There is a divide in what medical ethics and most health professionals and what some patients consider active hastening death. This article contributes to what is known about how patients perceive end-of-life practices that potentially hasten death. Participants asserted that active and passive practices for ending life were morally equivalent, and preferred to choose the time of death over other legal means for death. They implied such practices were performed without patient consent, though they did not conceive of this as murder.
Some participants did not agree with the 'doctrine of double effect' ('DDE') and saw such practices as 'slow euthanasia' and 'covert euthanasia'. Most of the participants viewed current palliative care practices, such as pain relief with opioids and symptom management with PS, as hastening death, in contrast to some medical research which concludes that proportional therapeutic doses do not hasten death. We compared the findings to prevailing ethical frameworks. Interview transcripts were inductively analyzed consistent with thematic analysis. We asked them about why they would consider AD if it was available. An additional six family members were also interviewed and included in analysis. Their mean age was 61 (range, 34-82) years and half were enrolled in Hospice. We recruited 14 people with life-limiting illness and life expectancy of less than a year. The aim of this article is to describe the perspectives of a group of New Zealanders with life-limiting illness, who want or would consider AD, on the provision of end of life services, including assisted death, withdrawal of lifeprolonging treatment and symptom management with opioids or PS. Its relationship to other end-of-life practices such as palliative sedation (PS) is the subject of ongoing debate. Appropriate use of these pain relievers does not shorten life or prevent breathing.Assisted dying (AD) is currently of wide interest due to legislative change. Properly prescribed opioids do nor cause or hasten death but can make the patient more comfortable. All side effects can be managed properly and rarely interfere with a patent’s ability to use opioids. Sleepiness or sedation can also result, especially when morphine is first started or when the dose is increased. However, some experience side effects of nausea, vomiting or constipation. Most patients find they function very well while taking pain medication. These are called “break-through” or “short-acting” medicines. If there is pain between regular doses of long-acting opioids, other medications can be given as needed. Controlled release opioids are “long-acting” medicines taken every 12 hours. Pain can be helped most effectively by taking pain medication on a regular basis as prescribed. True addiction is rare when opioids are used to relieve pain. Opioids do not quit working over time, but the dose may need to be increased as pain increases. If a patient’s pain requires the use of strong opioids, they should be used immediately as this will help prevent changes to the nervous system that can make future pain more difficult to treat. Giving them early in the disease process does not limit the amount that can be given later as the disease worsens. There is no maximum dose and the dose can be increased as needed. When opioids are no longer needed, the dose is gradually decreased. They can also be given by rectum, injection or IV, and can be “short-acting” or “long-acting”. Most often opioids are given as a pill or liquid. It can relieve “air hunger” and make breathing more comfortable. Studies have documented that morphine relieves the sensation of shortness of breath. It enhances quality of life and helps patients to live more fully and comfortably. While morphine is used in all stages of illness, many patients under hospice care have pain and/or shortness of breath which is best managed by morphine. Why are opioids used in hospice patients? Oxycodone is a semi-synthetic pain reliever with actions similar to those of morphine. It is used to relieve moderate to severe pain or shortness of breath. Morphine is a pain reliever that acts directly on the central nervous system (brain and spinal cord). Both are referred to as “opioids.” They are the two most commonly used opioids in hospice and palliative care. There are many myths associated with morphine and oxycodone use. Help When You Are Not Ready for Hospice.Tree of Light: Remember Your Loved Ones.Watch as Caregivers Talk About Our Care.Help in Your Nursing Home or Assisted Living.The Butterfly Program & Pediatric Hospice Care.
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