
Doctors' Secret Language for Assisted Suicide - nitin_flanker
http://www.theatlantic.com/health/archive/2015/05/doctors-secret-language-for-assisted-suicide/393968/?single_page=true
======
LCDninja
I accidentally euthanised my father because I misunderstood the conversation I
was having with a nurse. He had a stroke and was in intensive care, we were
told he probably wouldn't live - and if he did - he'd require care for the
rest of his life. He had fallen into a coma when the nurse kept asking me if I
thought he was in pain and needed more morphine. She kept giving him more,
returning to ask the same question and doing it over and over. I can't
remember how many times. He began Cheyne–Stokes breathing, and eventually
died.

I remember feeling strange about the situation, and years later I connected
the dots between the amount of morphine given, the breathing (symptomatic of
morphine overdose), and his subsequent death. Understanding that I was
responsible was something that took a long time to cope with.

My mother faced terminal cancer a few years ago, and I found myself in exactly
the same situation. Thankfully I understood what was happening. The decision
to take her off fluids and to "help her along," was made by a team of medical
staff with myself deeply involved in the discussion (which looking back, was a
desperate attempt for me to negotiate any way I could for her life). At least
Mum understood she was going to die, and I'm glad my eyes were open to what
was happening.

I feel that the economics of hospital beds have a lot to do with this. Beds in
the oncology ward are in demand, as of those in intensive care. I've seen all
of my families previous generation die of cancer in either in the same way -
in hospital, in oncology or intensive care, always assisted death.

It makes me think that if I ever go down that road I don't want to be anywhere
near the medical industrial complex.

~~~
utexaspunk
My grandfather had Alzheimer's and after several years of accelerating
decline, he fell and broke his hip and over the course of another year slowly
deteriorated into him being wheelchair-bound and basically catatonic, until he
developed a wound which would not heal.

It finally got bad enough that he was moved to hospice. The doctors and nurses
at his hospital did not make any sort of suggestions about "helping him along"
and it was my wife (whose mother works for a probate/guardianship attorney and
has observed the process many times) who suggested that they use the code
words to "help him along". My parents and grandmother, ever in denial, would
not consider it.

So instead he lay there being given palliative care but no food or drink, only
water sponged on his lips to keep them moist, for 2 weeks before he finally
died of either starvation or dehydration. It was awful- his urine turned a
dark purple and it was like he melted from the inside.

I _wish_ the doctors had been a little more forward about it. There was
absolutely no purpose in making him endure that. I can only hope his mind was
by then too far gone to suffer, but it sure looked like suffering to me. My
wife and I have discussed it and both know that's we would prefer a little
help. Sometimes it really is the most humane thing to do.

~~~
edc117
This is ghoulish. I'm sorry you had to go through that, and it honestly makes
me terrified of having to deal with it when my parents pass someday - my
father has already had a stroke, and told me he does not want to go through it
again, that he would rather be taken off life support and be allowed to pass
peacefully. I can't even imagine having to watch someone I cared for starve to
death in front of me.

------
draugadrotten
The doctor said to my relative, "Here is the morphine injection device. If you
press this button once, you will get a small dose of strong morphine. If you
are in severe pain you can press it twice. Never press it more than three
times, as you would die for sure at five or six presses." He had terminal
cancer, severe pains and he died peacefully thanks to the hint.

~~~
shultays
Is this like a syringe or a machine? I thought those machines would limit the
output

~~~
draugadrotten
It was a machine. I think the other posters may have already described
configuring it for plausiable deniability. It was no secret that this was a
possibility, my relative told me and several others about a week before he
finally used the opportunity. The end was good - as much as you can call dying
of cancer good. It was indescribably hard to see him die, but it was even
harder to see him suffer in agony being slowly eaten from inside by this
terrible disease. I cried then and I cry now but more time would only have
meant more suffering. I can't even call it a suicide. It had nothing to do
with suicide, he didn't want to _die_. He wanted to stop the pain and there
was no other way. Ending his life was the final pain relief.

~~~
jacobush
But suicide is sometimes that - no other way to stop the pain.

------
nkoren
The first assisted-suicide advocate I ever met left an impression I will never
forget.

He had the most romantic life story. He was an Indian from Gujarat who had
moved to America in the 1960s to become a hippy. Then one day he found a flier
for an Indian dance troupe that was coming through town. In the back row of
the group photo he saw a face that he instantly recognised as the love of his
life.

He followed her back to India, where he courted and they fell in love. Her
parents refused permission to marry, so he got a haircut and a job in the
civil service, and the parents accepted. They married and soon had two small,
beautiful children.

Then she got breast cancer.

"At the end, she was in so much pain. It lasted so long. I would have done
anything, anything to make that easier for her. But I could only watch while
the cancer slowly tortured her to death." He was still broken from the
experience. It had been 30 years. Life-sized portraits of her were hung
throughout the house. The mythic quality of their love was undiminished, not
only for him but for anybody who entered that house.

What their love needed was a quiet, peaceful, comfortable death. That would
have been good and right and true. It's worth fighting for.

~~~
jpatokal
> the cancer slowly tortured her to death

With the help of the Indian government, which makes it extremely difficult for
people to get access to opioids, even if they're terminally ill patients.

[http://www.newyorker.com/tech/elements/an-epidemic-of-
pain-i...](http://www.newyorker.com/tech/elements/an-epidemic-of-pain-in-
india)

~~~
MichaelGG
Wow that's evil. The war on opiates is unethical. The fear of people enjoying
a vice overrules compassion, which is just sick.

------
taneq
Having gone through the death of a grandparent following a stroke, the magic
words we had to use were "I think he's in pain." He was well and truly gone by
then, but his body was still battling on despite that. Any questions regarding
whether we could give him something to let him down easy were met with
legally-mandated "no, we can't give him anything... _unless you think he 's in
pain_."

It took us a few rounds of this before we cottoned on and completed the dance:
"Yes, I think he's in pain."

~~~
bryanlarsen
Confirmation from the article:

"It is legal for people to take or give large doses of narcotics to relieve
pain, even if a known side effect is that it may hasten death."

\-- Stanford medical ethicist David Magnus

------
Daneel_
My heart just aches for the poor woman who had to inject her husband.. I can't
even begin to imagine having to do this with my partner.

For every person talking about it openly now, I'm sure there are literally
hundreds more dealing with this in secret, and that's a terrible shame. I
really hope euthanasia laws progress globally to allow these poor people some
peace.

~~~
PantaloonFlames
Funny, i thought the exact opposite. "How lucky!" She was so fortunate to be
there at the end and have the ability to take action.

Watching a loved one die, slowly, while you stand by helplessly observing
their pain... that is much worse.

~~~
scott_s
She obviously did not feel this way. She had no support from the medical
establishment she was surrounded by. I imagine it was isolating, and made a
painful moment worse.

------
fixermark
I've seen a terminal cancer patient breathe her last after the nurse (with
doctor authorization) overrode the safeties on the infusion system to give her
an overdose of painkillers. She wasn't ever getting out of that room alive,
and everybody knew it. She died with her family and loved ones at her side.

I think what a lot of people (in America) may not understand about the
national euthanasia discussion is that in the absence of firm policy, we don't
have no euthanasia; we have ad-hoc, case-by-case, absolutely-functionally-
necessary euthanasia. The notion that doctors can always do no harm is a
polite fantasy that blinds people to the messy realities near the boundary of
human life and death.

Similarly to the abortion question, end-of-life euthanasia is something people
find medically necessary sometimes, and in the absence of a society-wide
consensus that allows for it, doctors, nurses, and patients are left doing the
best they can and bearing the moral responsibilities alone. Unlike the
abortion question, absolutely everyone _is_ going to be in a place where they
are either caring for someone who is dying or dying themselves.

------
cisstrd
Also on assisted suicide and interesting: "By the time you read this, I’ll be
dead - Between 1999 and 2001, I helped eight people die, including the poet Al
Purdy. Now, as I prepare to take my own life, I’m ready to tell my story" by
John Hofsess

[http://torontolife.com/city/life/john-hofsess-assisted-
suici...](http://torontolife.com/city/life/john-hofsess-assisted-suicide)

I also recommend the Documentary "Choosing to die" with Terry Pratchett
[http://www.dailymotion.com/video/xnu340_terry-pratchett-
choo...](http://www.dailymotion.com/video/xnu340_terry-pratchett-choosing-to-
die_shortfilms)

Very powerful and thought provoking

------
shermozle
The problem with this being a secret, behind-the-scenes thing is that there's
plenty of scope of serial killers. Harold Shipman got away with being the most
prolific serial killer of all time because he was knocking off old people.

This is the argument that needs to be made, because euthanasia is and will go
on anyway.

~~~
beobab
Good point, shermozle. And the problem with it being allowed and acceptable is
that older people "don't want to be a burden", and younger people with
inheritances in the balance might make a decision based more on greed than on
wanting to help.

It's a difficult and emotive subject, and you can easily argue both sides
convincingly.

------
CaptSpify
I had a similar 'secret language' experience, though not at all related to AS.
I have a diabetic pet, and the vet was explaining how to use insulin.
Naturally, one of our concerns was cost. He kept mentioning how he'd seen many
people use insulin for months after it's expiration-date. He was clear that
you should "always follow the instructions", but that occasionally he'd seen
people use old insulin, and, as long as they were consistently checking their
glucose, it worked fine for them.

We finally figured out his message: The insulin expiration date might or might
not be valid. Testing is better than going by the bottle's expiration date,
within reason of course. He couldn't tell us to ignore the date, but he could
tell us about when he'd seen it work past the date.

------
briffle
Oregon was the first state to approve physician assisted suicide.. but last
year, after a stroke left a relative in a coma with no possibility of
recovery, my family got to learn that the state recently passed a law making
it illegal to disable a pacemaker.. So even though we requested that they
unplug her, they were not able to turn off the one thing that was still
keeping her going for a day or so longer..

------
mdturnerphys
"Just over 3 percent of U.S. doctors said they have written a prescription for
life-ending medication, according to an anonymous survey published in The New
England Journal of Medicine in 1998. Almost 5 percent of doctors reported
giving a patient a lethal injection."

That seemed really high, given that most physicians aren't in relevant
specialties. Clicking through to the article, it actually says: "The sample
was drawn from 10 specialties, selected on the basis of previous surveys as
those in which physicians are likely to receive requests from patients for
assistance in hastening death." Further, it was clear that there were self-
selection biases in the responses.

------
pcrh
Another process that "assists" dying is withdrawal of fluids while someone is
heavily sedated. The ensuing death is "natural", but inevitable.

~~~
sago
Allowing someone to die of dehydration (a process that takes many hours and
involves gradual shut down of organ function) might be marginally more kind
than letting someone die more slowly, but is only fractionally so.

Fortunately most doctors have more empathy and ethics.

The difficulty comes with conditions that aren't immanently terminal.
Campaigner Debbie Purdy took eighteen months to starve herself to death after
she reached the point where she did not want to continue with her progressive
MS. That's just insane and barbaric, but fewer doctors will step in at that
point.

We need better laws, as a matter of civil rights. If I have the right to life,
I should have the right to relinquish it.

~~~
draugadrotten
> If I have the right to life, I should have the right to relinquish it.

That statement needs better justification than sounding good. For assisted
suicide, It is necessary but not sufficient that the person wishes suicide.
Just because someone wants to die doesn't mean that we should let them die.
And even if someone wants to die, it doesn't imply that that person have a
right to demand someone else to kill them - you do not even have the right to
demand that someone else kills you by looking the other way when you kill
yourself. The criteria for when someone should be allowed to help someone else
to die is complex and requires a lot of safeguards.

~~~
sago
> Just because someone wants to die doesn't mean that we should let them die.

I think it does mean we should let them. In most places it isn't illegal to
commit or attempt suicide.

By having a process to end your life we've a much better chance of having
professionals encounter people at an earlier time. For people who want to end
their life because of other addressable needs, we've a better chance of
helping them through it.

Forcing someone to live indefinitely when they desire to die is cruel and
draconian and ultimately fruitless. People will find ways to end their life,
and often in ways that traumatise or damage others.

> it doesn't imply that that person have a right to demand someone else to
> kill them

Straw man. Nobody is suggesting people have the right to demand any particular
person kill them. Assisting with dying is optional for patient and assistor in
jurisdictions that allow it.

> The criteria for when someone should be allowed to help someone else to die
> is complex and requires a lot of safeguards.

The criteria supporting any human right is complex and requires legal
safeguards. Your point seems artificially argumentative.

~~~
gutnor
> By having a process to end your life we've a much better chance of having
> professionals encounter people at an earlier time.

Indeed, it is not like it is going to work like the suicide booth in Futurama,
probably you will need to see some therapist and you will have the opportunity
to explore different resolution to your problems. The "call for help" suicide
for example will most likely been caught with no risk of death.

Isn't that what happened with abortion ? Because parent argument is very
similar to those against abortion.

~~~
chillacy
"You probably don't want an abortion, talk to this psychologist and wait a
minimum of X days before you can do this" =? "You probably don't want to end
your life, talk to this psychologist and wait a minimum of X days before you
can do this"

In the case of abortion you weigh the mother's wishes vs the child's potential
existence, in the case of suicide you weigh the individual vs their friends
and family. I suppose whether or not they're similar depends on how you weigh
these factors.

------
wmeredith
The heartbreaking stories in this article, as well as several from the
comments, all seem to be the symptoms of an overly litigious climate in our
healthcare system. Health workers are afraid to speak plainly. It's gross.

~~~
scott_s
I don't think that's the case. I think the primary factor is the laws which
govern how medical professionals can act - and I think that has more support
from the article, and by people's comments.

