Friday, August 25, 2006


I saw in the news the other day that Switzerland is worried about becoming the assisted suicide capitol of the world. Apparently it has liberal laws regarding that and more and more people are making it a destination for their final trip in life. I guess they're worried about what effect it might have on their regular tourist industry.

I've got some ambivalence about assisted suicide and euthanasia. There are some situations where I think most people would agree it's okay to help death come. I think of a small very premature baby who clearly is not going to make it. We decide to remove her from the respirator and let mom hold her in her final moments. In such instances, it seems appropriate to me to give the baby a little morphine, to relieve any pain and perhaps to relieve any discomfort or panic as the baby feels what must be like suffocation. We know, though, that morphine depresses a baby's breathing efforts and may actually hasten death. Is it, then, euthanasia or analgesia? Mercy killing or merely pain relief?

In adult assisted suicides, I worry about possible abuses that could happen, such as children pushing it on an elderly parent they don't want to take care of; or a depressed patient doing it when he really just needs psychiatric help for his mental illness; or someone whose chronic pain hasn't been treated properly and who needs proper analgesia, not death. Jack Kervorkian - one of the true clowns of our time - demonstrated that all those things could and would occur if assisted suicide became legal.

On balance, I think assisted suicide is a step a little too far down a slippery slope for my taste. I feel bad for people who legitimately want out of this life, but if we make a mistake in assisted suicide, we can't take it back.

P.S. Check out the latest Change of Shift nursing blog carnival at Emergiblog.


Anonymous Dianne said...

I feel ambivalent about this issue too.

On the one hand, it seems to me that the person who should decide when a person has suffered enough, there is no hope, and the only solution is to end their life is the person doing the suffering.

On the other, there are so many bad reasons that a person might reach that decision. Pain is often undertreated, especially in terminal diseases like cancer. Relieve the pain and the desire for death may decrease. Other forms of discomfort--fatigue, air hunger, nausea, depression, etc--can sometimes be treated better than they typically are as well.

I've also seen people with terminal illnesses consider suicide because they're afraid that they are a burden to their families (or spend too much money) when their families only want them around as long as possible but are afraid to voice that feeling because they don't want to pressure the patient into living when life is hell for them. An open discussion between the patient and his or her relatives can relieve everyone's mind in such a case.

Good hospice care, baseline medical insurance for all, appropriate treatment of pain and other causes of discomfort, and emotional support can help people feel like they can live a while longer and enjoy their lives at least partly. But when that doesn't work any more: the pain can't be controlled, breathing is a constant struggle, etc, well, I go back to my original statement.

4:23 PM  
Blogger Flea said...

It's your intent that matters.

If you paralyze a patient when you extubate him (as is/was the practice in a PICU where I trained) and your intent is to spare parents the horror of witnessing their loved one take agonal breaths, then you are hastening death.

If you shoot a man between the eyes as he falls past your window on the way to the pavement, you've done the same thing.

If, on the other hand, your intent is to decrease the discomfot to the patient by giving him MSO4, you are acting more like a doc.



4:46 PM  
Blogger neonataldoc said...

Thanks. Flea, I gues my intent is a little of both.

12:14 PM  
Blogger overactive-imagination said...

Agreed. I'm not liking this shift towards the acceptance of assisted suicide for the exact reasons that you mention.
I think it should be used only in extreme circumstances when death is already imminent and that person is suffering needlessly and then I think it's considered more of a pain management issue..not assisted suicide as long as noone is intentinally giving larger than necessary doeses, it's a slippery slope for sure.

9:29 AM  
Blogger Judy said...

Neonatal Doc,
One reason I like working in a Catholic hospital is that we have very strict guidelines and help from our ethics committee which is consistent with my personal religious beliefs.

Morphine for patients who have been removed from life support because said life support is futile is standard practice here. We have a moral obligation to relieve pain - even if doing so might hasten death slightly.

You know in your heart that this is different from Flea's example of paralyzing the patient (which cannot help the patient, only those around him) or assisted suicide, which may hasten death by months or years.

It helps me greatly to know that it is not only acceptable. It's the right thing to do.

11:30 PM  
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9:26 PM  

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