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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 abou

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 8y ago
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 8y ago
  > 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 8y ago
    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 8y ago
      <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 8y ago
        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 8y ago
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.
- stormduck 8y ago
  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.
- david-gpu 8y ago
  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.
- jessriedel 8y ago
  > 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.
- debacle 8y ago
  In a morbid vein, you only get to die once. Wouldn't you want to be able to experience it fully?
  - mirimir 8y ago
    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.
ErikVandeWater 8y ago
> 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 8y ago
  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?
  - DanBC 8y ago
    > 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 8y ago
      >>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 8y ago
        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-and-brain-death.html 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.

pfortuny 8y ago

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 8y ago
> 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 8y ago
  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 8y ago
    <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 8y ago
      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 8y ago

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.

stormduck 8y ago
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.
david-gpu 8y ago
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.
jessriedel 8y ago
> 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.
debacle 8y ago
In a morbid vein, you only get to die once. Wouldn't you want to be able to experience it fully?
- mirimir 8y ago
  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.

ErikVandeWater 8y ago

> 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 8y ago
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?
- DanBC 8y ago
  > 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 8y ago
    >>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 8y ago
      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-and-brain-death.html 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.