[GoodOldNe]

I disagree with some of the above posters.

This is often confused with, but is not the same thing as, physician aid-in-dying or euthanasia. People do talk about this in hospitals, and it is appropriate treatment for many patients at the end of life if they are suffering.

The ethical principle of double effect makes this permissible in these contexts. If the aim of the treatment with a benzodiazepine or opiate is to reduce suffering, the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications to achieve the first aim of relieving or preventing suffering.

Suggesting that this is a "workaround" for euthanasia distracts from the fact that this is not available as a treatment for most, if not almost all, dying patients. It is very different from physician aid-in-dying and is not a replacement for these other forms of end of life care.

[pfortuny]

As a matter of fact, when curing is impossible, what doctors must to is to relieve the pain, nit to prolong life.

That it has a negative outcome is (with the “proportionate” clause) secondary.

[jessriedel]

> what doctors must to is to relieve the pain, nit to prolon

No, doctors implement the patient's wishes. If the patient would like to live as long as possible, even if in pain with an incurable condition, that's the patient's prerogative.

[pfortuny]

Nope: doctors are not obligated to provide care they deem futile. This is essential: you cannot force anyone to do something against their conscience.

Notice the”futile”.

[jessriedel]

<eyeroll>. It's obvious that doctors don't have to implement any patient desire at all. It must be part of the doctor job description, and sham medicine is obviously not included. But living longer, even with pain and even if the patient is still going to die, is not considered futile or a sham. (We all have an incurable disease because we all are going to die eventually.) Doctors are of course able to decline to participate, but they must refer you to another doctor.

[pfortuny]

I was referring to cases where "life" is just "not death", in the sense that "this person is alive just because we are keeping him so" (apart from the elementary support like feeding, cleaning, etc.).

I was not (certainly) referring to cases where the person is conscious and able to make decisions. There is little "palliative sedation" in these cases.

[yters]

Is there any way suffering at the end of life can be good? Someone I know chose to forgo this treatment as he died from leukemia, so that his mind would not be dulled at the end. I also heard of another lady who resisted this sort of treatment at the end for the same sort of reason. People may value being fully present during their last moments more than they want to avoid pain.

[david-gpu]

People who wish to forgo sedation at the end of life should be allowed to. Likewise, people who want a quick dignified death should also be allowed to. And everything in between as well. One size does not fit all.

[debacle]

In a morbid vein, you only get to die once. Wouldn't you want to be able to experience it fully?

[mirimir]

Sure. The gradual physical deterioration and loss of consciousness are OK. But I want to skip the painful parts.

A huge part of enjoying LSD at high dosage was being OK with forgetting who/what I was for a few hours. So maybe dementia will be OK too, as long as I don't stress too much about it. And as long as people around me are also cool.

[ataturk]

My 81 year old mother has dementia. It is a terrible disease. She has no short-term memory at all and it makes caring for her extremely difficult. Also, as the disease has progressed, she has gotten into crazy hallucinations and almost hurt herself and my father many times. She puts him into all kinds of bizarre situations when out in public by often screaming for help and telling bystanders she is being kidnapped/held against her will, which makes life for my father a living hell since he already hates cops and government authorities, and now he has to talk to them and explain his situation all the damn time. It's...a...living...hell--for her, for him, and for the entire family and she can't die soon enough because death would be far better than having no ability to be productive and able to care for herself.

[mirimir]

That is an alarming situation.

However, it sounds like their relationship has become confrontational. And it might help to empathize with her. Perhaps she does have cause to feel held against her will.

Some years ago, we realized that an uncle, who was ~85 years old and living alone, wasn't taking good care of himself. He wasn't eating enough, wasn't keeping himself clean, and just dozed on the couch, watching TV. And one of his feet was gangrenous.

So we invited him to live with us, and he agreed. And we saved the foot. However, my wife is very kind and caring. But she has high standards. So there was much conflict. She argued that, because he had Alzheimer's, and because he was living in our home, he didn't get to choose when to get up, when to eat, when to wash, when to shave, etc, etc.

It got to the point that we hired a big guy who basically forced him to do what she wanted him to. It was horrible. But finally, I convinced my wife to cut him some slack. We let him grow a beard. We let him wash at the sink, rather than showering. We let him watch TV all day, if he wanted, and got him a cat to keep him company. And we made sure that he ate enough, and had proper medical care. We retained the big guy, but he became our uncle's closest friend.

So anyway, whenever I hear horror stories from caregivers, about people with dementia or Alzheimer's, I wonder how it looks from the other side. If for no other reason, because that's the side I'm approaching.

[sorokod]

This is a good question, definitely worth thinking about. Also: you only get to live any particular second of your life only once, wouldn't you want to be able to experience it fully?

[pdonis]

The key is that it's their choice. A patient who says they want to forgo treatment and experience the suffering should be allowed to. But a patient who says the suffering is unbearable and they want treatment to alleviate it should get it.

[jessriedel]

> Is there any way suffering at the end of life can be good?

If a patient values life for its own sake even in the presence of suffering.

[stormduck]

I'd second this, even though I'm only a 30 year old, I have done a fair amount of thinking about death. As a result, this is something that I would fight against...suffering or not. Allowing my experience to remain as clear as possible towards the end of my life is of the utmost importance to me. I'm not religious.

[ErikVandeWater]

> the possibility of hastening death via respiratory suppression shouldn't stop physicians from treating patients with appropriate dosages of these medications

Talk to opportunistic plaintiff's attorneys about how this works. A doctor knowing they might be doing harm by providing opioids that could cause respiratory failure is opening themselves up for a world of hurt

[onetimemanytime]

Who is going to be the plaintiff? I agree that administering x amount of morphine to alleviate pain when 99% of doctors know it's going to kill the person it's practically euthanasia but either the person or the closest kin decide. And the person has the right to be administered pain relievers and not suffer for months because the meds might kill them.

The long lost aunt that didn't even attend the funeral, I guess could try to sue for losing her dearest relative but not sure if she any standing. Any lawyers here? If the children decide for mom, can her brother sue the doctors?

[ErikVandeWater]

> Who is going to be the plaintiff?

The descendants. You answered that in your second paragraph.

> And the person has the right to be administered pain relievers and not suffer for months because the meds might kill them.

This isn't a right. Your just stating a platitude - If a person were extremely allergic to painkillers, a doctor could not prescribe them, even if the patient was in lots of pain.

[onetimemanytime]

>>The descendants. You answered that in your second paragraph.

So everyone of them (descendants) must agree? How far back, 4-10 generations? What if a fourth degree cousin cannot be reached in time, hold up everything or let the closest ones--children and or/ or spouse--decide?

[DanBC]

> If the children decide for mom,

Where are you living that children are allowed to make medical decisions for their dying parent? What legal powers are the hospitals using to follow the wishes of the children? I guess the brother can't sue if those legal powers are in place.

[onetimemanytime]

>>Where are you living that children are allowed to make medical decisions for their dying parent?

https://www.nia.nih.gov/health/understanding-healthcare-deci... "Joseph’s 90-year-old mother, Leilani, was in a coma after having a major stroke. The doctor said damage to Leilani’s brain was widespread and she needed to be put on a breathing machine (ventilator) or she would probably die. The doctor asked Joseph if he wanted that to be done. Joseph remembered how his mother disapproved when an elderly neighbor was put on a similar machine after a stroke. He decided to say no, and his mother died peacefully a few hours later."

"Ali’s father, Wadi, is 80 and has lung cancer, as well as advanced Parkinson’s disease. He is in a nursing facility and doesn’t seem to recognize Ali when he visits. Wadi’s doctor suggested that surgery to remove part of a lung might slow down the course of the cancer and give Wadi more time. But, Ali thought, “What kind of time? What would that time do for Dad?” Ali decided that putting his dad through surgery and recovery was not in Wadi’s best interests. After talking with Wadi’s doctors, Ali believed that surgery would not improve his father’s quality of life but would cause him pain and discomfort.*"

[djrogers]

> Where are you living that children are allowed to make medical decisions for their dying parent?

Given the prevalence of mental deterioration and incapacitation in many end of life scenarios, it is very common for children or a spouse to have power of attorney and decision making ability for someone who is near death.

In fact, many people take care of filing a durable power of attorney for medical decisions before it gets that far. I know I’d prefer my children have the ability to end my life if I were suffering.

[onetimemanytime]

>>Where are you living that children are allowed to make medical decisions for their dying parent? What legal powers are the hospitals using to follow the wishes of the children?

Child in coma, doctors say it's over. Parents decide to pull plug or not. Never heard of this scenario in USA?

[DanBC]

No, fucking horrific. Who's looking after the best interests of the patient?

Also, it doesn't happen like that in all US states where the hospital makes a decision and presents it to the family, who'll need to go to court if they disagree.

http://medicalfutility.blogspot.com/2018/04/medical-futility...

> First, in California, Texas, and Virginia the burden is flipped: the families must go to court to stop the clinicians. Moreover, that is a widely recommended approach at the institutional level: announce the plan and give the family time to challenge, but do not seek permission from the court.