Their death of choice antibiotics which is poison for a person with fungal sepsis. This was just all a horrible tragic way of murdering a perfectly healthy person. Euthanasia/murder takes elders lives and people who are sick. Sometimes without the knowledge of the family. The medical staff just wanted our family to believe that it was a death of natural causes (old age) instead of what it really was murder. This has got to be stopped. Medical staff have no business deciding to end a person's life with these deadly sedatives that they give to patients who should not even be taking them leave alone the amounts that they give. I say prison the murderers or medical staff that even attempt to kill this way. Prison is where these disgusting scums need to live their lives forever and ever and throw away the key.They not only steal lives like my moms but they destroy whole families.

 
At Monday, February 17, 2014 8:55:00 AM, Anonymous Anonymous said...

Hi Anonymous Jan. 9 Hospice Nurse.
Would you care to tell more of your stories on what you have seen?

My Dad was put into a terminal sedation in a hospice setting with 5 different drugs - and this was after we had told them NO drugs!! They made their own decision to do him in. He died within 36 hours of being at a "Respite" hospice facility.

 
At Thursday, April 17, 2014 11:41:00 PM, Anonymous Anonymous said...

The challenge of hospice is that the biology and will of living beings is to fight to survive and hold on until it is no longer physically possible. Traditionally the responsibility of medicine is to preserve life. Once all external supports are removed from those that are ailing (food, water, air, medicine) the only result is death.

My family member recently passed away in hospice, and because I live far away the updates I received about the person wasting away were morbid and depressing (12 days to wither away and die). To us the hospice goal seemed to be forcing the person to die so that the person would be at peace(?). The funeral home commented that the body was so emaciated perhaps we should have a closed casket. How revolting! There has to be a better solution than what we now have in place.
Being elderly and ill should not signify that one has lost value in society. Quality of life cannot be evaluated the same, either, as compared to a young healthy person.
However, I certainly understand the overwhelming stress the caretakers are under and how hospice seems to offer support and a (final) solution. But the process of watching a loved one disintegrate is very traumatic, and I am not sure I can ever believe it was the best option. If only we could assure a natural, painless and speedy parting for ourselves and our loved ones.

 
At Sunday, April 20, 2014 7:20:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from April 17, 2014. the alternate to hospice would be physician assisted suicide which now available in a few States.

There certainly will be a greater emphasis put on referral to hospice care in the United States as the politics of healthcare become more oriented as to the costs of healthcare and the need to bring down unproductive end-of-life treatments expenses. ..Maurice.

 
At Friday, May 23, 2014 1:07:00 PM, Blogger coup de grace said...

Seems like the USA is well underway with a T4 Program of it's own. As in Germany it will be the task of health care to initiate it before the government takes it over and it becomes another holocaust. Euthanasia advocates are about eugenics and ruling governments are about being able to financially remain in power "He who has the gold makes the rules". When the 2 forces team up it becomes deadly for those deemed less than beneficial to society and as in history past many will turn their heads and pretend it is not happening as long as it is not happening to them. Forewarned is forearmed! it is time to speak out on the Elephant in the Room before it is too late!

 
At Friday, May 23, 2014 10:59:00 PM, Blogger Maurice Bernstein, M.D. said...

I doubt that T4 (euthanasia) program will gain any traction in the United States. There are too many "pro-life" groups who would rebel against any governmental approval of euthanasia. ..Maurice.

 
At Friday, June 06, 2014 9:00:00 PM, Anonymous Anonymous said...

NOTICE HRN has given some very good points and when a human gets to the point where they are as described; hospice is a god thing. But, the elderly are being signed up too soon for hospice and the hospice is glad to get a patient and will not question. It only takes a family member, health care surrogate, durable POA, medical professional to sign you up if you are diagnosed with a terminal illness and it can even be done without notification to your family and against your directive; only two docs to sign is needed with no exam necessary. There is no protection for the elderly and it depends on the strength of who is in charge of you as to whether you get institutionalized in hospice or not. You may not even be told that you are dying, it is a cruel process and you will fight; it has nothing to do with your younger perception that “I would not want to live like that” and it has everything to do with biology.
It is not illegal to pump an elderly person with controlled substances as chemical restraints to control the fighting behavior and psychotropic drugs to treat the anxiety of the assumed disease progression because you are fighting for your life and someone decides you need a more dignified death, unless the individual had a developmental or intellectual disability prior to their terminal illness diagnosis; then they are under a protected class with the ADA (or the terminal illness is diagnosed before age 60). It is also acceptable under the Medical Practice Act and no MD management is required. Nowhere is this legal except with the terminally ill over 75 and especially if you have had a catastrophic event like a fall, stroke, heart attack or infection to sway to the opinion to you being medically futile. Once signed up for hospice, you are removed from your life-sustaining meds and given comfort meds to pass. You are denied you right to live out your terminal illness with your co-morbid conditions. It is not even euthanasia because it is not a peaceful death. A hound at the pound suffers less.
It is not the fault of the individual nurses, doctors, social workers, caregivers, aids, Chaplains that are doing this; they are following a hospice protocol which is based upon Medicare guidelines and it is happening so often that it is very common. Just call a nursing home and talk to an administrator; I have and they say, “It happens all the time”. Call an attorney that specializes in Elder Law they will say, “It happens all the time”. Talk to caregivers, it happens all the time. The process is a result of the lack of planning for the older population. It is a social problem that medicine has developed a plan to resolve. It is a bioethical issue to spark debate.
We need to start focusing on the functionality of the patient rather than the terminal illness. Ronald Regan lived 10 years with Alzheimer’s, Arial Sharon lived 8 years in a coma and Steve Jobs lived 5 years with stage 4 pancreatic cancer. I recently had a personal experience with this situation and I sent a letter to the quality and compliance department of the hospice under the grief counseling services. I received a letter back that stated the individual could not state their prognosis, diagnosis or their plan of care. Really! Is this a reason to end someone’s life? You could clean out a nursing home with that criteria.
When a person becomes elderly where their body starts to wear out and the mind becomes demented, some of the same behavior, safety and crisis supports used with individuals with disabilities can be applicable; but, we are focusing too much on the use of skilled nursing and hospice institutionalization and it is a very expensive band-aid solution to a problem that is rapidly growing.

 
At Friday, June 06, 2014 9:39:00 PM, Blogger Maurice Bernstein, M.D. said...

And then comes to question: Is There a Duty for the Elderly to Die?

Former Governor of Colorado Richard Lamm had lit a firestorm of controversy when he suggested that old people have a duty to die. This concept has been elaborated by others. The reasoning is that our society, at least in the Western world, have no good financial plans for long-term care for the aged when they become incapacitated because of illness or mental debility. Often these persons become a financial and emotional burden for family members and may require family members to alter their own lives and goals simply to care for their aged relatives. It has been suggested that these burdens are not acceptable and that the aged should find a duty to terminate their lives before they have reached such a dependent state. This means that an elderly person while mentally competent and not terminally ill should arrange to die. The argument is that their life is almost over naturally and they should not interfere with the lives and careers of others who have yet many years of life ahead. Also implied is that society's monetary costs for caring for the elderly infirm could better be spent on children and younger people.


For much more on this topic, here is to the link to my 2006 thread titled "Is There a Duty for the Elderly to Die" presenting visitor responses from an earlier presentation on my now inactive "Bioethics Discussion Pages" and followed by a number of responses to my current blog presentation. ..Maurice.

 
At Saturday, June 14, 2014 7:01:00 PM, Anonymous Anonymous said...

The gov needs to understand that the care of old people can create jobs for the young people. End of life plans are a good thing for any age if you have a terminal illness that makes life not worth living. However, for the elderly and demented, use of end of life plans just to get rid of the burden is not medicines response that he will want either. If we would employ some of the same practices used to care for individuals with developmental and intellectual disabilities for the elderly and demented, rather than using skilled nursing institutions; it would cut the cost of caring for a dementia patient in half and create jobs for the youngsters. A dementia patient, for example, does not need 24 hour skilled nursing staff for the last 5+ years of their life. Residential staffed homes with case support agencies can be used to care for several patients throughout their life. Some states currently have pilot programs going on for this type of option.
The use of chemical restrains to force withholding/withdrawing is not something anyone would want done to them; not even the gov. Lawmakers need to focus on “right to live” language and we need definite interpretations of “terminal illness”. The demented elderly patient that is still functional and responding to their environment has every right to live out their terminal illness. We need to look at the successful plans that have developed for caring for individual with disabilities and apply the models to caring for the demented. It will put more people to work and cut costs. I just cannot understand why no one has figured this out including the gov.

It is responses like this that show the demented population over 75 needs to fall into a protected class.

Notice

 
At Monday, June 16, 2014 11:17:00 AM, Blogger Maurice Bernstein, M.D. said...

Another question:
Chronic dementia in the aged is one population. Chronic dementia in those in the "non-aged", "the middle age or below" is another population. Should both be treated equally? In other words, does the chronological age of the chronically demented determine the goal of management? ..Maurice.

 
At Monday, June 16, 2014 4:45:00 PM, Anonymous Anonymous said...

Absolutely, their interests would be different and older mentally challenged would have additional co-morbid conditions to address. If you look at some of the residential models for caring for individuals with developmental and intellectual disabilities, autism, downs, cp, mmr, ect; you will see that the programs are geared towards getting the individual out in the community, developing their own life-time interests and making new social connections. The elderly did all of that when they were younger and their expectations are much different. The POCs would be much different, but still patient centered rather than focusing on the "duty to die". The poc would cost much less for an elderly person in a residential staffed home than the poc in a 24 hour skilled nursing institution; waiting to breath their last breath.

 
At Monday, June 16, 2014 5:42:00 PM, Blogger Maurice Bernstein, M.D. said...

Anonymous from today, it is true what you write about the younger mentally disabled, but perhaps it is society's (and, of course, the patients' families) continued urge to treat the ongoing severe physical illnesses of those who are elderly demented, to prolong their lives, rather than shortening them, waiting for a medical miracle, that is the explanation why society has encouraged that particular patient population to be directed to skilled nursing facilities. ..Maurice.

p.s.-..Perhaps, if you continue writing here, you can end your commentary with a pseudonym for personal anonymity but helpful for identification of the writer.

 
At Monday, June 16, 2014 6:18:00 PM, Anonymous Notice said...

Yes Dr. Maurice. I agree with your comments and please understand that I am not saying there is no need for skilled nursing for dementia patients that, like you say, the family has decided best based upon their loved one. I appreciate the comments in this site and appreciate the opportunity to voice; I certainty hope there is someone that can implement more options plans for some of the elderly that do not want the nursing facility, or hospice plan for death, options. Plans of care need to be person centered for all, even the aged dementia, and for the families choices. I am an advocate for more choices and more protection for the elderly. Thank you.

 
At Tuesday, June 17, 2014 9:10:00 PM, Blogger Maurice Bernstein, M.D. said...

Notice, here is an example of "more choices and more protection for the elderly":From Caring.com: "He had advanced cancer and was DNR. Why did I send him to the ICU"...Maurice.

 
At Thursday, June 19, 2014 7:05:00 PM, Anonymous Notice said...

Dr. M, Thank you for sharing this story. It sounds like a story where Mr. H was able to live out his terminal illness with his co-morbid conditions under proper doctor management. The doc was awesome! I would say that even if the doc had made the decision to not send him to the ICU; docs are not perfect like the rest of us. We are limited to the medical knowledge that we have and there are too many that are so apt to put the blame off on the doc when things don’t go well. The doc was wise in asking the patient and being tentative to his documentation of his dying wishes. Mr. H was not signed up for hospice too early or against his wishes and hospice was a comfort and a blessing to him. This is the real and purposeful meaning of hospice. I have a couple of hospice success stories in my own family too.
However, Mr. H could have received the same level of care in a residential home instead of a nursing home if he had had a family member to be able to take care of him. Although it is not the case with Mr. H, some patients are signed up too early for hospice. If the reason is to get rid of the burden and expense of caring for them and usher in their “duty to die”, we can find ways to eliminate the burden and expense so that there is no need to sign people up early. I do not want to be signed up too early. Residential homes are choice models that will put people to work, limit expenses and still maintain a patient centered approach. Through properly trained staff a patient will receive the necessary safety, comfort, function and quality of life that Mr. H received in his dying days in what sounds like a wonderful nursing home. Again, thanks for sharing.

 

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