Doctor and 2 Nurses arrested for possible "euthansia&qu

[Joshua Benton]

An Associated Press article was just released that arrest warrants for a physician and 2 nurses have been issued by Loiusiana authorities for possible "mercy killings or euthanasia" during the utter devastation that was Katrina. It remains to be seen what will transpire during the investigation, etc. My question is this:

Is there a time or situation when euthansia would be acceptable to you personally? :3some: Please to all who read this: I am not simply asking because of some morbid curiosity. I am considering writing an article that I hope would be accepted in some type of peer reviewed journal as a stand alone piece not a scientific poll per se. I value tremedously your opinions. Please do not cite other works. I am interested only in this demographic: your feelings and thoughts. Please ponder this and roll it around in your head and think it through.

Much love and Respect

Joshua B. (the poster formally known Whelson P. Monroe)

[Ace844]

http://www.emtcity.com/phpBB2/viewtopic.php?t=5225

[Joshua Benton]

Sorry I do not think that is the question that I am asking. The article posted is "about" the allegations, I am asking for personal responses to the question of when and if this type of behavior would be acceptable to YOU.

Much love and Respect

Josh B.

[Ace844]

:

I posted the link to make you aware that there was a related 'topic' to the one you posted with relevant related discussion going on there in case you were unaware...of its existance...thats all...Post containing answers to your questions to follow..

Out here,

ACE844

::

[Andrewtx]

Sorry I do not think that is the question that I am asking. The article posted is "about" the allegations, I am asking for personal responses to the question of when and if this type of behavior would be acceptable to YOU.

Much love and Respect

Josh B.

I brought up the issue of the medical ethics involved during cases of emergency and so forth in the other thread, so to prevent duplicate posts you might consider just discussing there.

[Joshua Benton]

Sorry,

I am guilty of not reading the entire thread. You did address the ethics issue but I still would like to get some more feedback from others about their thoughts on "mercy killings" In the case of my own grandfather, he was in the hospital in the beginning stages of respiratory failure. His lungs were filling up with fluid and he was unresponsive except to pain. He was extremely restless. The man was 92 and had been an alcoholic for 75 years. The doctor spoke quietly with the gathered family and told us that he could give Grandpa something to both "help him rest and reduce the fluid in his lungs" He also told us that there was a chance that it would make his breathing slow down and maybe even stop. We all agreed that he should be made comfortable and after signing the DNR order as my grandfathers power of attorney/ Pt advocate my grandmother gave the ok for the "medicine to make him rest and reduce the fluid in his lungs" to be given. 20 minutes later my grandfather was gone. Wonder what that medicine was??

Much Love and Respect

Josh B (the poster formally known as Whelson P. Monroe

[Ridryder 911]

Welcome back, Whelson ..or ?..

Ethics is a hard thing to study... there is never really a clear cut answer. I sometimes feel we loos sight of what our mission is ...A person with 50% second degree and 45% third degree burns and has their eyes melted out, ears are missing as well as nose, fingers and hands are burned off to wrist , just like the feet .... the physician refers to them as "tree"... because they are "going to have to take off one limb at a time"...

Should let such individual suffer?

I am definitely do not believe in euthanasia... but, we should not allow ones suffer as well. If the side effects of the analgesic medication causes death... that is what happens. This should not be considered though intentional to purposely killing someone, or performing the act with the sole intent of causing cessation of life.

This scenario is played out in Hopsice, burns centers all the time....p.s. this was a real patient, that lasted over 2 weeks in a burn center, yes he was conscious and alert.

R/r 911

[Ace844]

"Josh,"

Here's an article which relates to your query and thought may help you with some more perspective...

(Vol. 296 No. 3 @ July 19, 2006

The Physician’s Counsel

Donald A. Misch, MD

Evanston, Illinois

dmisch@northwestern.edu

JAMA. 2006;296:259-260. )

More than ten years ago my mother died as a result of a sudden, massive stroke. Although she had suffered from breast cancer, she had been doing well until she made an out-of-state visit to my family. During her visit there was no specific symptom or sign that something was wrong, but my mother simply did not look good, appearing less energetic than usual. Several days after returning home she was found unconscious on the floor, having apparently lain that way for most of the previous night. My mother spent the subsequent two weeks in the hospital. Computed tomography showed enormous bilateral cerebral infarcts with tremendous surrounding edema. No etiology could be determined to account for the extensive tissue destruction on both sides of her brain.

What became increasingly obvious was that my mother was not going to recover. She had severe aphasia and motor deficits, and it appeared that she was unaware of events proceeding around her. She was unable to care for herself. And yet, her cancer was, to the best of our knowledge, in remission; her heart was strong; and, with the exception of her brain, she was in generally good health.

And so the question arose: What should be done? My mother did not have a written living will or advance directive, but she had made it clear to the family and her oncologist that if her breast cancer had recurred she would commit suicide. She had already made contact with the Hemlock Society, and she was an ardent supporter (too ardent, from my perspective) of Jack Kevorkian and his campaign for assisted suicide.

I am the only physician in our immediate family. Thus, my assessment of my mother's situation, my perspective on the likelihood of any significant recovery, and my judgment as to whether every appropriate—a very important word—step had been taken in diagnosis and treatment were to be central in the family's ultimate decisions as to her future care.

Our entire family knew what my mother would have wanted, indeed what she would have demanded in her usual way, were she able to speak for herself. Whatever other qualities she may have possessed, she was a woman who never sat still, who never let cancer slow her down, who was determined to die on a golf course where she could drive a golf ball further than many men. And she had told us all, in no uncertain terms, that if she could not continue to enjoy life in exactly that way, she did not want to live. I believe then, and I still do, that my mother would have "pulled her own plug" had she been able to do so. And I, and all of the physicians involved in her care, believed that the likelihood of any significant recovery was nil; the cerebral damage was massive, overwhelming, and irreversible.

And so my family and I decided to let nature take its course.

But first I needed to speak with a physician, a rheumatologist who had been my personal physician and my friend, who had been asked to consider the possibility of vasculitis as a cause of my mother's illness. When he and I discussed the situation, we both used the same information as to what had happened to my mother, the laboratory tests and CT scan findings, and what we knew of her wishes. Independently we both came to the same conclusion—in line with my mother's wishes, no heroic measures should be undertaken.

I did not need another physician to assess the situation intellectually and medically, and yet it was clear that my rheumatologist friend's words were critically important to me. I needed a physician's counsel to let my mother die. This was true even though I was, and am, a physician, dually trained in internal medicine and psychiatry, and I had on many other occasions helped other families struggle with similar decisions. I needed a physician—not simply other family members or friends or advisors (although all of these were helpful as well)—to tell me that under the particular circumstances of my mother's situation, my conclusions were reasonable. Because all decisions about significant others in one's life are laden with emotion, conscious and unconscious meaning, and history, I needed to be sure that my motives for making this irrevocable and lethal decision were not contaminated by my longstanding conflictual relationship with mother. I needed a physician to assure me that my judgment was consistent with my mother's wishes and her best interests.

And when my friend, the rheumatologist, told me that under the same circumstances with one of his own parents, he would do the same thing, I cried. I cried partially for the impending death of my mother, but I also cried with relief that I had a physician's counsel in support of such a decision.

Physicians make diagnoses and provide treatment. They relieve, or at least ameliorate, suffering, and they help individuals and their families deal with the effects of illness. They give reassurance and hope, and they provide empathy, compassion, and concern. But physicians give something else to patients and patients' families—they give counsel.

The Encarta Dictionary defines the noun "counsel" as "advice sought from or given by somebody, especially somebody who is wise or knowledgeable." Similarly, according to the Oxford English Dictionary, "counsel" is an "opinion as to what ought to be done given as the result of consultation; aid or instruction for directing the judgment; advice, direction." When physicians give counsel, they do not substitute their judgment for that of the patient or family. Instead, physicians work in partnership with patients and families to craft a mutually determined decision that best meets the demands of a particular situation.

The physician as counselor encourages patients and families to explore their own beliefs, needs, and motives and to exercise their own best judgment. In the process, however, he or she brings to the table extensive medical knowledge about the symptoms, course, treatment, and prognosis of disease as well as an understanding of the experiences of illness, pain and suffering, fear and loss. Moreover, the physician often possesses an intimate knowledge about a given patient and family. And when these assets are marshaled together with a physician's societal license and symbolic role as a healer, the physician is uniquely suited to provide counsel in health matters.

Almost 30 years ago, in my second month as an intern in internal medicine, I admitted a patient who had cancer of the prostate that had widely metastasized to bone and peritoneum. He was in considerable pain, and surgical consultants recommended what, at the time, appeared to be the best opportunity for palliation: bilateral orchiectomy. Pain-ridden as he was, it was clear that the idea of testicular removal was anathema to him. Every day the surgeons would come into his room and ask if he were ready to undergo the operation, and every day he would resist, downcast and ashamed, indicating that he still had not made up his mind. The choices were stark. The surgeons were increasingly frustrated and impatient.

After watching this process continue over the course of a week, I asked to speak with him, alone, early one evening. I told him how much I sympathized with his difficult predicament, and I did not presume to know the correct answer to his dilemma. If he were interested, however, I would be willing to give him some of my thoughts. He agreed.

I told the patient that, if it were me, the first thing I would want to know are some key facts. Is there any reason to believe this procedure will prolong my life? If I decide not to undergo surgery today, can I change my mind and return tomorrow? If I don't have the operation today, will it be less effective a week from now? We discussed these questions as I provided him with the best information available.

I then told him that I could never put myself exactly in his shoes, that I would never know precisely what I would do in his situation. "Nonetheless," I said, "if you’d like, I’ll tell you what I think I might do if I had to make your decision." I went on: "Everyone agrees that this surgical procedure will not prolong your life, so its only purpose is palliation, relief of pain. And if you were to go home today, there is no reason you could not come back tomorrow and have the operation, and it will likely be just as helpful, or not, as if you had it today. But when I listen to you and when I watch you, I think that the psychological pain of having your testicles removed at this time is greater than the physical pain of your cancer. If the goal here is palliation—relief of suffering—it seems to me that right now, for you, the proposed treatment is worse than the disease. I believe that if it were me, I’d go home because I’m just not ready to have this operation today and I know that I can change my mind later."

Perhaps it was my imagination, and yet I know—I know—that for the first time a look of relief came over his face and he was close to tears.

He went home the next morning, forgoing surgery. I do not know if he returned the next day, the next week, or ever. But when I look back over almost 30 years in medicine, when I ask myself what are the things I have done as a physician for which I feel the greatest satisfaction, this is one of several memories that invariably returns to me. And I may be wrong, but I like to think that somewhere, somehow, this terribly distressed man confronted with a frightening and painful choice continues to thank me for providing him counsel to make the decision that he knew, in his heart, was the right one for him.

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.