Palliative sedation, an end-of-life practice that is legal everywhere

WASHINGTON — Toward the end, the pain had practically driven Elizabeth Martin mad.

By then, the cancer had spread everywhere, from her colon to her spine, her liver, her adrenal glands and one of her lungs. Eventually, it penetrated her brain. No medication made the pain bearable. A woman who had been generous and good-humored turned into someone hardly recognizable to her loving family: paranoid, snarling, violent.

Sometimes, she would flee into the California night in her bedclothes, “as if she were trying to outrun the pain,” her older sister Anita Freeman recalled.

Ms. Martin fantasized about having her sister drive her into the mountains and leave her with the liquid morphine drops she had surreptitiously collected over three months — medicine that didn’t relieve her pain but might be enough to kill her if she took it all at once. Ms. Freeman couldn’t bring herself to do it, fearing the legal consequences and the possibility that her sister would survive and end up in even worse shape.

California’s aid-in-dying law, authorizing doctors to prescribe lethal drugs to certain terminally ill patients, was still two years from going into effect in 2016. But Ms. Martin did have one alternative to the agonizing death she feared: palliative sedation.
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11 Responses to Palliative sedation, an end-of-life practice that is legal everywhere

  1. Padawan says:

    Why do we have the rights to put our pets down when they’re suffering like this but not ourselves or other suffering human beings?

    • Trish says:

      I just watched my Dad pass away on July 2nd. His greatest fear was to lie there in a vegetative state and that is what happened. He hung on for a week. It was the hardest thing I have ever done. I miss him. Still trying to deal with it.

      When my time comes it will be when I choose. I have already made plans and let my kids know of my wishes. I do not want to lie there like that.

      • Wirecutter says:

        My dad went into the state the day before he died. I remember sitting there the next day looking at that big bottle of morphine and I knew he wouldn’t survive the night if I had 2 minutes alone with him.
        Luckily he did die that night so I didn’t have to kill my father.

  2. Winston Smith says:

    FUCK Assholepoliticians. Its MY life and I’ll do what I want with it, including deciding when to end it.
    Keep a person from that and they might decide to take the motherfucker that is legislatively causing his pain with him on the short ride to hell.

    • Winston Smith says:

      EDIT/CORRECTION:

      Should have read “FUCK Assholepoliticians and Sanctimoniousassholereligiousnuts.”
      Sorry for the omission of the other of the worlds string pullers.

  3. Sanders says:

    If I ever get that bad, my family knows that if I am able, I will crawl up into the mountains and let things take its course.

    Bears gotta eat, too – same as worms.

  4. Mike_C says:

    I could talk for hours (or write 1000s of words) on this topic, because it is important for many reasons, but unless there’s interest, I’ll leave it at the following two items.

    Nearly any MD who has served as the attending of record (the primary doctor, not a consultant* such as a psychiatrist, or a podiatrist or something) in an inpatient hospital setting (especially in an ICU) has given orders for medication with the full knowledge and expectation that those orders will lead to the death of the patient. It is done NOT to euthanize the patient, but to alleviate pain (or air-hunger — the sensation of suffocating, for various reasons) in a terminal patient. As the linked article (I only skimmed it) says, the ethical/moral/legal issue is one of INTENT. This is NOT specious logic chopping**, it is at the core of what we do and why we do it.
    This is a link to an article called How Doctors Die by a fellow called Ken Murray, a family practice physician. I think it is pretty good.

    http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html

    Footnotes
    *attending doctor vs consultant: I am using American terminology. Confusingly, what we call an “attending” in the US, in the UK they call a “consultant”.

    **logic chopping. If you think INTENT behind a medical procedure doesn’t matter then every damn surgeon ought to be locked up. Because cutting a living human being open with a scalpel is vicious, cruel and illegal (and my cardiothoracic surgeon colleagues subsequently take a fucking power saw to the breastbone and crack the chest cavity open, for example). If you (or I) went on the street and slashed open a random stranger with a scalpel you (or I) would go to jail. But do it in an operating room with the purpose of trying to fix some problem, and you are a good guy. Intent ABSOLUTELY matters.

  5. Andrew says:

    It’s called ‘snowing’ and it is practiced in hospitals all the time.

    Also the reason some coroners don’t look too deeply when the seriously fucked-up by life people ‘accidentally overdose.’

  6. Bacon says:

    No matter what one believes, suffering as the body breaks down is hard to deal with. But it’s actually harder, not easier, for religious folks. On the one hand, we’re supposed to emulate the compassion of the Lord (to the extent of our limited human capacity), which means we desire to end suffering. On the other hand, life is sacred, and the Lord gives us our suffering purposefully, and suicide is a sin. Quite a catch-22.

    FWIW, I used to believe in palliative-only end-of-life care. Now I strongly believe that we are expected to endure the unendurable, for the good of our souls. But being weak as I am, if and when the time comes and I still have the ability to give myself a way out, I’m pretty sure that’s what’s likely to happen. (If I can head for the hills and do it there, so much the better.)

    Part of this comes from personal weakness. Part of this comes from life experience (I’ve been a hospice care provider for a family member and witnessed months of unbelievable agony in one of the strongest people I ever knew.) Part of this comes from not trusting modern medicine. And part of this comes from simply being a stubborn SOB.

    I think it comes down to personal choice. After all, isn’t that the essential nature of free will? I’m utterly sympathetic to those who want palliative-only care, including terminal sedation. Just as I’m in awe of those with the inner strength to endure and see the process of dying through until the end. May G-d have mercy on each of us and grant us all a peaceful end and an easy transition.

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