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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.
15 Comments:
'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
"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.
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
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.
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.
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!!
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???
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!
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
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
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
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
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”!
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.
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.
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