Euthanasia

[VentMedic]

I haven't taken the relevant law, but I finished a biomedical ethics course last semester and euthanasia is a softball as compared to things like healthcare allocations, organ donation, and all the other limited-resources problems.

The problem with euthanasia, as seen in this thread, is that lots of vague personal beliefs creep in.

As far as the relevance of this thread to EMS, which was the point of my earlier post, euthanasia doesn't happen in the prehospital environment. Outside of that, any EMS providers involved seem to be techs under the direction of a doctor, which is a different environment. Ethical issues are less important there because you're not making any ethically significant decisions beyond participate/find another job. As much as I love interesting, discussion-provoking threads, this doesn't seem to have provoked discussion as much as shouting matches.

Also, is there really a Scilon on here?

So do you think additional education on the subject is a waste of time?

Any discussion about organ procurement, which has now crossed the boundaries beyond brain death, can give the EMS provider a different way to look at death. If you get a chance to see the respect given to a body by procurement teams and the surgeons present to retrieve the organs, it enlightening and almost a spiritual experience within a scientific world.

Yes, EMS providers do deal with Euthanasia issues. They transport patients to Comfort Care and Hospice facilities all the time. They pick up patients from LTC facilities who for some reason have reversed their comfort care orders. They may know of their regular dialysis patients that have made a decision to no longer have dialysis. Some patients may even want to talk about their decision, death or life.

Are EMS providers going to directly pull the plug on a ventilator...no. But, they will have a better understanding when an ETT is pulled from a conscious and alert patient in the ED that has made it clear NO INTUBATION and then goes on to die. Pulling the tube is assisting the patient to fullfil his/her wish.

If they have some knowledge of the law and principles of ethics before they are faced with them, they have a chance to confront some of their own issues. It is much better to deal with this in a classroom for the first time rather than losing it in front of a patient, their family and other professionals.

One of the last times we allowed a Paramedic student into our NICU was unfortunately the same day we were withdrawing life support from a baby. The student called us all, including the parents, murderers and ran out of the unit telling everyone he saw us kill a baby but from his limited point of view. Agreed the Paramedic student probably should not have been part of this but some thought that death should be part of the education also.

We have had numerous threads here about working the dead, especially children, for many reasons. However, most of the reasons come down to the healthcare providers' beliefs and not necessarily those of the family. Death, euthanasia, suicide, assisted suicide, end-of-life, comfort care, hospice and DNR are all things that should be discussed in a classroom dedicated to those subjects and not just a paragraph in an EMT or Paramedic text.

 

[daedalus]

There are safety reasons why some vehicles are used for transport and others are not. Also, Licensed Mental Health Professionals to stretched very thin. Just like EMS complains about being used for routine transports, the mental health professionals could put their education/skills to better use doing something other than a 30 minute transport for about 50 patients per day which is a slow day for some centers. That is why PD and EMTs are used to transport these patients.

As far as children are concerned, we have a locked secure facility attached to the hospital for children that makes me shake in my sneakers when get a call there. Damien and Michael have nothing over these kids.

Actually Vent, I do not believe I am below these routine transports. I believe the policy is misguided thinking Ambulances are safer for these types of patients, as the providers do not know how to handle them.

This is yet another education issue. The psychiatric emergency section in the EMT text is like two pages and a 15 minute read.

 

[VentMedic]

Actually Vent, I do not believe I am below these routine transports. I believe the policy is misguided thinking Ambulances are safer for these types of patients, as the providers do not know how to handle them.

This is yet another education issue. The psychiatric emergency section in the EMT text is like two pages and a 15 minute read.

True.

There have been facilities that have had their own technicians and vehicles to transport patients in the past. Of course, regulations and complaints from private ambulance companies changed some of that.

 

[EMERG2011]

'Tis a witch. Burn them, burn them!

"SHE TURNED ME INTO A NEWT!!!!

A newt?

I got better...."

 

[JPINFV]

Beat ya in post 33.

 

[EMERG2011]

I'm sorry, I don't believe in mental illness, my beliefs don't permit treatment for such ailments. Other than making them feel like it's not actually an illness, more of a feeling that was caused by their actions and views of life. That is just the way I was told to act and feel, I'm not brain washed, but what else am I supposed to do?

I'm going to abandon my usual diplomatic tone for the next few minutes, so yall get ready for it. What a load of crock! There are decades of valid neuroscientific research and study that show that psychological diseases have chemical and structural bases. The most prominent example of which is schizophrenia - which is associated with an increase in both size and pressure in the cerebrospinal fluid tracts in the 1st and 2nd ventricles of the brain, as well as functional abnormalities (mapped with fMRI) of the hippocampus, temporal lobes, and frontal lobes.

I'm not sure how much psychological training you've recieved, but I'm sure that nowhere in the DSM-IV, Oxford's Clinical Psychology, or even Freud does it say that someone should be given a "stern talking to" after attempting suicide. In fact, clinical treatment for depression involves cognitive therapy, wherein the healthcare provider acts as a neutral yet understanding partner to help the patient work out their feelings - a process which takes months, if not years. It has been shown that someone getting on their high-horse and delivering a speech as it appears that you do actually causes regression in clinical state and has no clinical value. Most patients who attempt suicide do not mean to die, they just are seeking attention and realize that fact shortly after they complete their attempt. The aftermath of this attempt brings on waves of shame, self loathing, and hopelessness which may last from hours to days depending on the patient's clinical progression. Now tell me - if you had just made the ultimate cry for help, would you like to get dressed down like you do to your patients???

A very dear friend of mine tried to off herself this past year due to clinical depression. Frankly my dear, had you been the provider who responded to the 911 call I made for her, and tried to give her a lecture, you would have needed an ambulance yourself. Take these words of advice - as medical providers we can not judge, we can not lecture; all we can do is keep the patient alive until we can get them to someone who knows more than us, and in the meantime, provide support - be it medical or a simple "its all going to be ok."

 

[reaper]

This is one of the best posts that has been written in a long time! Congrats.

 

[MRE]

It almost certainly isn't ethically justifiable for EMS providers to be assisting in euthanasia.

/thread

What if we call med-con first?



On the serious side; nice post EMERG2011, you covered the issue very well.

 

[JPINFV]

I'm not sure how much psychological training you've recieved, but I'm sure that nowhere in the DSM-IV, Oxford's Clinical Psychology, or even Freud does it say that someone should be given a "stern talking to" after attempting suicide.

Well, there's you're problem. Have you checked out the DSM-IV-TR? I'm pretty sure that the preface tells any non-psych practitioner to give their patients a stern talking to.

/sarcasm

 

[mycrofft]

OG here, harrrumph.


In most states (all?) suicide per se is not illegal, probably since the early 1970's. However, the definition of suicide is taking one's own life, and the term "assisted suicide" was coined to create a new category of action, since the closest term before it was dreamed up was "murder". Euthanasia (literally, "true" or "proper death") usually refers to people killing other people (or animals) as a means to stop and prevent agony. It has also been applied to ethnic cleansing, when the good granted by the act is to society's benefit as defined by one man or group; also, to the elimination of poeple felt to have inferior traits such as mental instablity or left-handedness, homosexuals, people with heretical views, etc. It has also been advocated as a means to hasten inheritance before an estate is exhausted by a vegetative pt who amassed the estate in the first place.

So except when it has been spelled out beforehand by the patient and the pt has a legal advocate to enforce their will after incapacitation, euthanasia is unlikely to occur legally.

Failing to prevent a suicide by a person afflicted with a mental disease is not assisted suicide, it is dereliction of duty, since that disease can be treated or the pt may simply change their mind.

Plus, youngsters, we OG's (old guys/gals) come to adapt to and appreciate some of our infirmities which thirty years before we would jump off a cliff to prevent.

EMERG2011, welcome to the fraternity/sorority of the aquaintances of suicide survivors. I enjoyed your comment.

 

[BossyCow]

Euthanasia is the act of ending a life, generally described as a mercy killing and for those who are terminally ill or in chronic debillitating pain. This is not the same thing as suicide. The term Euthanasia is generally applied when the ending of the life is done by someone other than the patient, ie. Dr, Friend, Caregiver.... ala Dr Kevorkian. But even Kevorkian had to come up with a method he described as 'Assisted Suicide' to get around the legal definition of murder.

This is very different from choosing to not extend your life. You could say that every diabetic who doesn't watch their diet and monitor their blood sugar is committing suicide. Every chain smoking COPD pt, every inactive, fat eating, smoking, drinking CHF pt. Engaging in behavior that leads to a hastening of our eventual, inevitable death is a type of suicide.

I have lost several friends to suicide over the years. I have seen mental illness become as fatal as a heart attack. None of these suicides were the result of Tommy asking Sharon to the dance. Rather they were an act of desperation, brought about after much soul searching and the exhaustion of all other methods to relieve their pain. This is very different from the suicide attempts and theatrical events staged by the majority of our patients.

I have issues with euthanasia as it is a sentence imposed by another on the pt. An advanced directive is different as it is done by the pt. with all the criteria of informed consent and is merely a pt determining their treatment plan. Family members are not the best ones to determine what is in the best interests of the pt. Look at the Shiavo case, different relatives with different motivations and religious beliefs arguing in court over who 'knows best what Terry would have wanted'.

Personally, I have an advanced directive on file. In my state known as a P.O.L.S.T (Physicians Orders On Life Sustaining Treatment). I am not going to live through treatments that prolong my life at the expense of my life. I will allow a disease to progress naturally unless it can be cured quickly and easily. I make exceptions for things like diabetes, which can be managed and CHF which can be managed through medication, diet, excercise etc.

Once even the exceptions reach the point where decline is inevitable and irreversible, I will allow the disease to run its course and my finite life will end. I have had some near misses with my asthma and have had to face my mortality a time or two in my life. I think being able to do this is important and part of being a mature and emotionally healthy adult. None of us are getting out of here alive and the sooner we all accept that the better off our society will be as a whole.