Physician's Notebooks 10 - http://physiciansnotebook.blogspot.com - See Homepage
(Includes Chapter 9 on doing suicide. Scroll down. Updated 22 September 2021 new Physician-Assisted Suicide.)
(Includes Chapter 9 on doing suicide. Scroll down. Updated 22 September 2021 new Physician-Assisted Suicide.)
8. Voluntary or Decided Death
“Should we assist a person to die?” becomes important as modern medicine can keep an end-of-life, nearly brain-dead person alive, prolonging suffering, and causing terrific expense for the family and society.
“Should we assist a person to die?” becomes important as modern medicine can keep an end-of-life, nearly brain-dead person alive, prolonging suffering, and causing terrific expense for the family and society.
Depending on the situation, I should like my caregivers to allow doctors to assist or speed my death in a terminal illness. Each person must decide based on latest facts and a logical, scientific idea.
At present, a voluntary-death-seeker must anticipate problems.
In Japan, a hospice for terminal cancer patients may allow a non life-support death.
If a chronic condition with near death is certain and one desires death, and if one can arrange it, then termination is best. If no choice but at home, it is best to have a companion who will assist your death-wish when you lose control. (To read a useful fictional account from http://adventuresofkimi.blogspot.com, Slim Novel 12, click 12.36 Helping Dan Die - The Morphine Effect )
The mode of assisted medical dying is: 1) Voluntary avoidance of life-sustaining actions by reducing oral intake and by not starting it or; if started, stopping life-sustaining medication; 2) No life prolonging technology; and 3) Injection of morphine to stop breathing. The late UK King, George V, (grandfather of the current Queen Elizabeth), was said to have been “mercy killed” with morphine at home with the consent of family, and my second wife was put out of her terminal liver-cancer coma life with an Intra-Venous morphine drip in a hospice, and it worked well.
If a chronic condition with near death is certain and one desires death, and if one can arrange it, then termination is best. If no choice but at home, it is best to have a companion who will assist your death-wish when you lose control. (To read a useful fictional account from http://adventuresofkimi.blogspot.com, Slim Novel 12, click 12.36 Helping Dan Die - The Morphine Effect )
The mode of assisted medical dying is: 1) Voluntary avoidance of life-sustaining actions by reducing oral intake and by not starting it or; if started, stopping life-sustaining medication; 2) No life prolonging technology; and 3) Injection of morphine to stop breathing. The late UK King, George V, (grandfather of the current Queen Elizabeth), was said to have been “mercy killed” with morphine at home with the consent of family, and my second wife was put out of her terminal liver-cancer coma life with an Intra-Venous morphine drip in a hospice, and it worked well.
Physician-Assisted Suicide is available legally in the USA in the states of Washington, Oregon, Montana, Vermont, California, Hawaii and Main, and in the District of Columbia (City of Washington). For specifics of each state or the district one can consult the Internet. Here is an abstract from Oregon’s law, which is a model for the other states: The patient must be certified as terminally ill expected to die within 6 months and mentally competent by a state licensed physician and a 2nd doctor must agree. Patient must be a resident of the state. (But it may be recent.) There is a 15-day wait period between patient request and doctor’s writing Rx for the suicide dose of medication.
The patient receives the doctor Rx—-it is typically 9 grams secobarbital in capsules or 10 grams of pentobarbital liquid to be taken at one time on an empty stomach.
The experience data—-now several years along—-is uniformly good. No state has reversed the laws and they have been upheld by SCOTUS.
9. Suicide
Distinction should be made between rational and irrational suicide. Rational suicide may be in one's best interest. Rational suicide motives include escape from fatal progressive, painful, incurable illness. Also where the suicide helps family or companion by preventing the burden and cost of care. A rational suicide is not impulsive and not done quickly without careful consideration.
Irrational suicide is connected to social disgrace, financial failure, existential despair or is just impatience. It is usually a poorly thought out; often dramatic act, like jumping or hanging ( cf. David Foster Wallace).
A person wanting suicide should consider the bad effect on family member especially child, i.e., disruption of society as in jumping from building or in front of train, and try to avoid it by doing the suicide in a quiet place, with no left-behind pills or bottle, no last letter.
Most suicide is an irrational, selfish act – it means ending one's only experience of consciousness. One who accepts that should not volunteer lightly to say permanent goodbye to consciousness.
From caregiver, therapist, family member, close friend standpoint, every obviously or diagnostically depressed patient should stimulate immediate intervention to head off suicide. First directly ask the patient “Are you thinking of ending it?” Second, try to determine if the suicide is rational or not, and in either case put the patient on a suicide-watch (Constantly observed by companion while engaging the patient in Cognitive Behavioral Therapy [CBT] of Dr Aaron Beck in which one directly addresses the rationality and purposes of the patient’s plan.) And third (with assistance of M.D. psychiatrist) convince the patient to start anti-depression medication. Obviously it is difficult but if one really cares for the patient, success can happen more than one might expect.
Suicide should not be rushed. The more you feel you must do it now, the more to delay. Easiest delay is sleep. If nothing else, take sleep pill or alcohol. Or a strong-dose opioid. Or a double-dose anti-depression med like Tofranil (imipramine) two 25 mg tabs. The endorphin pleasure will delay the suicide attempt enough to allow one to change mind. No one commits suicide who is feeling good, whether the good feeling is natural or drug induced.
Phenobarbital has been a popular suicide pill. (But note the experience with secobarbital and pentobarbital in Physician-Assisted Suicides as given above.) The problem is, and I have experimented, it takes too many pills for the suicide and you cannot sure if you have taken enough. So, I have given up on the idea of relying on phenobarbital alone. Phenobarbital is a slow actor so even after swallowing a fatal dose you will have a few hours consciousness before deep, terminal sleep. If you change mind, you may reverse suicide by phoning 911 and eating activated charcoal (obtained ahead through drugstore) until it provokes vomiting.
Assuming you do not change mind, you will lapse into sleep and then coma and your phenobarb blood level will peak during the 6 to 18 hours after swallowing all pills. Phenobarb slows and finally stops breathing. Death should come between 18 and 24 hours but some have lingered in deep coma for up to 96 hours. If you are going to try it, best at the start of a long holiday behind your locked door so that no one comes upon you while you are sinking into deadly coma,
The phenobarb pills come as 15, 30 and 60 mg; the easiest pill to get in bulk (by M.D. Rx) is the 15 mg. The 1.5 g possibly fatal dose is: 1,500 mg, obtained by approx. 25 sixty mg, 50 thirty mg, or 100 fifteen mg pills. Splitting the dose into 2 is useful: the initial dose is one third of the total dose and the remaining 2/3 is taken when sleepiness starts. Splitting allows you to change mind and not suffer bad consequence and it will also make less likely to vomit.
For those coming upon a suicide try, here are the stages after taking the suicide pills.
1: Stupor – immediately provoking vomiting will save life here.
2: Asleep and not aroused by shouting into ear but moves extremity on sharp pinch. Stomach pump can save life here.
3: Painful stimuli result in no movement yet the suicide person still breathes regularly and skin warm. Here death is hour(s) away. Renal dialysis may save it!
4: Shallow breathing and slow and irregular, worse yet, gasping; eye pupils dilated. Here death is imminent. Death can be diagnosed when breath has stopped for more than 3 minutes and eye pupils remain dilated and fixed even when flashing bright penlight in eye in dark room. Skin becomes cool within minutes after death.
The 1997 suicides of the Heaven's Gate cult show the efficiency of phenobarb in assisting suicide. They added a plastic bag tied about head. In news report the medical examiner is quoted as lethal dose “50 tablets” but mg dose of the tablets was not reported. Sixty mg pill would be 3 g; 15 mg pill would be 0.75 g.
Finally it should be mentioned that the reason behind irrational and many rational suicides is our faulty social system. A social system that addressed itself to these needs - financial, attitudinal, etc - would eliminate the problem.
Finally it should be mentioned that the reason behind irrational and many rational suicides is our faulty social system. A social system that addressed itself to these needs - financial, attitudinal, etc - would eliminate the problem.
END OF CHAPTER: For fictional chapters about rational suicide click
12.33
Dear Miss - Could You Help Me to Die?
12.34.
Suicide Should be Painless
To read next, click 10.10 Why Seek Healthy Longevity?
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