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Thread: The right to die--ethical dilemmas in persons with spinal cord injury. SCI Nurse?

  1. #11
    SCI Nurse, thank you. This is excellent information. When I was in my most serious pain, I checked into palliative care in my area. I could never get a clear understanding of the differences between hospice and palliative care. There seemed to be two paths. 1. Pain management - for chronic long term situations. 2. Hospice/palliative care - end of life stages. This may be in part because I live in an area without an established multidisciplinary practice.

    There still seems to be lots of grey areas when it comes to pain management for someone who is not terminal. Meds often cannot control the pain. As funklab described above, if you lack dexterity, you can find yourself in a real jam for a very long time.

    regardless, I always appreciate information and feedback
    Jason

    C5/6 Complete - water skiing accident 1994.

  2. #12
    Quote Originally Posted by Le Todd View Post
    Many genuine suicidal attempts fail. It has nothing to do with the fear of death, but about efficiency. Are you going to seriously argue with me that terminally ill people who're suffering don't genuinely want to die peacefully because they're not putting a bullet to their skull?
    Anyone with reasonable hand dexterity and an IQ above 70 can easily kill themselves on the first try. I've definitely seen people fail, but I'd argue they were in the depths of a deep depression that did not allow rational thinking (shooting yourself in the abdomen?!?!?!?!? in what world is that going to work well for you) or the old standard overdose on tylenol which is almost always meant as a suicidal gesture (but can easily cause liver failure and a prolonged and very painful death). I haven't searched google for ways to kill yourself, but I can't imagine it would take more than ten minutes of searching to find an effective way, if you're too apathetic for that, you are severely depressed and not "rationally" suicidal (whatever that means). I've seen dozens of people in the hospital who have failed suicide attempts with blades, guns, drugs and self-induced car wrecks, but with one exception they all said they were glad to still be alive (despite the severe medical consequences of what they had done to themselves). The one person who still wanted to die had been intoxicated when they tried to kill themselves, or they probably would have been successful.

    Enabling someone to commit suicide isn't necessarily a bad thing, but the healthcare system doesn't need to have anything to do with it (in all but the most extraordinary situations). The one thing that bugs me in some ways is that because of the system we have to keep people alive (involuntary psychiatric commitment and the illegality of suicide) people outside of states with a right to die law cannot say goodbye to their friends and family and bow out gracefully surrounded by loved ones. That part is a shame, but the same can be said for 95% of people who die from natural causes.

  3. #13
    I agree. I also find it distressing the number of my clients who refuse to set up an advance directive for themselves, and to choose an agent who will follow their wishes related to this. Whether you want extraordinary measures taken or not in a serious illness, unless you have set up an advance directive, all efforts will be made to maintain you "alive". I know mine is quite extensive in the specifics for myself, and I have made this very clear to my sister (who is my first "agent") that I expect her to make decisions for me if I cannot that are consistent with my directions in my advance directive.

    (KLD)

  4. #14
    Senior Member Stormycoon's Avatar
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    Irelevant input . Please delete
    Last edited by Stormycoon; 01-02-2016 at 01:37 AM.
    I am not your rolling wheels
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  5. #15
    Quote Originally Posted by funklab View Post
    Anyone with reasonable hand dexterity and an IQ above 70 can easily kill themselves on the first try.
    I know, but I'd hate to shoot my brains out, live, and having had wronged my beautiful visage and brilliant mind.


  6. #16
    Senior Member Oddity's Avatar
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    Quote Originally Posted by Le Todd View Post
    Many genuine suicidal attempts fail. It has nothing to do with the fear of death, but about efficiency. Are you going to seriously argue with me that terminally ill people who're suffering don't genuinely want to die peacefully because they're not putting a bullet to their skull?
    If you're after efficiency there are plenty of reliable options that have nothing to do with asking someone else for help, or asking The State, or the medical establishment, for validation.

    I am saying anyone that genuinely wants to die, and is still alive, doesn't really want to die. It is incredibly easy to end a human life. Obstacles that exist are between our ears, and yes, they boil down to fear.

    Fear of the process. Fear of messing it up. Fear of the pain.

    Whatver the obstacle it is born of a fear.

    A fear that is only proven over come after the deed is done.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  7. #17
    Senior Member Oddity's Avatar
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    Quote Originally Posted by Le Todd View Post
    I know, but I'd hate to shoot my brains out, live, and having had wronged my beautiful visage and brilliant mind.

    Fear of being an ugly idiot. I left that one off my list.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  8. #18
    Senior Member Oddity's Avatar
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    Quote Originally Posted by funklab View Post
    Anyone with reasonable hand dexterity and an IQ above 70 can easily kill themselves on the first try. I've definitely seen people fail, but I'd argue they were in the depths of a deep depression that did not allow rational thinking (shooting yourself in the abdomen?!?!?!?!? in what world is that going to work well for you) or the old standard overdose on tylenol which is almost always meant as a suicidal gesture (but can easily cause liver failure and a prolonged and very painful death). I haven't searched google for ways to kill yourself, but I can't imagine it would take more than ten minutes of searching to find an effective way, if you're too apathetic for that, you are severely depressed and not "rationally" suicidal (whatever that means). I've seen dozens of people in the hospital who have failed suicide attempts with blades, guns, drugs and self-induced car wrecks, but with one exception they all said they were glad to still be alive (despite the severe medical consequences of what they had done to themselves). The one person who still wanted to die had been intoxicated when they tried to kill themselves, or they probably would have been successful.

    Enabling someone to commit suicide isn't necessarily a bad thing, but the healthcare system doesn't need to have anything to do with it (in all but the most extraordinary situations). The one thing that bugs me in some ways is that because of the system we have to keep people alive (involuntary psychiatric commitment and the illegality of suicide) people outside of states with a right to die law cannot say goodbye to their friends and family and bow out gracefully surrounded by loved ones. That part is a shame, but the same can be said for 95% of people who die from natural causes.
    Good points, as usual.

    I can't help but wonder how a "right to die", as validated by law, can be reasonably contained to the terminally ill, or those chronically suffering intensely, as validated by medical establishment.

    If there is to be law, and it doesn't affirm the right as natural and inalienable for everyone, I couldn't support it.

    We either own the living of our lives, or we don't. If The State owns it, as they currently seem to, by reserving the right to execute undesirable citizens, while denying citizens equal power over their own existence, then no one should be granted special dispensation.

    The most important ethical consideration, IMO, is whether or not our lives are actually our own, under the law.

    I also wonder whether a "right to die" could ever create legal obligation for anyone other than the individual that wants to die. It does seem to currently mean the "right to be assisted by the medical establishment" in dying. What if no one wanted to help? Does not providing the assistance constitute a violation of someone's "rights"?

    Another thing I wonder about is how low do we want to set the bar for making the decision. If the process is made very simple, painless, and/or otherwise "peaceful", then the natural obstacles are being eliminated, therefore the amount of suffering in life required to overcome the natural obstacles also becomes lower. In other words, the easier the process of dying is made by technology, the easier the decision to end one's life becomes. How easy of an "establishment" process do we want to make it?

    I see images of a dystopian future in which "the establishment" sanctions suicide, and the process of dying becomes a twisted commercialized parody. If the state fully validated our natural right to die, why couldn't we sell our lives for the benefit of our survivors? Running Man, Hunger Games, for profit death!!! Sweet!
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  9. #19
    Senior Member lynnifer's Avatar
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    This is (was) just coming to fruition in Canada ... but according to most statements, good luck finding a doctor to aid in the transition. Kevorkian was right all those years ago!
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  10. #20
    There is a young man that is a C2 with a brain injury. He's unable to move below his chin and has been suffering this way for years. I've been communicating with him hoping to just provide an outlet. However, his condition, along with some of my own experiences is what prompted the initial questions.

    I have no doubt that as a C5/6, I could figure out how to end life if truly motivated. Although, even for myself, I would prefer to say goodby.

    It's not my place to suggest anything to this young man or his family. It has just stirred a stronger desire to learn. Perhaps then I might be in a position to answer a question or suggest a direction if asked.

    It just sucks that this person and everyone around him is stuck in such a horrible position! Sorry venting a bit.
    Jason

    C5/6 Complete - water skiing accident 1994.

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