The Glade 4.0

http://www.msnbc.msn.com/id/35650679/ns/health-cancer/

Is alleviating pain the wrong thing to do? Yes, Morphine does repress the respiratory system, and death is sometimes sooner due to it's use. I don't think it should be used in all cases, but to call it Euthanasia?

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Dream as if you'll live forever...
...Live as if you'll die tomorrow

Vivere Senza Rimpianti

Sounds to me like they are claiming the doctors deliberately gave an overdose at the parents request. Unclear if that's true or not. To me, none of my business. I just need to know the patient wants it and is able to make that decision.

So depressing reading about a young child suffering and dying.

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“Strong people are harder to kill than weak people, and more useful in general”. - Mark Rippetoe

Sounds to me like there's just an increased risk of death sooner with pain medication, or the children are dying of their illnesses and parents are choosing to believe the doctors complied with their requests.

Maybe in some cases they do, but I don't see anything to indicate it.

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"Hysterical children shrieking about right-wing anything need to go sit in the corner and be quiet while the adults are talking."

When my mom was dying, we had her at home and took care of her ourselves and had a hospice nurse who checked on her every couple of days to make sure she wasn't in too much pain and to give us guidance on dosing and other caretaking things.
A couple of days before she died she had a pain-crisis. I was taking a break and walking the kids on the beach and I'm glad I missed it. Apparently, after being in a comatose state for several days, she abruptly sat up and started moaning and begging for death she said "why can't I just die?? Why can't I just die???" They upped her morphine dose and it didn't happen again. We thought it was happening again as she entered her final hours and so we upped her dosage some more, a lot more, and then 2 hours later she died.
Whether the extra morphine pushed her over the edge or not really was not something we even considered, as close to death as she was I really don't think it mattered.

Before I experienced any of this, I always thought that mercy-killing was wrong. But after actually watching my mother suffer like that? Dear heavenly father....I can only imagine experiencing that myself, or God forbid one of my children.
I am friends with some women and their husbands who have lost their children to cancer and held their little ones and went through exactly what I went through with my mom...God bless them. I cannot imagine anything more terrible in this life than watching your child die slowly and in such great agony.
I believe that we all have to experience some suffering here on earth, that is just the way it is, but I have a hard time saying its wrong to help ease someone's suffering when they are so close to death already.

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"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Jesus of Nazareth

Sounds like indications are they acted within the realm of what the parents wanted in this case. There may be a case for the general (via the FDA) restriction of morphine for younger patients

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I prefer to think of them as "Fighting evil in another dimension"

I have some very strong feelings on this issue. Partly from my own moral compass, but most from the fact that I just went through this exact situation with my Father only 2 months ago. Dad had a degenerative disease called Progressive Supranuclear Palsy and died on 12/24/09. The last 2 days were the worst to watch. He was always very stoic, saying that he wasn't in pain, but it became obvious in the end that he was putting on a bold face for Mom. Around the 22nd, he lost conciousness and it was then when his breathing was "automatic" and not under his concious control that we started to realize the amount of distress he was in. With doctor consultation, we slowly increased a regimine of morphine to allow him to relax and finally die in peace, but because he hadn't been on anything until that point, it took 2 days for it to catch up to the pain. 2 days that were basically torture for him and the family and that all could have been prevented.

In talking with one of the nurses at the nursing home, apparently the body needs to relax in order to be able to die. Pain obviously can prevent that, which is what was the case for my Dad and sounds like what happened with your Mom as well LK.

I've always found it the height of hippocracy that we'll put down a pet or animal that is in pain and obviously going to die, but don't have the decency as a society to do that for our our family or friends.

*hugsAizle*

That explains a lot. Mom was probably not getting enough morphine even though we had her on several times the recommended dose....she hung on for 2 weeks after the Doctor swore she was about to take her last breath. I guess we finally gave her enough relief from the pain that she could let go.

What an amazing man your dad must have been. Faced with his own death and that amount of pain and still able to muster the strength to put up a brave front. He must have loved your mother very much. That touches me.
*hugs*

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"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Jesus of Nazareth

I watched my wife die slowly, painfully, and at home. I asked her if she wanted to end it quickly with an 'accidental' overdose, to alleviate the pain. She refused, eventually she slipped in a coma and died.

Her reasoning was that she had lived with pain for so long, over 20 years from her rheumatoid arthritis, it was just a few more days and she wasn't going to commit suicide or let me commit murder.

She was strong willed, stubborn, and religious, especially toward the end. For some reason, I think she thought she deserved the pain or she wouldn't be in it. I disagreed, but agreed to abide by her wishes.

She slipped into a coma about a week after we talked about it. She died three days after that.

She was 47, and I respected her desire to go out on her terms, to fight to the end. I would not have had the strength to do so, I would have taken the overdose when the pain made life unbearable and I knew it wouldn't go away or get better.

For the kids dying, in great pain, with no hope of recovery, I would be sorely tempted to alleviate their suffering to send them home.

There isn't an easy answer.

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The U. S. Constitution doesn't guarantee happiness, only the pursuit of it. You have to catch up with it yourself. B. Franklin

"A mind needs books like a sword needs a whetstone." -- Tyrion Lannister, A Game of Thrones

What a strong woman, Micheal. I only hope I am half that brave when my time comes.
I can only imagine how hard that was for you as well...but God bless you for loving and caring for you wife as you did...."in sickness and in health"...it sounds like you both really understood the meaning of your marriage vows and what it means to truly love someone. It is a very very strong couple that is able to face death together, hand in hand like the two of you did.
(Wow its dusty in here..my allergies are acting up!)
*bigbearhugs*
You are such a wonderful man, Micheal. I am so sorry you lost your wife.

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"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Jesus of Nazareth

Thanks LK, I appreciate your comments.

Not quite the same issue, but how about this one: (I saw this article a few months ago but your post reminded me of it)

http://www.time.com/time/health/article ... 92,00.html

LK - You should look into a living will, if you feel that strongly about it. Otherwise, it could be out of your hands if it comes to that.

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This cold and dark tormented hell
Is all I`ll ever know
So when you get to heaven
May the devil be the judge

Wow, that's way over the line, in my opinion. Unless he felt she was about to panic in a way that was physically dangerous given the operation (which doesn't sound like the case), he absolutely violated ethical rules.

Wow, I agree RD, that was not ethical at all. That Doc made a decision that was not his to make.

Aethien, Living Will may be ok thing, but in my experience..you can have whatever Advanced Directive you want, it doesn't matter. Your family has the ultimate decision as to whether you will be resusitated or not. So, better to make sure you have someone who will follow through on your wishes than hoping that a piece of paper will ensure that. I have seen family unable to make the decision in the midst of chaos, even knowing the wishes of the patient, and keeping them a full code. So, we do CPR, break Grandma's ribs in the process, stick a tube down her throat, put in lines, in the process give her a pneumothorax..and she is 95 and wanted to have no heroic measures. I understand it is a hard thing to do, but people need to think of it as fulfilling someones final wishes.

The hospital I work at is trialing something called "Family Presence." Normally in a critical situation family is asked to leave, but now we are offering a choice. Stay or leave. Some different decisions have been made during the moment, when families see what happens during CPR. I am not sure how this is going to work, I can see positive and negative. Some people are not able to handle it, and you would need an extra person to be with the family, but then I have heard that some family members like to be present, just for the shear fact that they are there at the moment of passing. I dunno..

I guess, back to the original thought of the thread, what I don't like is people saying that using Morphine to ease a person's passing is "killing them". Its these comments that make people second guess themselves when they need to make the decision. Allowing someone to pass in peace is something that is so much better than the pain the body can still be going through right up till the end. Morphine drips are not ordered lightly, so it's not something that you can request if not appropriate.

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Dream as if you'll live forever...
...Live as if you'll die tomorrow

Vivere Senza Rimpianti

I don't have a problem with it. I think the Anesthesiologist performed a good maneuver, and saved the woman some panic and heartbreak and whatnot. Maybe it was skirting the bounds of ethics, but ethical doesn't always mean *right*.

In the same situation, I know I'd have wanted him to do that.

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Holy shitsnacks!

But, thats the point...he is making the decision, not the patient and not everyone would want that decision made for them.

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Dream as if you'll live forever...
...Live as if you'll die tomorrow

Vivere Senza Rimpianti

I don't see that it matters in that particular instance. They were in the middle of another procedure.

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"Hysterical children shrieking about right-wing anything need to go sit in the corner and be quiet while the adults are talking."

Administering a drug without any actual medical justification is generally considered unethical -- even if you have the patient's consent.

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Sail forth! steer for the deep waters only!
Reckless, O soul, exploring, I with thee, and thou with me;
For we are bound where mariner has not yet dared to go,
And we will risk the ship, ourselves and all.

the point could be argued that emotional pain is still measurable and real. We give medicine to ease pain.

Not sure I agree with the argument, but I think there is valid point there. An EMT will administer painkillers without waiting for actual consent wont they?

I concur with the article's author. Awesome job Frank.

Delaying the relay of the same information at a time when the patient can be prepared and mentally/physically able to handle it is the mark of a good doctor.

Now, had the doctor done that and then not told her the same information later, I would have a problem with it.

Would you have a problem if the doctor hit her to knock her unconscious rather than use the drug, assuming it had the same effect of making her not remember being knocked out or what she heard just moments before?

Yes, as that also produces physical damage, and counter to what hollywood would have you believe isn't as easy as it looks.

I have this crazy fear that the day I make out my will, living or otherwise is the day that I die or something.

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"Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own." Jesus of Nazareth

Depends on situation, and care level.

BLS isn't permitted to give painkillers.

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Grenade 3 Sports Drink. It's fire in the hole.. Your hole!

Primum non nocere.

I think that in *this* situation, it worked out, because, yes, the pt had expressed a desire to not be put under.

Which would be more harmful? Not being put under and hearing in a not particularly caring manner "Hey, you have a really shitty kind of cancer and you're gonna die" or, a little dream juice and being later told the same thing in a caring, professional manner with family and support around.

That's pragmaticmüs speaking though

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Holy shitsnacks!