Civilians may think it is cruel or flippant to wish a patient would just let go and pass on, but nurses understand what sort of life a person that close to the edge of death actually lives.
This brings up the specter of assisted suicide.
We have hospice, DNR, and other ways of augmenting how we give care to the dying, but is assisted suicide something that is ethical or merely unthinkable?
What is Assisted Suicide?
Assisted suicide can range from helping a healthy person end their lives up to withdrawing care. Some would argue that withdrawing care isn’t assisted suicide, but what else is it if we don’t do everything in our power to attempt to help that person live?
Does assisted suicide end at the Dr. Kevorkians of the world, or do we participate in some form of it on a daily basis? Many nurses want DNR tattooed to their chests, but would you be willing to endure the pain of colon cancer when you know what is coming?
This brings into question the patient’s right to choose. Do they have the right to decide when they want the suffering to stop and do we have the right, as healthcare providers, to help them with carrying out that decision?
Defining assisted suicide and deciding if you are for it are slippery questions that will plague medicine as we devise new ways to keep patients alive. Would you rather be trached and pegged or just allowed to go on your own? What would you want for your loved ones? Your patients?
Hospice and Comfort Care
In some ways, hospice and comfort care are societally acceptable methods of assisted suicide. No, they are not as direct as taking a medication that immediately results in death.
However, there is the sense of giving up with hospice, and many people don’t support it for that reason. For most, it is a humane, beautiful, and dignified way to allow for the transition of life, but how different is this from some assisted suicide paradigms?
You also need to consider that some of the drugs given on comfort care can actually directly impact the moment of death. A large bolus dose of morphine may just be enough to stop that cancer patient from breathing, though you only gave the dose to ease their pain.
Whether we want to believe it or not, we participate in some form of allowing death every day when we go to work. We can’t save everyone, and we take the option at times to stop heroic measures. Why is this different from someone who doesn’t even want to get to that point?
DNR and Withdrawing Care
Yes, even the beloved DNR is controversial. For some patients, we are incensed when the 86-year-old demented patient with multiple organ failure is a full code. Should we be?
Who determines who is DNR? Often, the patient is the one who decides, but family decides in a great majority of the cases, too.
The question is, though, if you had an inoperable brain tumor, why wouldn’t you have the right to take the DNR before you could no longer think for yourself? Sure, miracles happen, but certain forms of cancer and diseases are death sentences, laced with pain and suffering.
Withdrawing care is problematic, too. Who is to say that the person wouldn’t recover from that traumatic head wound and achieve a better quality of life?
Besides, who can say what is a decent quality of life? Many trached and pegged patients live long lives, although they almost always need assistance.
The question remains what is assisted suicide and what is acceptable in our culture. We have certain methods of assisting death that we deem allowable, but how different is this from what Kevorkian does?
Where do you stand on the issue of helping your patient die or letting them ease with dignity onto a better place?