When we last saw our heroes, they were discussing topics such as whether all terminally ill persons would necessarily have to submit to a psychiatric evaluation before requesting PAS. Further discussion?
I think also someone might have seen more recently polling regarding the moral acceptability of PAS? If so, would you post that information here?
Is there more to say about the line between responsibility of a medical professional to his/her patient vs. to a family member? Are the responsibilities different?
What will you do when faced with a friend/family member/patient/client who wants to do something about which you are morally undecided. Perhaps you wouldn't do it yourself, but you're not certain that other people should be prevented from doing it. How would you reason through the situation?
Honestly, I don't think a psych evaluation is going to help any. I believe that the person has already decided and is not going to change their mind. Also, if it is is just one psych evaluation then I don't think that the person is going to want to discuss his decision with a complete stranger on why they want to end their life. Discussing a serious decision topic like that involves the person to develop a therapeutic relationship with the psychologist which takes time.
ReplyDeleteI would not be able to perform PAS on a patient or a family member. I will be both supportive to the patient and my family member and refer them to someone else that will do participate in it. It is against my morals to help try to kill someone, I don't think I could deal with it personally. I would feel guilty that I ended someone's life even though they wanted to willingly die. Also, it is against the American Nursing Association (ANA) to participate in PAS. They believe that the patient should die from the disease they have and we can only help manage the symptoms. Even though I think PAS, people are going to do it anyway. People are free to do what they want and I'm not going to try to stop them because I am only one person. I will support them in what they decide, but I will not participate in it.
http://cbhd.org/content/depression-elderly-emphasis-terminal-illness
ReplyDeleteThis is an article I found that articulates my position on the idea of a psych evaluation for the patient. This applies to me because I am a Christian and am sympathetic to the religious argument that is given. However, I think this is applicable to anyone under the circumstances. In class I was struggling to prove why I think a psych evaluation should be mandatory, but after reading this, I realized what I was trying to say. If anyone who was not terminally ill or elderly wanted to commit suicide, people would see their condition as being depressed. One of the most most radical symptoms of depression is wanting to kill oneself. So why should people who are at that stage in their life be seen any differently. We should reach out to them and try to help them. If we want a system that stresses the use of palliative care, then we should take the wish for the doctor to perform PAS as a cry for sympathy as well. They want their pain and suffering to go away so we need to find a way to help with the emotional pain as well as the physical.
This may be my nursing education talking, but I feel like not only is a psych evaluation need to be done before PAS, but I think that symptom management needs to be addressed along with the patient's other affairs such as family and financial needs. Many things can cause a person to want to end their life early, i.e uncontrollable pain/nausea/diarrhea, feeling like they are a burden to their family, not wanting to leave more bills for their families to take care of, etc. If society takes steps to ensure that terminally ill pt. are admitted into hospice appropriately, are given psychosocial support and counseling, and aggressive symptom management, people can die from their terminal disease in peace instead of putting themselves through the moral and ethical torment of PAS. It is the responsibility of the medical professional to explore all the patients options and advocate for the pt.'s needs.
ReplyDeleteThe American Nurses Association has a GREAT position statement on assisted suicide that really puts things into perspective: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/prtetsuic14456.aspx
I agree that a terminally ill person should not have to submit to a psych evaluation. I think that if they had been in the hospital before then the doctor would have already assessed whether or not the person was able to make informed decisions like this or not. I also think that they deserve credit for having gone through the disease and making decisions for themselves. It would be demeaning to them to ask them to submit to a psych evaluation in order to allow them to make a decision that they have already thought about at length. I also don't think that a person will disclose important information to a therapist or whoever would be conducting the evaluation if they just meet with them one time.
ReplyDeleteI think that I would be able to help someone with PAS. While I think that it would be a very difficult thing to do I would not want to watch a person suffer and I would want them to be happy. I think that I would be more likely to help with a family member though because I would especially not want them to suffer. I don't think that it would be okay to support the suicide but not do it yourself and pass it off on someone else. You would know that another person would do it and if you truly disagreed with PAS you would try to get the person to not do it at all. I think that a person that did this would only be thinking of themselves when they just passed it off on someone else and the feelings that they would have instead of the wishes and concerns of the patient which should be the real focus.
I think that it is the physicians and nurses job to help the patient in any way they can by giving them medication to ease their pain and making them as comfortable as possible. I believe that a physician should respect the patient’s wishes in regards to a DNR and other things that allow the patient to die naturally, but I do not think it is the physician’s job to provide the means for the patient to commit suicide. Although I don’t agree with PAS, if it was going to happen I agree with Christy that not only is a psych evaluation necessary, but also looking into the patient’s history and personal life. In doing so, you would have a better understanding of where the patient was coming from and have a better grasp on their reasoning for wanting to die. I also agree that society needs to make it so people are admitted into hospice sooner. It seems like most people are admitted into hospice only days before they die. I understand we don’t know exactly when someone is going to die, but I definitely think it takes longer than a couple days to benefit from the psychosocial support and counseling that hospice provides.
ReplyDeleteI believe that it is also the nurses and doctors job to assist the patient's needs in anyway possible. Because the patient is always our priority and healthcare providers want to do everything possible for the patient. Many people do want to die, due to various factors in which Christy mentioned and I definitely think that a psych evalution is needed when someone is wanting to partake in PAS. When one is admitted onto the psych unit the nurses and doctors do everything that they can to prevent one from committing suicide. And I believe that PAS should not be allowed. I could never hand a person medication to die even if that was their wish because that goes against my beliefs. I would find another nurse or physician to carryout that duty. I try to treat all my patients as if they were my own family members, and I don't think that it should matter if it is a random person off the street or my mom laying there. I never could partake in PAS, even if they were suffering. I believe that God will take everyone when it is their time, and that PAS should be illegal.
ReplyDeleteI agree with Christy on the psych evaluation needing to be done before PAS, and with the fact that other affairs should be looked at. By looking at the patient’s life, you may find out that they want to die only because they feel they are a burden, or not wanting to rack up high medical bills. I believe that it is the physician’s job to help the person they are caring for, and PAS goes against that role as a healer. There are always alternative ways to approach a problem instead of just ending a life. Instead of PAS physicians should meet the needs of the patient at the end of their life. Once it’s determined that a cure is impossible, instead of PAS, the patient should receive counseling, hospice care, religious support and anything else they may require. Basically they should receive emotional support, comfort care, pain control and good communication as to what is happening. I personally would never be able to support the decision of a friend or family member who wanted PAS. It goes against my moral and religious beliefs that I hold.
ReplyDeleteWhen discussing the topic of PAS in class, I found myself becoming more and more confused during the conversation regarding psychiatric help for those contemplating suicide. While I agree whole heartedly that having a trained professional there to talk with the patient (not evaluate or judge the act for the patient ) would be a wonderful addition to the treatment available for the patient, I do not know how effective this help would be. Like others on the blog have stated, it takes time to develop a therapeutic relationship and the trust that is needed to discuss openly topics such as these. I fear that, the patients already granted or contemplating PAS, will not think that long-term because they are not planning on being on the earth that much longer. The ultimate goal of therapy, I would hope, would be that the patient would rethink his/her choice and find other options for living out the extent of their lives bearably (a field of care that needs further investment, as Christy pointed out). I do not think that the goal of therapy would be accomplished though – namely because the patient may not be willing or able to give the time it takes to connect with another person on that level. Acknowledging the difficulty of the task, I think that healthcare providers should try to screen patients who are dealing with life altering illnesses or shortened life spans and bring a licensed therapist to speak to the patient (before they are considering PAS). The therapist would be a member of the treatment team. If the patient can make contact with a person willing and able to help them sort through the many problems surrounding end of life and debilitating diseases, the patient may not get to the point where he or she feel desperate enough to take his or her own life. Of course this therapeutic care would have to be accompanied with improved palliative care, resources for the immense financial burdens of chronic illnesses, and care for family members, ect.
ReplyDeleteWhile I believe that the patient is a part of a larger family system, the doctor’s main responsibility is to the patient. Family must be considered in the care of the patient (just like the patient’s culture or the patient’s support systems) but should never be the main focus of care. Care is structured so that it meets the needs of the patient, and if one is lucky enough, the needs of the family. Despite this, the doctor and healthcare staff will interact with the family on a regular basis and should be knowledgeable of the educational needs of the family, the resources available to the family, and should include the family in the patient’s plan of care (if appropriate). If I am ever faced with the prospect of a loved one contemplating PAS, I will find it very hard to support them in their decision and will not participate in the PAS. I would be there as a support for them, but morally and as a healthcare provider, I could never administer the fatal dose or condone their act.
I do not feel like PAS or suicide is the best choice. Death is a natural process that we should let run its course. We cannot end any other natural processes should we should not be able to end life. We learn from experiences in life. If you are terminally ill you will gain experiences from that that will make you stronger. Doctors are barely ever right when they give a person a length of time that the doctor believes they have left to live. Humans should not have the power to act like God. We did not create life therefore we should not have the power to take away life. The negative effects on others are too great to constitute making it alright.
ReplyDeleteWhile I am whole-heartedly against PAS, I do agree that if one were to consider performing PAS, a psychological evaluation on the patient must be enacted. Mental disorders are the most common disorders found in humans and often go unnoticed. In fact, mental disorders may be even more common with terminally ill patients with the stress they are currently undergoing. Due to this, psychological evaluation is critical. If a patient's mind is not stable enough to make a well-thought out decision on whether they wish to continue to live or not, then they should not be considered for PAS.
ReplyDeleteMoreover, I feel that a health care provider's responsibility to both his family and patients should run parallel. This is what separates good doctors and nurses from excellent ones.
No matter the background, beliefs, or social status of the patient, they should be treated with same level of care and responsibility that you would treat a sibling or parent in the hospital. With this being said, I feel that a health care provider should not be able to do anything to a patient that they could not do on their own family member. This includes PAS or euthanasia. In my own personal opinion, if I had a family member or patient wanted PAS I would want the psychologically evaluated and then give them some type of encouragement to reconsider. If they ultimately decide that is what they want, I would hand my patient/family member off to another doctor to perform the PAS. I simply could not have the death of another human being that I intentionally caused, hanging over my head.
Is there more to say about the line between responsibility of a medical professional to his/her patient vs. to a family member? Are the responsibilities different?
ReplyDeleteDoctor patient confidentiality is always number one in the medical field. It is the medical rofessional’s responsibility to give all the medical information to the patient. This should only be broken when a patient becomes unconscious or when their mind has completely left them. In these such cases, then and only then should medical info be shared with the next of kin. At that time the doctor and family members can discuss the next course of action for the patient.
What will you do when faced with a friend/family member/patient/client who wants to do something about which you are morally undecided? Perhaps you wouldn't do it yourself, but you're not certain that other people should be prevented from doing it. How would you reason through the situation?
We have to remember first and foremost that we are responsible for ourselves. Depending on our upbringing we each have a different set of values and morals. Just because we may or may not want to do something doesn’t mean we should stop another from doing it, unless it could cause them personal harm.
As mentioned in class, it would be rather difficult for a psychiatric evaluation to be done when that person is being evaluated in order to get permission to end their own life. I mean how would you pass the test? If you really think about it, it would be rather difficult to prove your own sanity when your only goal in life is to die. I do not believe an evaluation would help but I do think seeing a psychologist to talk things through would be good. I think often times mental health is ignored because we often treat what we see and forget that emotions affect how we feel physically.
ReplyDeleteI think that if a doctor truly considered himself to be a medical “professional” then there would be no difference in how he would treat a patient versus a family member. As a doctor you strive to achieve what is best for the patient and likewise we do the same with our own family. I, personally, could not participate in PAS for reasons Brittany and Nicole already mentioned.
If I were ever presented with a situation in which someone I knew wanted to end their life via PAS, I would try my best to discourage it. I would try to be there for them and help make them comfortable but I would let them know early on that it is not something in which I am willing to partake. As a doctor, I would not do it and if I could not convince them otherwise, I would refer them elsewhere. As a friend or family member, I would not agree but I would still love them and remind them of that every day. I would try to have faith that they might change their mind or that God would end their suffering before they took it into their own hands.
I believe that a patient should go through psychologic evaluation before the procession of PAS, however, I also believe that when a person is diagnosed with a terminial illness or debilitating illness (ALS, Alzheimers, Cancer, etc, etc, etc), he/she should go through the psychological evaluation, but also should be able to, prior to two weeks before their death, be able to clarify via will/MPOA what and when they deam PAS acceptable. A person with alzheimer diagnosis should be able to state that when he/she is unable to speak, swallow, eat, etc should be able to have PAS without hte verbal request to the Dr. 2 weeks prior, and then the day of the procedure for at that point, there really is no meaning to life, he/she is wasting away, no enjoyment from life, no familial links, etc. Keeping him/her alive is doing a disservice to the person. I know that if I were ever to receive a diagnosis or a terminal diagnosis which I could not come back from, I would take the PAS, not only for myself, but for my family. I have watched my loved ones go through HELL with illness and they were worried about how we, the family members were handling the death, and stressing themselves out where if they were able to receive PAS they would have had a more peaceful end, and we the family would have had a quicker and more effective grieving process for we would have known that it was our loved one's decision to go and they were okay with death, rather than wondering if thye were scared, etc. It would just be a comfort to all. This procedure is not for everyone, but I believe that it should be available.
ReplyDeleteI agree that someone should not have to see psychiatric help to decide if they would want to end their own life. If someone wants to die, they will find a way if it is through PAS or not. Having to see a psychiatrist may persuade people to not take the PAS route and instead do other things that could harm their families more. I would suggest that the patient go to counseling to deal with how to cope with family after making a decision like this instead of to persuade a patient out of PAS.
ReplyDeleteIf I had a patient who wanted to follow through with PAS I would likely grant their wishes. I do not know that I could give the drug to the patient but I could leave it for them to take on their own. I feel like this goes less against my morals because I am not really killing someone, I am just allowing someone to die how they wish. At least that is how I see it. I think that as a doctor, it is your responsibility to do what is best for the patient while respecting their wishes. So if they would want to do PAS, it is the doctor’s responsibility to provide as much information about the topic as possible while also providing alternative options. I would not try to persuade them any certain way but would just provide the information to the patient.
It would be hard on me if one of my family members decided to do PAS. I would eventually understand and respect their choices but I would be a selfish person and want them to live as long as possible. I would regret being selfish about this because I know that my family member would just like to not suffer and be put out of their misery. This would be a very hard time for me but I would learn a lot about myself and my family.
I believe the biggest thing about PAS is the term suicide at the end. Once a lot of people, myself included, hear the term suicide they are against it from the start. Throughout my life I have always been taught suicide is wrong no matter what. I have lived a pretty sheltered life and I believe my teachers didn’t really give me the complete perspective on everything. I can honestly say when Dr. Sherron gave the poll of how many of us were against suicide I raised my hand. Then she went into details of “what if” and it made me think a lot more.
ReplyDeleteI believe I am against the suicide when someone who is completely healthy kills themselves over things that just happen on a daily basis in their lives. Examples would be relationship problems, money problems, work problems, etc. I have found ways that I believe suicide is acceptable, such as the soldier example in Barry. To be honest, I thought PAS was wrong from the start, but now after learning more about it and hearing different sides to things I can see why people would want it. That doesn’t mean if I were a Doctor I would follow this, but I can definitely see why people would want PAS.
I would have to agree with the people who said a psych evaluation is needed in order for PAS to work. I agree with Christy that a lot of the reasons why someone might want PAS is they are worried about the hospital bills or they feel they are a burden to their family, etc. I don’t think that the therapist should necessarily talk the patient out of going through with PAS, but act as a guidance to make sure they are doing it for the right reasons and not just because they feel like a hindrance.