Euthanasia

[TheDemonLord]

Yes, but that's not strictly pain relief.

That's guesswork.

Assuming my conjecture is valid - its not guesswork - its an educated opinion based on experience.

[Reckless]

The treatment regime for end-stage palliative care is designed to accelerate organ failure cascade while keeping the patient pain free. Just follow the process and you're covered.

I think this is very true seen it a couple of times with close family.
Case in point a close family member.
I stood at the end of his bed at his home with the family around and shared his last moments.
Given what I witnessed in those last days leading up to it. I'm convinced it was the morphine and drugs rather than the cancer that finally put him to rest.
And thank goodness for that! It was very serene and peaceful the way he drifted off. The family broke down as you would expect but as far as I know where always grateful for the peaceful way the doctors managed a youngish mans passing.

I for one wouldnt have wanted to last another minute if it was me that is for sure.

I think we already have Euthanasia by default in the last days but the question remains if the diagnosis is 2 years previous to your passing should you have the choice to go quickly rather then slowly and probably Painfully.

Not even factoring on the effect on the family In my case the answer would be a definite selfish yes.
You only have to read the Sig I've had here for the last 10 years. I don't want to live on like Micheal Schumacher might be?
When my quality of life drops to the point there's is little quality left please someone pull the pin! I'd rather rot.
Well managed euthanasia I'm in favor of.

[Katman]

Assuming my conjecture is valid - its not guesswork - its an educated opinion based on experience.

I'm struggling to imagine what experience doctors can have of judging an unconscious person's level of pain.

When a person is in a conscious state they can say "it still really hurts Doc".

How do unconscious people express their level of pain with any degree of clarity?

[Maha]

Thanks jonbouy for reviving this thread instead of letting it die naturally... see what I did there?

[Katman]

... see what I did there?

You managed to create a post without any spelling mistakes?

Well done you.

[TheDemonLord]

I'm struggling to imagine what experience doctors can have of judging an unconscious person's level of pain.

When a person is in a conscious state they can say "it still really hurts Doc".

How do unconscious people express their level of pain with any degree of clarity?

I would imagine they would base it off dealing with Conscious patients:

as a hypothetical (with figures pulled out my arse):

you have dealt with 20 patients with end-stage cancer, who were of a similar size and build -they needed between 20 mg and 40 mg of Morphine. With an unconscious patient - if my Conjecture is correct, you would administer a 40 or maybe a bit more (again, in your professional experiance as a Doctor you would know how much you could go over over the dosage and not be hauled in front of a Medical hearing) dosage to make sure they weren't in pain and to persuade the body to move on.

but again - all conjecture and hypothetical.

I would also put forward that if such a practice was happening that it would be a case of don't ask, don't tell and that we would be unlikely to get any written confirmation from a Doctor on it.

[Katman]

....and to persuade the body to move on.

See, that's the bit I'd like some more info from Jim on.

I wasn't aware that end stage palliative care involves 'persuading the body to move on'.

[Big Dog]

Taking the conjecture out for a moment. At least 2 adult males I know were given morphine pumps. Pumps that issue a minimum dose on a schedule and supply up to a maximum dose that is safe for the age, height, weight and gender of the patient on demand from a button the patient has taped to their hand. At least I assume they are all involved in the pumps calculations. I saw them input a couple of times as shifts changed, bags changed etc.

Then came the talk.
Followed by a doctor having a frank discussion with the patient about what the significance of turning off the metering. About how in an emergency the first step taken by staff would be to turn metering on.

All very humane and caring, but it left no doubt in our minds the staff would be in a power of shit if we talked out of church.


Stupid phone / Tapatalk, apologies in advance.

[Ocean1]

And let's not forget that while we're talking about increasing morphine dosages we're still talking about lingering death.

The effects of morphine vary a large degree with the level of pain, there's only one reason you'd typically give anyone a lot more than a "std" dose.

My wife nursed a guy who arrived with 70% burns, walked out of the ambulance, (no skin nerves). An hour later they had to give him morphine, and an hour later another 200mg. That's an insane amount, dangerous, but there was no way that was what was going to kill him. It never touched him.

[RDJ]

An appropriate knowledge of physiology & pharmacology and the application of robust protocols - and monitoring - for making sure the patient has "more than enough" analgesia circulating, sums up how to manage pain in the unconscious patient in the patient's best interests.

Bear in mind that every time someone is anaesthetised for elective or emergency surgery, they and we want them to be profoundly unconscious; but they're undergoing painful procedures (or in the case of trauma patients, already have a lot of pain on board) so it is not sufficient to only keep them sedated/anaesthetised; they need pain relief pre-operatively, intra-operatively, and post-operatively.

Managing pain in an unconscious patient regardless of the cause of the unconsciousness is not done by guesswork.

[Katman]

Bear in mind that every time someone is anaesthetised for elective or emergency surgery, they and we want them to be profoundly unconscious; but they're undergoing painful procedures (or in the case of trauma patients, already have a lot of pain on board) so it is not sufficient to only keep them sedated/anaesthetised; they need pain relief pre-operatively, intra-operatively, and post-operatively.

The difference being that when you operate on someone you don't want them to 'feel' anything.

Why should a person be forced to face their death 'feeling' nothing.

I think it's far more civilised to allow a person the right to die feeling (and being profoundly aware of) the love of others that may be sharing those last moments with them.

[RDJ]

The difference being that when you operate on someone you don't want them to 'feel' anything.

Why should a person be forced to face their death 'feeling' nothing.

I think it's far more civilised to allow a person the right to die feeling (and being profoundly aware of) the love of others that may be sharing those last moments with them.

My mistake to have answered the question that you had asked earlier which was -

I'm struggling to imagine what experience doctors can have of judging an unconscious person's level of pain.

When a person is in a conscious state they can say "it still really hurts Doc".

How do unconscious people express their level of pain with any degree of clarity?

Since you then immediately set up a straw man of "a person being forced to face the death feeling nothing,..." I regret re-engaging in this discussion.

[Katman]

Since you then immediately set up a straw man of "a person being forced to face the death feeling nothing,..." I regret re-engaging in this discussion.

So what would you describe a person being denied the right to choose to die while being aware of loved ones surrounding them as?

Because as a person slips further and further into an unresponsive state they are most certainly going to be facing death feeling nothing.

If they have been denied the right to choose the time of their death then they are most certainly being forced into that situation.

[Ulsterkiwi]

selective quoting
the man answered your question

[Katman]

selective quoting
the man answered your question

Well he didn't actually.

After a point, increasing the morphine dosage towards the end of a terminally ill person's life appears to be more about the doctor (or nurse) speeding the dying process along rather than pain relief. (Like I said, an unresponsive, unconscious person cannot tell you what level of pain they're feeling).

Now, I'm not saying that's a bad thing but what I am saying is that if a terminally ill person prefers to die while being aware that they're surrounded by the company of loved ones, I believe it is wrong to deny them that right.