Palliative Care to Hospice and Now Physician Aid in Dying?


Palliative Care to Hospice and Now Physician Aid in Dying?

question-423604_640Hello all,

As a caregiver of both my father prior to his passing and now my mother, as well as being a registered nurse with a multitude of healthcare experiences, I have to sit back and truly contemplate how we care for those in need.  Believe me, after seeing many go through struggles of disease processes, I could not be more of a strong advocate for palliative care and hospice care. I have found both personally and professionally the value of palliative care for those who struggle with chronic disease states. And as far as hospice, I am also a strong believer of the benefits hospice provides not only the patient but also the family caregiver and other family members.

I had the opportunity to attend a Grand Rounds seminar yesterday at the medical center I work at. The topic was on Physician Assisted Suicide. Gosh, for me that opens up so many ethical areas when it comes to life and futility and what the patient may want.  I reside in California, where this law is coming thru for legalization. But honestly, there are so many gray areas that I simply cannot wrap my brain around it.  Let alone the issues that arise ethically. Are we going to extremes? For those of us who are Christian's, does this go against our beliefs? I have to sit back and really think. Doesn't palliative care and hospice provide the patient and family the care and compassion and assistance to relieve most suffering?  I definitely have more questions then answers but wanted to share and also get other's thoughts.

Thanks for reading and blessings to you for the caregiving your provide!


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Our family has discussed this question, as you see things in the news. I think our consensus is we are not sure we could do the assisted suicide, as the person left behind, but we can see where people would want that option in their life.\r\nTo us, it seems quality of life is a factor. We will all die. Not one of us will live forever. Just think back a generation or two when reaching 70 was a milestone, now 100 seems normal. We sort of feel that if you are 100 and in generally fair health, enough to know where and who you are, enough to get out and enjoy a meal or travel to see relatives, then 100 is ok. On the other hand, if you are 100 and have no awareness of your surroundings, know no one, live in a facility and never get out, then where is the quality of your life?\r\nI have always said, if I am diagnosed with something terminal, let me live the best quality of life I can, but do not do any treatments that take that quality away. I know doctors are the people who want to care and cure, I get it, but they really need to evaluate what that means.\r\nMy husband has an untreatable, terminal illness. He does not want any more colonoscopies, surgeries or treatments that do not \"cure\". I know this because we have talked about this for many, many years. We have stopped looking for skin cancers, we have stopped being all about prevention.\r\nWe eat healthy meals, we walk so we can continue to get around and enjoy life. We live today, in the moment. We enjoy laughter. We find amusement in life. We will live as best we can for as long as we can, but there will be no more \"treatment\", except for comfort sake. It is what we choose, we made our own decisions while still healthy. I will honor his wishes because I know they are his wishes.


I'm not sure about ending life with physician's assistance, but I am very much against prolonging life with advanced means after a certain point/age. I walked into the facility where my parents are living and a resident had just had a heart attack. There was no DNR. They did CPR on this frail little woman. I can't imagine how that would be for someone who is old, possibly with brittle bones and skin that tears easily. She collapsed right outside the nurse's desk, right in everyone's view. When I came, she was bare from the waist up. \r\n\r\nNow, don't get me wrong, if something happens to me now, I want CPR. Take my clothes off in the middle of a crowd, if need be. But in my mid-80's? Let me go. It's a strange balance we need to find. \r\n\r\nMy husband is a strong supporter of Death with Dignity - the name many prefer. Another strong supporter are our veterinarians. They experience the ability to ease a dying pet of their suffering and wonder if, when the time comes, someone will ease their suffering. I'm not sure how I feel.


A friend of mine passed away this week. He had been receiving palliative care for quite some time. When I visited with his wife yesterday, she shared her husband's experience of seeing \"angels\" visiting with him. It reminds me of a discussion a heart physician had with me about whether patients needed signed DNR's. He said he believed that most patients passed away in God's timing. My thoughts are that we are created by God and we don't have the right to purposely decide when a person should die. Yes, it is sad when sometimes loved ones seem to suffer lengthy illnesses and we hurt to see that. The most difficult thing I have ever experienced was sitting by my father's bed after he was diagnosed with bone cancer. He was in great pain and lived his last two weeks in hospice care. As a Christian, I have never found a verse in the Bible telling us that we should put to death people who are aged, infirmed, or have life-threatening diseases. The Bible does say that when believers die God's angels surround them and protect them on their journey to heaven. Luke 16:22 is one reference. Rev. Billy Graham and others have written books on the subject.


I never want to live with advanced dementia, nor do I want my children or strangers to care for me in that state. I would personally choose assisted suicide. But you are right, there are so many ethical questions, which diagnose qualify, state of mind when decision is made, etc, etc.


A sensitive topic to be sure. I imagine in your professional experience you have seen some situations (chronic incurable diseases and disabilities of the most devastating types) where palliative care does indeed NOT provide the patient with relief from suffering. I know it would be hard for some to set their beliefs aside and try to put the needs of the sufferer first.