
Palliative sedation, an end-of-life practice that is legal everywhere - spking
http://www.post-gazette.com/aging-edge/aging-edge-reports/2018/07/05/Palliative-sedation-an-end-of-life-practice-that-is-legal-everywhere/stories/201807050128
======
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.

~~~
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.

~~~
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.

------
ananonymoususer
When my mother was dying from pneumonia (after it had destroyed her lungs),
she had been on a respirator for several weeks and was only getting worse. She
also had been unconscious because she had been "fighting" the machine. She had
told us that she never wanted to end up that way, but she did not have an
advance directive on record. The family made a decision to pull the plug and
her doctor administered a large dose of morphine to ease her passing. She went
peacefully. We were all very grateful to the doctor for this.

------
vslira
Something I wish was more common is some type of therapy for treating death
anxiety. I read somewhere that LSD can reduce the fear of death[0]. I can
think of few things I’d like more in life than not being afraid to cease to
exist[1] in my deathbed.

I suppose those going through terrible terminal illnesses suffer enough to
accept death over the suffering, but I don’t see why one should need to
experience such extremes to accept the inevitable.

[0] That’s a big maybe, don’t go around self medicating serious issues based
on unsourced comments on unregulated drugs [1] I know religion or philosopy
can sometimes fill this gap, but let’s remember those who are skeptical or
didn’t have a lot of time to prepare

~~~
wpietri
I had one parent die from brain cancer in 2011, and another was just diagnosed
with a terminal brain tumor, so this is on my mind.

Honestly, I don't think this is a problem specifically for the person with the
terminal illness. So much of the difficulty comes from everybody else.
American culture does not prepare people to face death, either their own or of
loved ones. So a lot of my energy goes in to helping other people manage their
feelings at a time when I don't have energy to spare. I want _other_ people to
take LSD or do Zen retreats or serve at a hospice or whatever they need to do
so they can manage _their own_ death anxiety.

Speaking of which, I strongly recommend the "ring theory of grief" article.
The gist is that if bad shit is happening to somebody, you help them rather
than imposing on them. It sounds obvious, but I promise that it's
unfortunately rare. Here's the article:
[http://articles.latimes.com/2013/apr/07/opinion/la-
oe-0407-s...](http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-
ring-theory-20130407)

~~~
Omnus
I'm skeptical that any of those things actually "prepare" people to face death
in the first place. Feeling like you're "prepared" weeks, months, or years
before the final hours of your self or a loved one does not necessarily
translate to those final moments when you are actually going through it.

~~~
hanshan
It's pretty well documented how terrified western culture is of death relative
to others. The Power of Myth by Joseph Campbell is an excellent book which
goes into insightful detail on this subject.

~~~
Omnus
Terrified is the wrong word. Western culture simply understands the reality of
the situation. Sure, you can delude an entire society with fairy tales and
they will feel better about dying...that's not a virtue though.

~~~
reitanqild
>Western culture simply understands the reality of the situation.

You mean not waking up again?

I don't see what is so worrying about that?

If one truly believe there's nothing after this life I'd think one should be
very calm?

Edit: to be clear, I'm a Christian, - I just happen to be puzzled by why non-
religious people are afraid of death (except for worrying about their loved
ones and the pain of dying that is.)

~~~
wpietri
Well, one obvious reason is that it's the loss of everything. Friends, family,
loved ones. Future experience, memory, agency. Everything.

If you thought you'd never wake up again, how comfortably would you go to
sleep?

~~~
hanshan
>If you thought you'd never wake up again, how comfortably would you go to
sleep?

If we have no choice but to go to sleep, why would we want to spend those last
moments feeling terribly uncomfortable?

If we face the facts that death is a part of life, and that _we all must die_
, what's the practical value in fretting over that fact? (Aside from being
wise not to do stupid things that lead to a stupid death)

~~~
wpietri
Excerpting my point out of context like this isn't helpful. I'm responding to
the Christian's glib notion that he doesn't understand why atheists worry
about dying.

There's no value at all in fretting over death once it's inevitable. There is
great value in fretting over possible deaths we can avoid. And regardless,
death for atheists is the loss of everything, and loss aversion is a well-
studied component of human psychology, so it should be unsurprising even to a
Christian that atheists are not particularly jolly about death.

~~~
hanshan
Yes, I understand why atheists are so fearful of death, but also see the
illogical and impractical nature of it.

>death for atheists is the loss of everything

Atheist logic _should_ lead to the realization that from an individual
standpoint, there is no possibility for the experience of this feared loss,
_at all_. Immediately before the moment of death, you still have it all.
Immediately at the moment of death, you have no conscious ability to
experience the loss. Therefore the fear is not logical, it's irrational
because your "total loss" is something you can never _experience_.

~~~
wpietri
It's "not logical" only from certain poorly considered priors that have very
little to do with how humans work. Emotions aren't supposed to be "logical".
Emotions are part of the biological machinery that keeps meat-machines alive
and active in the world.

~~~
hanshan
>Emotions are part of the biological machinery that keeps meat-machines alive
and active in the world.

Not all emotions are valuable, some are indeed quite harmful and anti social.

Which brings us back full circle to the original point of this comment chain:
that western society is extremely emotional about the subject of death
relative to other societies. This tendendency leads to unecessary suffering
and the prolonging of life at all costs.

The US has come very far from its founding mantra; "Give me liberty, or give
me death!" has seemingly been reversed to "anything but death"

~~~
wpietri
How nice of you to bring it back to my exact starting point. It's almost like
this whole discussion with you was a waste of my time.

------
pwned1
I just went through this with my grandmother. She decided she didn't want any
more care in the hospital, so they morphined her up to the point that she
never woke up again and she essentially starved and dehydrated to death, over
about a five day period. The whole thing was disturbing to me.

~~~
joshhart
I went through the same a few years ago with hospice. She had emphysema and
real trouble breathing. She was mentally checked out after a few days in the
hospital and opted for hospice. They started morphine and for a couple of
hours she was able to breathe and felt great. She even said maybe she could
get out of there - she fully expected to die.

Well after that she passed out, didn't wake up again, and died. Bothers me
greatly to this day and I wish I had been there for the whole thing to
challenge some of the decisions made that my parents didn't contest.

~~~
hanniabu
Gotta respect their decision. I mean, I see my father falling apart and if he
made the decision idk if I'd contest it. He's not able to really go out, has
trouble breathing, etc. Staring at the same 4 walls all day until you die
naturally isn't the best way to go out. A little bit of you dies mentally
every day going through that until you're just old, depressed, and unable to
function. Why put them through that misery if they don't want to essentially
rot in a bed or chair.

------
JudasGoat
I watched this in action with my father's death. My mother had a long nursing
career and had a talk with the doctor that lasted about 15 minutes (it was 20
years ago), after that a large morphine dose was added to his IV. Within 5
minutes I watched my dad stop breathing. My Dad was in his early sixties,
morbidly obese, this condition was aggrevated by his lifelong fear of doctors.
Dad needed hip replacements but wouldn't consider it because of his medical
phobia. This caused his lack of mobility which caused urinary track infections
from his dificulty moving to a toilet chair. He was in the hospital for
chronic UTI's when my mom made the decision. He was lucent and not at all
ready to die. Mom has passed too and it feels cathartic to say this.

~~~
SteveNuts
So your mom just straight up murdered your dad? Why on earth would the doctor
authorize giving him a lethal morphine drip for a UTI?

What was the fallout from the autopsy, etc.? This baffles me

~~~
JudasGoat
In my opinion the medical profession know quite well how to run the system. My
mom spent most of her career in a terminal cancer hospital. I was an active
opiate addict at the time, so my opinion wasn't solicited.

------
stef25
A few years ago my 90 year old grandma had a stroke in her sleep and the
doctors told us she'd never really have any more quality of life and what's
usually done is just pull out the sugar drip and basically wait for her to
(for lack of better word) starve to death.

After a day or two with no food or water she'd drift in and out of
consciousness. It was amazing how she would even refuse my offer of wetting
her lips with a sponge.

During a time I was alone with her, her breathing became so heavy, this
rattling sound. I asked a nurse "can't you give her something" and he gave her
a shot of morphine and a few min later the breathing stopped and that was
that. It was quite a humbling experience.

Another thing that comes to mind is the "Brompton cocktail", a mix of
morphine/heroin, cocaine, alcohol and thorazine against the nausea:
[https://en.wikipedia.org/wiki/Brompton_cocktail](https://en.wikipedia.org/wiki/Brompton_cocktail)

~~~
jonhendry18
When my dad was dying it took 4 days after he became unresponsive. They
administered morphine all along but not enough in one dose to be fatal.

The rattling came on day 2-3, then quieted down.

The strange(?) thing was that he lost consciousness and became unresponsive
shortly after my brother arrived at the hospital. My brother was the last of
the immediate, local family to arrive. My dad acknowledged his presence and in
a few minutes was unconscious.

Then on the fourth day he passed shortly after his grandkids arrived from the
airport.

------
Analemma_
This has been a thing-everyone-knows-but-no-one-talks-about in hospitals for a
long time.

And honestly, I wish it would stay that way. Because while I support the right
of terminal patients to die at the time of their choosing and avoid pointless
agony, opponents of euthanasia do have a good point– which is not appreciated
nearly often enough– that state-sanctioned euthanasia opens the door for
family members to start pressuring people to die when they don't really want
to. This is a thing that happens more than anyone wants to admit in areas
where it is legal.

Deliberate ambiguity, where euthanasia is allowed but we all pretend it's not,
is the best way to square this circle. Doctors have implicitly understood this
for a while, hence this practice. Unfortunately, most people hate ambiguity in
their laws, which I understand and think is a good priniple in general, but I
wish they'd look more carefully and see that the benefits outweigh the costs
here.

~~~
brandonmenc
> state-sanctioned euthanasia opens the door for family members to start
> pressuring people to die when they don't really want to

Everything I've ever read - or heard - from doctors, is the exact opposite -
that family members more often than not want herculean and unintentionally
inhumane efforts made to keep a suffering family member alive for just a
little bit longer.

~~~
bnjms
That may be the usual case but that is not all cases. It does happen that
people wish for there parents to die. You see it all over this thread. What no
one can say here is that some people also wish for them to die so they can
take their payout or stop paying for care.

------
jedberg
I was found it odd that I can choose to euthanize my dog but not myself. This
is an interesting workaround.

~~~
whatshisface
Choosing to "euthanize" yourself is something that is so predominately chosen
in fits of mental illness that society has probably made the right choice in
banning it outright. Further, I think there's a strong argument that _other
people_ shouldn't be allowed to add any weight to the idea of killing you...

As someone else brought up, there can be disagreements between family and an
individual about when the right time for them to die is in _both_ directions.
Even in America this can be observed with things like life support for the
very elderly, an intervention that is sometimes necessary for continued life
but not considered euthanasia to forego. You won't have to dig very deep to
find a doctor that has seen families argue about this.

So, if you say "only I can make the decision," then mental illness becomes a
lot more deadly than it has to be. If you say, "other people can weigh in,"
then what do you do when they want you to die more than you do (and start
pressuring you, and you're old, and already depressed...)? This leaves us at
our current state, which is "nobody gets to make the decision."

~~~
nightcracker
> Choosing to "euthanize" yourself is something that is so predominately
> chosen in fits of mental illness

No one is proposing to legalize impulsive suicide, and it's ridiculous to
equate euthanasia with it.

~~~
bb101
Quite. By the same token, if I took my healthy dog into my vet to have it
euthanized, I am sure my vet would refuse to do so, and probably inform the
relevant authority.

~~~
rootusrootus
Actually that happens often enough that it has a name: convenience euthanasia.
I believe most vets will try to find alternatives before they go through with
it, but some physically healthy animals are definitely put down due to
behavioral issues.

~~~
wavefunction
Some vets will do it but not most according to my vet and vet tech friends.
(Anecdotes, unfortunately.)

They find even the proper application of euthanasia terribly emotionally
draining though. It's being confronted by the feelings of the human family
that is the worst for them.

------
BrandoElFollito
I would be thrilled by the possibility of having an implant which requires a
timed confirmation (every 6 months or so) and if there is no, it would pour
poison in the bloodstream.

I am terrified by the possibility of not being capable to end my life when I
want to, either because I am too disabled, or senile to the point of
forgetting to do that.

------
Simulacra
I think it should always be left up to the patient, what they wish to do, and
doctors should support it. If it gets to that point, I would very much like to
spend my last days stoned and comfortable, and die peacefully. But if I have a
terminal illness or I am in great pain, I very much want that choice of when
to go.

------
danielam
End of life decision-making vis-a-vis the doctrine of double effect[0]. This
section addresses specifically some of the claims made in the posted article.

[0] [https://plato.stanford.edu/entries/double-
effect/#End](https://plato.stanford.edu/entries/double-effect/#End)

------
alberthartman
Best choice is to follow the wishes of the person who’s in the heat of the
battle. Be cognizant that those wishes may change as the illness progresses.
Do it as being of maximal service to the loved one.

------
mirimir
> Doctors wrestle with what constitutes unbearable suffering ...

Huh? It's whatever a patient says it is. Otherwise, it's torture.

~~~
saagarjha
What if the patient cannot speak?

~~~
mirimir
Well, it's a tough call if they're totally paralyzed. That's quite the horror,
no? Brings to mind Catch 22, and that Metallica song.

But otherwise, there are other ways to communicate.

------
intralizee
I've been trying to receive "euthanasia" for myself. I suffer gender
dysphoria. I think it's a shame how society can discriminate a person with an
illness compared to another group with a different illness; when it comes to
receiving what is considered a medical treatment for ending pain. The
terminology for who qualifies & receives euthanasia is flexible in the
jurisdictions that offer it by terminology but people will warp their own
perception around who they view should have a right to qualify to die by
personal opinions without understanding the pain of another. Society doesn't
help some people and euthanasia can be a real solution for the current system
until real help evolves; where euthanasia can be less thought about.

~~~
albertgoeswoof
I am not sure if this will help you, but to bring some perspective, this is
very much a rational position on public health. Given that gender dysphoria is
not actually a terminal illness it is probably not a good idea to offer
euthanasia for it - there is a not-insignificant chance you will fully
recover.

Suicide rates are much lower in areas where people have less access to things
that can end their life (e.g.
[https://www.hsph.harvard.edu/news/magazine/guns-and-
suicide/](https://www.hsph.harvard.edu/news/magazine/guns-and-suicide/)),
statistically speaking many people do make it through. By offering euthanasia
to people who would otherwise survive, those people will lose their shot at
life beyond their condition.

Public health policy has to be driven from the net benefits to all and not at
the individual case level.

~~~
intralizee
Gender dysphoria is an actual terminal illness depending on the person. Many
people end up dead because of it. My ability, desire, or whatever to eat
diminished years ago because of it and my health continues to get poor with
also lack of sleep. Similar to other illnesses where the body shuts down in
the functions of having good health. I've been seeing several doctors for
several years and continue to do so with trying to voice my right for
euthanasia the past several months. Currently people take a diagnosis and have
their opinion glazed over by success stories of people fitting the diagnosis.
It's sad when people then refuse to acknowledge the ones who have a different
reality with the same diagnosis. I think this happens a lot in the medical
community.

~~~
sokoloff
> Gender dysphoria is an actual terminal illness depending on the person. Many
> people end up dead because of it.

That doesn't seem to me to be a reasonable standard for medically-indicated
euthanasia. Influenza meets that test more strongly.

I do wish you the best in your future path, however long that may be.

~~~
intralizee
To you what would make Gender Dysphoria a candidate for Euthanasia? The
illness you listed is the same to some with Gender Dysphoria. I’ve known
people with my illness who have committed suicide and they all communicated
it’s like living in hell and feeling robbed of life. I think it comes down to
your own perception being discriminatory based on your own personal opinion
with disregarding pain not experienced of a certain life with an illness that
people can’t imagine because it’s psychological.

~~~
sokoloff
My personal inclination is that anyone of sound enough mind to carefully
consider the topic ought to be able to opt for physician-assisted suicide
after a short waiting/consulting period as an essential element of agency over
their own life.

That's beside the point in that the current medical practice and legal
environment doesn't support that position broadly, so with respect to medical
indication, the fact that some people die from a given condition does not seem
to be a workable threshold for supporting euthanasia as a treatment.

~~~
intralizee
Some people don't die from an illness that is considered a terminal illness
and which receives euthanasia in the current medical practice. I can think of
a few people who have survived certain types of cancer. Also it really depends
on where a person is located right now. I could obtain euthanasia if I were to
fly to Switzerland. I haven't considered doing that just yet and I don't
necessarily find it the same as receiving the treatment in my birth country.
There has already been a case where a person suffering Gender Dysphoria
received euthanasia (not my country) and someone obtained euthanasia from
traumatic rape throughout childhood (again not my country).

