Tuesday, August 19, 2008

The Danger of Living Wills

From an Article in the North Carolina Journal of Medicine, entitled "Palliative Care," by Phillip A. Sellers, MD (July / Aug 2004, Vol. 65, No. 4, Pg. 247;)

Here is what Dr. Sellers had to say about the dangers of living wills;

“Today some caregivers assume the presence of a living will or a DNR order is is also a “comfort care” order, when it clearly is not. Many health-care providers , including doctors, nurses, patients and families are unclear about the difference. At times, there is a tendency for the care giving medical staff to assume that is ok for the patient to die if there is a living will or a DNR order. The staff may not be as attentive to that patients needs and complaints as they would be to a patient with no living will or DNR order. Indicate3d or beneficial treatment may be delayed or not instituted.”

Thursday, August 14, 2008

An International Review of Hastened Death

Wednesday, July 30, 2008

An International Review of Hastened Death

Monday, July 21, 2008(Hopefully not a recurring feature)*Please read disclaimer at the end of post*The New York Times #6 most emailed article today is about the underground practice of hastened death via the procurement of barbiturates in Tijuana, where the medications are intended for euthanizing animals, not humans. It is interesting this practice fits under neither commonly used terms for hastened death by medical means:"euthanasia" - the administration by a medical professional (or other person) of a prescribed medication with the intent of causing a hastened death"physician-assisted suicide" - the self-administration of a medication prescribed by a physician with the intent of causing a hastened deathThis article describes people obtaining the medication without a doctor's prescription, therefore 'physician-assisted' is a disqualified descriptive. They merely need to show a picture of the medication they want at the Mexican veterinary stores. So I guess this is simply 'suicide?' Although I think 'suicide' is too broad to define the particulars about a situation where someone is in the terminal phase of a condition versus someone suffering from a severe depression but no terminal illness. But to label this 'terminal suicide', 'hastened death in the terminal phase' or some other contortion feels clumsy and is bound to cause even more confusion.Regardless of the term used, the issue has been made more relevant with a couple high profile cases of medicine and hastened death.In Australia, Exit International and Philip Nitschke have been making the papers and TV (and are featured in the NYT article) with a public campaign to legalize euthanasia including You Tube Videos, film screenings, book promotions (attempts at banning it are underway in Australia and New Zealand), workshops and political initiatives. More focus has been on Mr. Nitschke and his group since the recent manslaughter conviction of a woman who gave a barbiturate to her partner who had Alzheimer's. Another recent case is also being featured of a woman who was depressed but not terminally ill who supposedly relied on information form Exit International's materials to kill herself.In Germany, a lawyer/politician advised, and videotaped a 79 year old woman who prepared and self-administered a 'lethal cocktail.' The woman was not terminally ill but chose hastened death because she did not want to go to a nursing home. The politician, Roger Kusch, was inspired by Dignitas, a pro-euthanasia organization based in Switzerland who has many people from Germany requesting its services.In Scotland, a Member of Scottish Parliament, Margo MacDonald has filmed a documentary with the BBC and proposed legislation to adopt the euthanasia and assisted suicide laws similar to The Netherlands.In Italy, a case eerily similar to Terri Schiavo and Nancy Cruzan is being discussed publicly and was recently covered in TIME magazine. A 20-year old woman in a car accident (in 1992) now comatose and with a feeding tube that her father wants to have removed (and has fought for since 1999) was allowed by Italian courts to stop her artificial nutrition via feeding tube despite much opposition. The case is now pending appeal despite already having gone to the Italian Supreme Court in 2002.In Canada, Samuel Golubchuk, an 84 year old man whose family fought hard to continue aggressive life-prolonging measures died 9 months after doctors initiated discussions about end-of-life decisions. He died on full life support measures. If his life support was withdrawn it would have been illegal since a court ordered physicians and the hospital to continue partly based on the family's belief of hastening his death would be a sin under Orthodox Jewish law. The case was to be heard by a full court in September. Doctors refused to care for him, likening his medical treatment to 'torture.'In England, a man who was refused Sutent, a prostate cancer drug, by the National Health Service suffocated himself.So why is this all important to palliative care?Because guess who thinks about these things:your patientstheir familiesmedical professionals who consult youthe publicand they may never bring it up with you for a multitude of reasons. Or they may hint at hastened death, but never start an open discussion. Or they may make a sly joke about it, waiting to see how you respond. Or they may assume what is good standard palliative care is really euthanasia.Good hospice and palliative care practices can help people discover hastened death does not have to be the easy way out. If the lines are too blurred between the legal and illegal our field has significant trust to lose with the public and our peers. Being educated and aware of the public debate over hastened death is a responsibility for palliative medicine to ensure the safe, ethical, and legal care of the patients and families entrusted to us.(My Standard Disclaimer: Pallimed, Dr. Sinclair and his current and former employers and states do not endorse or practice euthanasia or physician-assisted suicide, but do encourage the open, non-judgmental discussion of these topics for educational and ethical discourse about this controversial area of medicine. Links do not represent endorsement.)Posted by Christian Sinclair, MD Labels: , , , , , ,

Hospice Killed My Sister

Friday, August 13, 2008


Another Hospice Horror Story / Another "Early" Death by Starvation & Malnutrition

HOSPICE KILLSPosted by deb on Sunday, March 18, 2007 2:01:28 AMI did not know anything about Hospice until my sister was recently put into Hospice. Not because she was dying, but because she was in pain. We thought she was dying because they told us the symptoms of dying were that they quit eating and started sleeping more, and their breathing rate slows down. So her children put her into Hospice. They did not tell us that these symptoms were all caused by being over-medicated. Her sleeping breath rate was down to 8 per minute. One day while she was in the hospital hospice, I told the nurses not to give her the Dilaudid which was in addition to the Phentynol patches she was on. Suddenly, my sister was alert and quite lucid, was able to eat, and drank more liquids in one day than she had in two weeks. When the doctor heard what I had done, she was very upset and told the nurses to put her back on the Dilaudid, because I was not a direct family member. We wrote the doctor a letter requesting that they try other medications that might not make her tired that she could not eat or drink. The doctor refused, saying she promised my sister to keep her from pain. My sister was not in pain - the patches were working well for her that day. She is now so drugged up that she has not eaten or able to drink anything for weeks, yet her vitals are normal, her blood oxygen is normal (LUNG CANCER).They are killing her from dehydration and malnutrition. She has been drugged up like this for two months now. How much quality life did she have left it she had been treated for the pain with the proper medications instead of being over-medicated to the point of not being able to talk, eat or drink.Do not put anyone into Hospice. They should be given treatment until the disease causes the body to shut down, not from being over-medicated which causes dehydrated and malnutrion.

How Could We "Not Know?"

Saturday, August 13, 2008

How Could We Not Know?

Another Family's Hospice Horror Story: HOW DID WE "NOT KNOW?" How did four highly educated adults not know that the purpose of hospice care was to kill our mother slowly and painlessly? Two weeks after enlisting the assistance of hospice, our mother whose only complaint was that it hurt to be turned, but not enough for pain meds was given a high dose of morphine by a hospice nurse of death. This was just minutes after a doctor had examined her and determined that her vitals were good, she was awake and not in pain. Now she cannot swallow or be fully aroused. Hours before the overdose I called to share how my first day of school went, because I am a teacher. She carried her end of the conversation asking appropriate questions and laughing at appropriate times. Now I cannot even have a conversation with her. The nurses have diagnosed my mother based on what? When she left the hospital she had just had surgery to remove a cancerous tumor. The doctors said that the cancer might have spread to her lungs or she might have pneumonia. The nurse determined two days later that she not only had lung cancer but that it had spread to her brain. WHAT!? Again I have to wonder what she is basing this on. And forget privacy. When I was leaving for a few days to return to my home 2,000 miles away, not sure that my mother would still be with us when I returned a few days later, the nurse found my wanting to spend my last few minutes at my mother's bedside inappropriate. In addition whenever we go into my mother's room everything we say to her is written down to be shared with others later. The nurse told my sister that I needed to come to terms with the fact that people die. "We are all dying," is her pat answer. I am an ordained minister and I accept that death is a fact of life. I know that I will die someday, but for now I am living, not dying. What kind of healthy person lives by the mantra that she is dying? So, you may be asking, "What's the point here?" Do your research. DO NOT USE HOSPICE unless you are looking for a way to speed up the death process albeit painlessly. If you feel that the best thing for your family member is to be heavily sedated so much so that they cannot eat and breathing slows to the point that their brain becomes deprived of oxygen then hospice is for you. If you happen to live in San Antonio, Texas and you use Vitas and better yet the nurse assigned to you is Phyllis, then you better start planning the funeral. Do your research. My family's experience is not unique. Now that it is too late, I have discovered thousands of others who have had similar experiences.

Monday, August 4, 2008


Hospice industry leaders and planners often explain public resistance to enrolling in hospice as being caused by the public "not understanding" what hospice is all about. While many individuals do not truly understand what hospice is all about, there are many who simply recognize the realities of the industry. Either through their own family's experience or the experience of a friend, they know that is becoming increasingly common for hospices to hasten a patient's death.The public is not as dumb as the professionals in the industry would like to think. The public knows that if they enter hospice, in some cases, their death may be hastened. Doctors in the community often comment, "if you enter hospice, you'll be dead in two weeks." Why? Because in many cases, patients are routinely given morphine and Ativan (a common sedative) even if their symptoms do not require it. The irresponsible administration of clinically inappropriate medications in order to make for a "nice hospice death" is seen by some as what it is: medical killing: