Suicide & the Christian

[Gregory Matthews]

The following article addresses an important issue for Christians.

https://adventistreview.org/commentary/left-behind-the-suicide-survivors-perspective/

 

[GHansen]

14 hours ago, Gregory Matthews said:

The following article addresses an important issue for Christians.

 Major medical centers have groups known euphemistically as hospice teams. They are known in break rooms as the "death squad." Rare for someone to last more than a week once they come under "hospice care." Hospitals employ psychologist types to convince nurses that killing some one with narcotics or neglect, is perfectly fine for informed people who make that choice. It probably is in most cases. An unexpected stroke which incapacitates a patient during "routine" surgery can catch a patient and their family unaware. That's why everyone should have a DPOA for health care. Pulling the plug can be the best choice but without that document, it's going to be difficult. Depending on the situation, health care facilities can have a financial incentive for keeping people in the twilight zone.

[Gregory Matthews]

I Do not know if GHansen has ever worked in health care, or if he is just repeating some piece of Internet gossip that he once read.  I have spent 20 years working in a Federal hospital (VA) and a private hospital.  In my experience his description of hospice care is false.

NOTE:  His comment on the need to have a Durable Power of attorney (DOPA) is correct.

By definition, hospice only occurs when a patient is expected to live for less than six (6) months.  The patient is provided with care that makes the patient comfortable.  But, the patient is not provided with care which is not intended to make the patient comfortable but is an attempt to prolong life.  So, for example, a patient on hospice will not be taken into surgery and under heart surgery.  But, that patient will be given medication that will help the patient to be comfortable.

He uses the phrase "killing the patient with narcotics" in a manner that is a half-truth.  We have a machine that will breathe for the patient.   But, a conscious patient is very uncomfortable when placed on that machine.  So, we give the patient a narcotic that will relieve the pain and make the patient comfortable.  Our goal is to allow the patient to live long enough so that the patient can begin to breathe on their own again, which normally happens.  At that time, we take the patient off of the machine and we stop giving the patient the narcotic. The patient has been restored to life.

Some patients never regain their ability to breathe on their own.  They die.  Some will say that they died due to the level of narcotic that we gave them.  There is some truth in that.  I would say that the underlying issue was the real cause of their death.  In truth the narcotic made them comfortable and resulted in the life of some patients.

 

 

[Stan]

am very familiar with "Morphine Runs" on those terminals people that are suffering in  harsh inhuman way. If we treat animals in the same way as we treat our loved ones am sure someone would put is in jail.

 

Life is harsh.

[bonnie]

My mother cared for many, many hospice patients. My mother was in hospice the last week of her life.  I don't recognize the description of  " Hospice Care" from the care she and others gave their hospice patients and the care she received in hospice. It is true that my mother only lived one week in hospice but that was because I cared for her at home until I no longer could.

Hospice was in a wing of the hospital ,, the aides and  hospice nurses pulled out all the stops to keep the patients as comfortable as possible. For those that did not have family staying with them the nurses spent many hours with them, if only sitting quietly and holding their hand. One nurse out of all I did not allow near my mother. But that is in any profession

[GHansen]

2 hours ago, Gregory Matthews said:

In my experience his description of hospice care is false.

My remarks were not based on "your experience." 

 

2 hours ago, Gregory Matthews said:

I Do not know if GHansen has ever worked in health care,

That's true.

"He uses the phrase "killing the patient with narcotics" in a manner that is a half-truth."

Not at all. It's an accurate depiction of what happens in a major medical center. Certainly my choice of words was a bit indelicate; nevertheless, when a patient is fully aware of their surroundings, chatting with others, receives a terminal diagnosis, and is dead within a week after a medication protocol is devised with the order "titrate to comfort," call it what you like. They are being killed. 

[Gregory Matthews]

I am aware of what you describe.  That is not hospice care.   It is your suggestion that it is hospice care that I take issue with.   Two different ways in which to provide comfort care.

 

[GHansen]

25 minutes ago, Gregory Matthews said:

I am aware of what you describe.  That is not hospice care

Duly noted. How would you describe it?

[GHansen]

Perhaps more important then the DPOA is a DNR order.  If your family member goes down at home and you call an ambulance, Cowboy type paramedics will try to revive that person, even if they are 100 years old with a terminal diagnosis. Paramedic cowboys have no respect for DPOAs, or family members. If you have a legal DNR, they will leave your family in peace or they should. Also required in hospitals. Get a DNR and a DPOA. Another option is to not call an ambulance until several hours after the person is dead. They may still come charging into your home but shouldn't try to resuscitate the deceased. Laws probably vary from state to state. In hospitals, nursing homes, LTC facilities and the like, a DNR is essential.

Hospitals have wards known as Gomerville. Nearly every patient is on a tube feeding, oxygen and non responsive. The futility of treating these people is encapsulated in the acronym GOMER. It stands for "Get Our of my Emergency Room." It acknowledges the usual futility of "treating" these people.

[bonnie]

When I first explored hospice care this is what was stressed to my mother and me as her caregiver

No cowboy paramedic......

Hospice patients can ‘t call 911 or receive emergency services. Hospice staff educates patients and their families about their choices for emergency care. Do you have to call 911 if someone is dying? When there is a medical emergency, such as a heart attack, stroke, or serious accident, we know to call 911.

With or without a DNR  DPOA. Hospice had a specific function.  Never heard of a hospice like you describe

 Close family members of mine own and operate hospice care.  Not even close to what you describe

[phkrause]

We were very much surprised about hospice care! The reason is, I was told, by the nurse that took care of my mom, the they were nasty, and wouldn't take care of her like he did!! After we brought my mom to our house, we called hospice and had them come and tell us what they do. Well if we had know all they do and how well they cared for her, we would've done it sooner. My mom actually at first wanted nothing to do with hospice because of her nurse, who painted a very bad picture of them. Anyway whenever we called they came, she got so much more care than she had before. But they did do a re-evaluation every six months to make sure she actually needed them. Personally Hospice was the best care she had gotten in a long time!! We were very happy with them!!

[GHansen]

Probably wrong of me to use the term "hospice" when what I intended to describe, in some situations,  was "end of life care." Laws vary from place to place and they may have changed in the last 20 years or so; nevertheless, what I described was quite real and accurate. If you had a good experience with "hospice" care, that's wonderful for you. A hospital "death squad" is probably not to be included in the meaning of hospice, but it might be depending on the institution. Hospice team sounds much better than "death squad." Certain religious faiths, as a matter of principle, oppose hospice care. They believe that the breath of life itself is sacred; consequently quantity rather than quality of life is important. 

Something else to consider is the impact of managed care versus fee for service. It used to be that health care providers simply  billed insurance for services provided. That stopped with managed care. HCP were allowed a lump sum i.e., the more costly the treatment, the less profit for the HCP. Old days, a patient might linger on for a month, the HCPs billing for various services. Managed care, every day that patient hung on, profits dropped. Why should a patient linger on in agony for a month, torturing the family and reducing profits, when the matter can be resolved in a few days with morphine? Discussions regarding end of life options became more common Some Physicians also became proactive in preventing futile, costly treatment. AIDS also brought a new perspective to "end of life care, the "right to die" and "assisted suicide."

1. "Will the EMT withhold resuscitative measures at the families request if the EMT cannot find the DNR form or evidence of a medallion? NO. Unless they are absolutely certain that a qualified DNR advance directive exists for that patient EMS personnel will proceed with resuscitative measures. [Cowboys]

2. "What about other legal documents, such as a Durable Power of Attorney for Health Care (DPAHC?) or “living wills”. Are they acceptable in place of the Pre-Hospital DNR form? While such official documents are generally respected by EMS personnel (check with your attorney and with the local EMS agency in your county), it is important to keep in mind that most EMTs or paramedics do not have the legal training needed to interpret such documents, and more importantly, do not have the time to read a lengthy document and make a life-or-death decision on the scene. If in doubt, the EMS personnel will err on the side of the patient and provide resuscitative measures."

3. DNR And POLST Forms | EMSA (ca.gov)

4.  

[Gregory Matthews]

In the medical field, the word "hospice" has a very specific, clinical meaning.  You (GHansen) have been describing care that does not fit within the standard definition of hospice.  Phkrause and Bonnie have been more accurate than you have been.

Your comments as to a DPOA and a DNR have failed to recognize that there are considerable differences among the 50 of the United States.   A DOPA/DNR that meets the legal standard in one State may be worthless in another state.

In addition, a DOPA/DNR is of value in that it informs as to what the patient wants.  However, such may not be legally binding and medical personnel may not be required to follow such.  I have personally been involved in such.  In one such case the family members were united in telling the physicians not to put the patient on a respirator.  The physicians stated that they had already done so and were going to continue such.  The family stated that they were going sue the physicians.  The physicians said O.K. The patient will die if we take him off of the respirator.  We believe that the patient will walk out of the hospital if we continue the respirator. Hire your attorney.

The patient recovered and walked out of the hospital.  The threatened lawsuit did not happen.  

A DOPA/DNR may advise and not be binding.

[GHansen]

23 hours ago, GHansen said:

 

You are right Chaplain, I probably used the word hospice incorrectly, as I said in a previous post. Some institutions use the term, supportive and palliative care rather than hospice. I also mentioned that laws in different places vary

As for the DNR, please note: "This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life. The success rate of CPR near the end of life is extremely low. (See also Overview of Legal and Ethical Issues in Health Care.)" Also  "Additionally, first responders are almost always required to initiate life support unless a valid DNR order is in place and presented to them. Many states are now incorporating DNR status into a portable medical order called Physician Orders for Life Sustaining Treatment."

According to an article here A patient sues when a DNR is ignored (kevinmd.com), most lawsuits are settled without trial. In one case that went to trial, a $1,000,000 was awarded the family of a man who was resuscitated contrary to a known DNR order. It's my understanding that a DNR is legally binding. Contravening it can lead to liability.

The doctor of an acquaintance contravened his DNR. The patient lived for many more years. There was no lawsuit. I'm fairly certain that another outcome such as paralysis, vegetative state would have led to a lawsuit which the physician would have been highly motivated to settle without a trial.

Nurses, sometimes, pit themselves against family members, over DNR orders. They might lie to family members about the  nature of treatments, describing aggressive antibiotic intervention as comfort care. A family that has been caring for an incontinent, assaultive, non communicative patient for a decade, has a different view of the matter than a nurse who has seen the patient for a week.

If you disagree with my point of view, that's fine. That's why there are lawyers, cash settlements, judges, courtrooms and juries. People with DPOA must be sure about their convictions. If they waffle, health care personnel might run over them in carrying out their own agendas Some hospitals have onsite legal services to help people understand the issues Best to have an attorney prepare documents  that will help burn down those who contravene orders.