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Quality of life, and physician assisted suicide

Medical Ethics Medicine Quality of Life Assisted Suicide

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#41 Eskaminzim

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Posted 17 November 2005 - 09:37 PM

The DEA is heavy here, too, and there are strict rules about the dispensing of narcotics and schedule class drugs.  I know that the quantity for shedule class drugs cannot be over X amount, and the refills can only reach a maximum of Y before the doctor needs to be called and questioned about the continuing need of the medication for the patient.  

However, if you have, say, MSO4 for breakthrough pain, which is very common, and you're on a Duragesic patch, and you don't need the MSO4 as much on some days as on others, you're going to have extras left over at the end of the month.

But, because you know that the script runs out in four months, and you know what it's like when you're in agony, you get the script filled the next month.  Perfectly legal, perfectly according to the DEA guidelines.  You're not required to bring your prescription bottle back so the pharmacist can verify that it's empty before he refills a valid prescription.

Same with antianxiety meds.  A so called legal dose might be 1mg, TID, thirty pills per bottle (10 day supply), with a max refill limit of 4.  But you might not be anxious every day...some days are good, some are bad, so perhaps you have ten pills left over at the end of the month, but you get the script filled anyway, because you never know, from one day to the next, what your anxiety level is going to be.

It's quite easy to stockpile drugs legally, IF you're not in complete need of them, but want to guard against a uncertain future that you know is coming, when you may well need the pills and won't be able to get them.

#42 rponiarski

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Posted 17 November 2005 - 09:47 PM

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- Some situations are far too ambiguous in nature, I wouldn't want to go into hospital fearing for my life if i fell into a coma or whatever. Doctors would easily be able to do it, or they could talk patients into it.

I hope I would never talk anyone into that. Yes, we can "easily" kill someone and most of the time no one would know. BUT, we go into this business to heal and not to kill. As I quoted a while ago, the first commandment of the Hippocratic Oath is "First, do no harm". You can look at that in various ways, but it is a powerful appeal.

Are there doctors who would euthanise someone? Sure. But even Dr. Kevorkian had standards he believed were valid and I would have felt safe with him if I was or wasn't terminal.

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- Doctors are often very wrong in their predictions of how long people will live.

Very true, which is why I try to tell all my patient's that I am only human and can make mistakes...And work as hard as I can to make sure that I don't.

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- It's easy for doctors, and may prevent them ever realising they have more to learn.

Medicine is never easy and believe me, most of my friends and I realize we will always have something to learn until the day we stop practicing medicine, which I hope will not be for a bit... :)


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- Let me quote a British doctor:

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Relieving pain, restoring dignity, quality of life and giving people back control over their lives is far better than fatal injections. Most people are visibly relieved when I tell them euthanasia is not an option. When symptoms are properly controlled, fears dealt with, appropriate practical, emotional and spiritual help is provided and people feel safe, it is very rare for people to ask again for death by euthanasia.

Well said. That should always be our job and hopefully we will only get better at it over time...
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#43 rponiarski

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Posted 17 November 2005 - 09:56 PM

SparkyCola, on Nov 16 2005, 01:08 PM, said:

Besides- you're talking about suicide. This is about Euthanasia. Before abortion was legalised doctors could say 'no i don't want to do that.' now they can say that till the cows come home -but they ultimately still have to do it. It would force doctors, like the one from my link- to do something they don't want to do- and that's not right.

Sparky

<{POST_SNAPBACK}>


Doctors can still say no and no one can force them to do anything they don't want. I had a patient come to the office and after talking with them a bit, decided that I did not want to treat him. Reason: he would be a very difficult case and the time spent to treat him properly was more than I felt comfortable agreeing to. Made a referral to a friend who I know and called him just to be sure he would see the patient.

Only time you can't say no is in an emergency, and even then you do not have to do something not in your area of expertise (that first do no harm I was talking about before). Yes, many states have "Good Samaritan" laws, but a dermatologist trying to do cardiac surgery would be a malpractice lawyer's dream case...
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#44 rponiarski

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Posted 17 November 2005 - 10:09 PM

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- The person who has to do it is likely to be scarred by the incident for decades, if not for life (and there's no going back if you regret doing it).

Doctors deal with death all the time. If every doctor was scarred for life every time an action by them (either by misdiagnosis, or if a patient passes on an operating table or during treatment) caused a patient death, I can't imagine there would be many doctors left. Do you have any evidence in support of your opinion that a single rendering of euthanasia will leave a doctor scarred for life?

Yes, we do deal with life and death on an almost daily basis. And it hurts when we lose a patient. It never gets any easier, I can assure you. I have been in the business for over 25 years and my father practiced for nearly 50 years and it has never gotten any easier over time. We second guess ourselves, beat ourselves up over it and eventually learn to deal with it. But it always leaves a scar...

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I don't like the 'well what if medicine cures something next month' suggestion, because it asks doctors not just to be doctors, but to be soothsayers and prophets as well. It demands perfect, 20/20 hindsight in advance, and I think that's an unfair burden to put on anyone.

Thank you. I wish more people thought as you do about that, but I am afraid your view is the exception rather than the rule...
Richard M. Poniarski
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#45 rponiarski

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Posted 17 November 2005 - 10:20 PM

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The DEA is heavy here, too, and there are strict rules about the dispensing of narcotics and schedule class drugs.  I know that the quantity for shedule class drugs cannot be over X amount, and the refills can only reach a maximum of Y before the doctor needs to be called and questioned about the continuing need of the medication for the patient. 

Actually, here in New York, with a few very small exceptions, you can not write a prescription for more than one month of any controlled substance and no refills are allowed at all. Used to be a copy of the original Rx would be sent to Albany (state capital) and kept on file there. Now I believe it is done electronically, but you still need to use special forms.

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However, if you have, say, MSO4 for breakthrough pain, which is very common, and you're on a Duragesic patch, and you don't need the MSO4 as much on some days as on others, you're going to have extras left over at the end of the month.

Agreed and probably a lot of people do just that.

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But, because you know that the script runs out in four months, and you know what it's like when you're in agony, you get the script filled the next month.  Perfectly legal, perfectly according to the DEA guidelines.  You're not required to bring your prescription bottle back so the pharmacist can verify that it's empty before he refills a valid prescription.

No, you do not have to bring in an empty bottle, but the pharmcy will have the last fill date on file and will not fill it even with a valid Rx until a certain date. Can't post date a presciption either anymore.

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It's quite easy to stockpile drugs legally, IF you're not in complete need of them, but want to guard against a uncertain future that you know is coming, when you may well need the pills and won't be able to get them.

And even easier illegally. On the street a 2mg "stick" of Xanax goes for about $5 a pill and you never find a shortage either...
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#46 Eskaminzim

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Posted 17 November 2005 - 10:31 PM

I think you misunderstood what I said about the refilling.  If the refill is once a month, and you've got ten pills left, and you go the next month, you don't have to show that you have no pills left in order to get another refill.  As long as there's a valid refill left, and it's been a month, they'll refill you even if you have all thirty of the pills left from the last month.

As for street drugs, I wouldn't know.  I wouldn't take the chance of losing my nursing license, even if I was into them, which I'm not.  Though never say never, right?

#47 Rhea

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Posted 18 November 2005 - 12:39 AM

rponiarski, on Nov 17 2005, 07:20 PM, said:

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The DEA is heavy here, too, and there are strict rules about the dispensing of narcotics and schedule class drugs.  I know that the quantity for shedule class drugs cannot be over X amount, and the refills can only reach a maximum of Y before the doctor needs to be called and questioned about the continuing need of the medication for the patient. 

Actually, here in New York, with a few very small exceptions, you can not write a prescription for more than one month of any controlled substance and no refills are allowed at all. Used to be a copy of the original Rx would be sent to Albany (state capital) and kept on file there. Now I believe it is done electronically, but you still need to use special forms.


Same here in California. I'm on one of those controlled substances, and I either have to hotfoot it to the surgeon every few weeks for a new scrip, or have them mail it to me (which I never do because one got lost in the mail once).

Unless you're completely hooked, stockpiling them wouldn't be too hard to do over a period of time.  I just had a friend die of cancer on Friday - thank God, she passed peacefully, but before she got to go home she spent weeks in the hospital in agony. They finally found a combo of meds that worked pretty well to control the pain, and they stopped dialysis (it had metastasized everywhere), and she slipped fairly quickly into a coma. But as often happens, the amount of pain she suffered for a while there was completely dehumanizing.

I guess my critera would be that the wishes of the patient be followed. If the patient is terminal and there's no chance of recovery AND isn't lucid or isn't ever going to be conscious again, then the family should be able to make the call. And I can't think of one good reason why a doctor shouldn't assist under those circumstances if asked and if it doesn't violate his own personal ethics.

As I've said before, my family all keep advance healthcare directives AND medical powers of attorney AND organ donation info because we've been through two nightmarish situations, one in particular where a family member died in absolute agony because the doctors felt that turning off the machines would be against God's will.

And if you don't know what those are here's a link:

http://www.uslivingwillregistry.com/  

All you have to do is look for your state and print out the appropriate forms.

The best thing to do is take care of the paperwork, because then if something goes wrong your loved ones won't have to agonize over what to do - they'll already know what to do for you.

Here's an interesting question: many people believe that turning off the machines to let someone die is interfering with God's will. How come using artifical means to prolong life is also not against God's will?

Edited to add: Gode, thanks for starting this thread. Interesting discussion.

Edited by Rhea, 18 November 2005 - 12:40 AM.

The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#48 Nikcara

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Posted 19 November 2005 - 02:39 PM

Personally, I think the idea that anyone knowns what "god's will" is is nothing short of spectacular ego and hubris.  How could we possibly know what god's will is when we can't even decide who god is (be it Christian or Jewish or....) or if he/she/it even exists?

I tend to believe that if the person asks to be kept alive, their wish should be honored.  However, if there is no hope of recovery or living a halfway decent life, and no advanced directives have been written, they should be allowed to die peacefully and with a minimum of pain.

Basically I think it boils down to what you think is right in the situation.  No two people are alike, there are always slightly different circumstances around each person and their death.  Let the people who know them best decide.  I also believe that if they are listening to their hearts then a god will guide them, because frankly the gods know enough to know that every family is different and blanket statements of "this is wrong" don't apply to every situation.
We have fourty million reasons for failure, but not a single excuse  -- Rudyard Kipling

Develop compassion for your enemies, that is genuine compassion.  Limited compassion cannot produce this altruism.  -- H. H. the Dalai Lama

#49 Schmokie_Dragon

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Posted 20 November 2005 - 01:12 PM

As I dont believe in 'God' in the conventional sense, and certainly dont believe that he has any right to start dictating my life to me, I would disagree completly. However, to keep an individual alive is the preservation of life, and isgeneraly seen as a positive thing. You are giving that person another chance, saving family grief and maintaining the species etc etc. To take a life is destructive, causes pain and grief, reduces the species chance at survival (abeit marginaly) etc. This is therefore negative. In this world of hypocracy people use God's will as an excuse to do alot of stuff - "Lets go kill heathen Muslims cos God wants us to!" for example. The crusades, Christianity's finest hour. So if people feel that something is positive, they will use God to justify it, and if they feel it is negative, they will use God to condemn it.
Besides, there is this whole thing that your body was given to you by God so you cant destroy it as only he can take it away. But surely such a justification would prevent any attempt to preserve life as this would be seen as contrary to God's plan? We either have free will or we dont.
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#50 Mandi

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Posted 20 November 2005 - 01:18 PM

Everyone in my family knows what my wishes are in case of a medical emergency. If i'm in hooked up, and that's the only thing that's keeping me alive. Let me go. I've told my mother, father, sister ect. It is ultimately my decision. If I was in the Terri Schiavo situation, I would have wanted the plug pulled long before they did. I see no point in letting a person live on that way. It's not only hard on the person in the question, but also for the family. And then add how much it costs. I'd just assume die.
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#51 rponiarski

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Posted 21 November 2005 - 11:39 AM

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I think you misunderstood what I said about the refilling.  If the refill is once a month, and you've got ten pills left, and you go the next month, you don't have to show that you have no pills left in order to get another refill.  As long as there's a valid refill left, and it's been a month, they'll refill you even if you have all thirty of the pills left from the last month.

Oh, now I see it. We still can not give refills on any schedule drugs. Doesn't stop the prescibing of things like Tylenol #3 or Vicoden, which CAN be refilled

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As for street drugs, I wouldn't know.  I wouldn't take the chance of losing my nursing license, even if I was into them, which I'm not.  Though never say never, right?

I personally won't either, but I deal with a lot of substance abusers and have a pretty good idea what's out there and how much it costs...
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#52 Rhea

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Posted 21 November 2005 - 05:53 PM

rponiarski, on Nov 21 2005, 08:39 AM, said:

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I think you misunderstood what I said about the refilling.  If the refill is once a month, and you've got ten pills left, and you go the next month, you don't have to show that you have no pills left in order to get another refill.  As long as there's a valid refill left, and it's been a month, they'll refill you even if you have all thirty of the pills left from the last month.

Oh, now I see it. We still can not give refills on any schedule drugs. Doesn't stop the prescibing of things like Tylenol #3 or Vicoden, which CAN be refilled

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As for street drugs, I wouldn't know.  I wouldn't take the chance of losing my nursing license, even if I was into them, which I'm not.  Though never say never, right?

I personally won't either, but I deal with a lot of substance abusers and have a pretty good idea what's out there and how much it costs...

<{POST_SNAPBACK}>


Even controlled drugs can be refilled, although it's not called that, by simply having the dr. fill out another prescription.  So it may not technically be CALLED a refill but that's what it is. I have to stop by my surgeon's a couple of times a month to get my non-refills. :p

I think the point is that anyone who is on pain medication can hoard if they really want to. Just ask the doctor for another refill (or non-refill, in my case) while hanging on to a few pills. Do it enough times and you have a stash big enough to do the deed.

Edited by Rhea, 21 November 2005 - 05:55 PM.

The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#53 Eskaminzim

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Posted 21 November 2005 - 06:14 PM

Yup. That was the point, alright.   :D

#54 rponiarski

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Posted 21 November 2005 - 08:04 PM

Rhea, on Nov 21 2005, 06:53 PM, said:

I think the point is that anyone who is on pain medication can hoard if they really want to. Just ask the doctor for another refill (or non-refill, in my case) while hanging on to a few pills. Do it enough times and you have a stash big enough to do the deed.

<{POST_SNAPBACK}>


Never doubted that for a minute, though you may need a bigger stash than you may think. Anyone who has taken opiates long enough develop a tolerance to it and even large doses may not be enough to end your life. Ask any heroin addict and I'm sure they'll tell you the same thing...
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#55 Rhea

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Posted 24 November 2005 - 01:26 PM

Here's some updated info on assisted suicide in the U.K.:
http://news.yahoo.co...zkxBHNlYwN0bQ--

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John Close endured the painful deterioration of his body from Lou Gehrig's disease for two years. By the time he died, he couldn't talk or swallow. He could barely move without assistance.

"He choked regularly on his own saliva," recalls his sister Lesley. "He didn't want to get to this stage where he could do nothing for himself. That was a step beyond a dignified life for him."

John wanted to end his life. Because assisted suicide was illegal in Britain, where they lived, John and Lesley flew to Switzerland, which allows assisted suicide for both citizens and foreigners.

More than 30 terminally ill people from England have ended their lives in Switzerland since John died at the age of 54 in May 2003, Lesley says, citing statistics provided by Dignitas, a Swiss group that helps people end their lives. "I don't want to have to go with any more members of my family," she adds.

Britons might not have to make such a journey in the future. This month, Lord Joel Joffe introduced an assisted-suicide bill in the British Parliament, setting the stage for a debate - likely in January - echoing those in legislatures across Europe and in America.

It is the latest example of how governments are struggling to craft laws that respond to public acceptance of euthanasia and assisted suicide without permitting abuses.

The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH



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