Euthanasia - assisted suicide

[Grace]

Some time back a close friend of mine's mother had a stroke. The still somewhat cognitive mother was a resident in a well-known nursing facility here in Lancaster County. It was determined this very elderly lady's swallowing was to poor the avoid expiration while eating. So, food and water were denied until she died. I fully understand the rational for denying food and water for the elderly when their swallowing reflexes are greatly diminished. However, my question is, where is the line between assisted suicide and denying food and water until one dies ?

Good question. I’m wondering why they didn’t put her on a stomach feeding tube and IV. That’s been an option for 30 years that I know of.

It's a very hard question and one that my family had to deal with this year.

My mother passed away of cancer this year. Toward the end of her treatment plan, she had cardiac arrest at home and had to be resuscitated. She was on a ventilator, and later a trache tube, and attempts to wean her off did not work as she could never breathe on her own for more than a few hours. She was being treated for blood clots, which had caused the cardiac arrest, and eventually developed major internal bleeding as a result of that treatment. They ended up in a corner where treatments were counteracting other treatments and there was no way forward. We were given the choice of stopping all life-saving treatment and placing her on comfort care only.

We finally chose this path. It was a very difficult time to say the least. The ventilator was removed, and all nutrition and medication stopped other than meds to keep her mostly sedated and comfortable. She had not been able to breathe on her own for more than a few hours before this, so we did not expect her to live more than a few hours. However, she breathed on her own nearly a whole week. During this time, she occasionally showed signs of being slightly aware, but was mostly asleep and seemed comfortable until she finally breathed her last.

In theory, she could have been kept on IV nutrition, oxygen, and ventilator assist and lived for an indefinite period of time. In reality, you just can't do that forever. In all this time, her cancer was not being treated, and the likelihood of her body being able to tolerate the treatments at any point in the near future was slim to none. It was an extremely hard decision to make, but there were no good options left.

In my opinion, this kind of end-of-life decision, which is essentially a decision to stop using life saving technology to delay the inevitable, including the delivery of nutrition by IV, is vastly different from the decision to assist a person in committing suicide. It is not even close. It is allowing nature to take its course, and allowing God to determine when life ends. Assisted suicide is intervening in the natural process by taking a life. Choosing to not prolong a person's physical suffering is not in the same category, even though technology often lets us decide when that point will be.

A week ago, a friend of mine had a sudden stroke and inoperable brain bleed, and was kept alive on a ventilator until all the family could be there, and passed away a few hours after machines were removed. This kind of thing is in a different category from assisting a person in killing themselves. I think it is crucial to keep a line between the two, but the decisions one has to make at times feel closer to that line than one would like.

Thanks Mike, the idea of "nature taking its course" seems like a better way of describing the situation. My friend's mother was well into her 90's and had other health issues. She had lived a long and full life.

[JohnL]

Some time back a close friend of mine's mother had a stroke. The still somewhat cognitive mother was a resident in a well-known nursing facility here in Lancaster County. It was determined this very elderly lady's swallowing was to poor the avoid expiration while eating. So, food and water were denied until she died. I fully understand the rational for denying food and water for the elderly when their swallowing reflexes are greatly diminished. However, my question is, where is the line between assisted suicide and denying food and water until one dies ?

Good question. I’m wondering why they didn’t put her on a stomach feeding tube and IV. That’s been an option for 30 years that I know of.

It's a very hard question and one that my family had to deal with this year.

My mother passed away of cancer this year. Toward the end of her treatment plan, she had cardiac arrest at home and had to be resuscitated. She was on a ventilator, and later a trache tube, and attempts to wean her off did not work as she could never breathe on her own for more than a few hours. She was being treated for blood clots, which had caused the cardiac arrest, and eventually developed major internal bleeding as a result of that treatment. They ended up in a corner where treatments were counteracting other treatments and there was no way forward. We were given the choice of stopping all life-saving treatment and placing her on comfort care only.

We finally chose this path. It was a very difficult time to say the least. The ventilator was removed, and all nutrition and medication stopped other than meds to keep her mostly sedated and comfortable. She had not been able to breathe on her own for more than a few hours before this, so we did not expect her to live more than a few hours. However, she breathed on her own nearly a whole week. During this time, she occasionally showed signs of being slightly aware, but was mostly asleep and seemed comfortable until she finally breathed her last.

In theory, she could have been kept on IV nutrition, oxygen, and ventilator assist and lived for an indefinite period of time. In reality, you just can't do that forever. In all this time, her cancer was not being treated, and the likelihood of her body being able to tolerate the treatments at any point in the near future was slim to none. It was an extremely hard decision to make, but there were no good options left.

In my opinion, this kind of end-of-life decision, which is essentially a decision to stop using life saving technology to delay the inevitable, including the delivery of nutrition by IV, is vastly different from the decision to assist a person in committing suicide. It is not even close. It is allowing nature to take its course, and allowing God to determine when life ends. Assisted suicide is intervening in the natural process by taking a life. Choosing to not prolong a person's physical suffering is not in the same category, even though technology often lets us decide when that point will be.

A week ago, a friend of mine had a sudden stroke and inoperable brain bleed, and was kept alive on a ventilator until all the family could be there, and passed away a few hours after machines were removed. This kind of thing is in a different category from assisting a person in killing themselves. I think it is crucial to keep a line between the two, but the decisions one has to make at times feel closer to that line than one would like.

I'm so sorry that your mom and family had to walk that valley of suffering. I agree there is a difference between allowing nature to take its course and deliberately committing suicide in whatever form. It's a really heart wrenching decision process when dealing with loved ones.

[justme]

I think it is crucial to keep a line between the two, but the decisions one has to make at times feel closer to that line than one would like.

i've come to the realization that once the decision is made, there really shouldn't be any second guessing.
and i've also come to the realization that it is not for me to 2nd guess a decision made by someone else.

when my dad was diagnosed w lung ca, he made the decision to not do anything. that was difficult for me. it felt like he wasn't even trying. but i've come to realize that we were spared so much of the side effects and quality of life deterioration. we had my dad, (weaker of course), but we had my dad clear up to the end.

[mike]

I think it is crucial to keep a line between the two, but the decisions one has to make at times feel closer to that line than one would like.

i've come to the realization that once the decision is made, there really shouldn't be any second guessing.
and i've also come to the realization that it is not for me to 2nd guess a decision made by someone else.

when my dad was diagnosed w lung ca, he made the decision to not do anything. that was difficult for me. it felt like he wasn't even trying. but i've come to realize that we were spared so much of the side effects and quality of life deterioration. we had my dad, (weaker of course), but we had my dad clear up to the end.

The worst part was suddenly not being able to communicate with my mom for the last 4-6 weeks of life. After her cardiac arrest, she could never speak again because of the vent, and it was near impossible to communicate by reading her lips. She was too weak to point to letters on a board. And she constantly tried to talk. It tore my dad up.

[Neto]

What about refusing simple treatments or intervention because death is preferred.

These are tough questions. Intervention covers a huge range of treatments. My wife's parents both had living wills, but this was most clearly applied in her mom's case. She had already experienced a couple of heart attacks from which she was not expected to recover, but with the 'do not revive' order in place, she avoided having broken ribs, etc, from efforts to restart her heart. (At her age at the time, this is, as I understand, a very common result, one from which she probably would have have been able to recover, even if they did succeed in restarting her heart. I think of the way it is in the Banawa - it's simple - you either live, or you don't. There is no hospital for many miles around, and the closest ones are regarded by middle class Brazilians as a place you go to die, whether it ends up being the thing that sent you there, or something you caught there. Our eye doctor told us this during an appointment, when he was very preoccupied because his mother had been sent to the hospital.)

I do not regard refusing extended treatments when it is already 'known' that it is only "buying time". On the other hand, a missionary we know from Brazil has been past her "end of use date" for 30 years or more. Doctors don't always know, and advanced medical treatment is what has created these difficult questions.

[barnhart]

I once read some statistics about historical causes of death and many people died from causes now easily treated, things like broken legs were considered usually fatal. I suppose the category of "things easily treated" is constantly shifting. I have an acquaintance who is a MD with Amish patients and she has quietly advocated for treatment for children when the parents were inclined to "let God decide". At least one of those children who would have died is now a parent with children of their own.

[JohnH]

I once read some statistics about historical causes of death and many people died from causes now easily treated, things like broken legs were considered usually fatal. I suppose the category of "things easily treated" is constantly shifting. I have an acquaintance who is a MD with Amish patients and she has quietly advocated for treatment for children when the parents were inclined to "let God decide". At least one of those children who would have died is now a parent with children of their own.

I’m not convinced the modern era is some improvement over the general Amish view of “let God decide”. In particular, we have made the end of life for elderly quite gruesome, and for many children their start of life is often also quite gruesome.

[JohnL]

I once read some statistics about historical causes of death and many people died from causes now easily treated, things like broken legs were considered usually fatal. I suppose the category of "things easily treated" is constantly shifting. I have an acquaintance who is a MD with Amish patients and she has quietly advocated for treatment for children when the parents were inclined to "let God decide". At least one of those children who would have died is now a parent with children of their own.

Good points. Medical advances are happening all the time but I don’t think there’s a cure for old age. Everything wears out and dies.