How can they enjoy themselves when they are riddled with pain? I guess high doses of morphine could be administered but I doubt it would amount to 'enjoying their remaining years'
i agree with your sentimate 100%, im not sure whats BEHIND your argument but the argument itself i agree with. Morphine IS relitivly safe (safer than alot of other drugs) even in very high doses as long as the pain matches the morphine level (ie if you double the pain you can double the morphine without an increase in respitory supression and the other side effects), however its by no means perfect and by no means does it work in all cases for pts with massive end stage pain. under current legislation all that can be done for these pts is to combine morphine with another drug (medazilam, a related drug to diazapram, valium, which im sure everyone has herd of) which causes a chemically indjuced coma until these pts die of respitory failure (either directly due to the doses of morphine or an untreated pnemonia). This is concidered to be gold standed palitive care because its aim is the management of pain however if anyone where to watch these pts, knowing there was a better option to offer to them we would see how backwards palitive care really is. Now im not arguing against this treatment at all, pain management and the right to refuse invasive and painfull treatments which carry huge side effects and surverly limit quality of life is a RIGHT to all people whos disease has progressed to a state where conventional treatments with all there side effects could offer them only days or weeks (right to refuse treatment is a right to all no matter what but im talking about this specific group). The problem is that there is another choice which could be offered to them, its the same choice we all make for our pets when they suffer and which has wide spread surport from pts in this situation, there families, health care workers, some pollitions and the general public at large. Sadly though there is a lack of political will to carry through on it by the major parties (at least in Australia). This option is vollentary chemical euthanasia and doctor assisted suicide.
Now there are various ways this could be carried out humainly, some people and doctors surport CO admistration, others helium. My feeling is that this excludes the family from being present when the pt dies and being able to hold there hand because its hard to do this in a sealed enviroment so the only person who is inhaling the gas is the pt. Some surport a potassium OD, the same as is used in lethal injection in the US but there are problems with that as well, evidence is currently being examined as to wether this causes a painful death which has been unrecognised because of the joint admistration of paralitics. Parlitics alone will cause respitory failure but it wont be a plesant death for either the family or the pt as their body gasps for air. So my personal preference is the very safe drug morphine, if given in a massive (massivly above the level of pain i mean) rapid dose it will cause type 2 (wont breath) respitory failure. This means that pts simply lose the drive to breath in responce to the first hypercarbic and then hypoxic drives to breath. These simply stop being recived by the respitory center of the brain and the pt has no desire to breath. There would be no gasping for air, no panic from the pt as there is for those who die from type 1 respitory failure (cant breath), some examples being drownings, asthma, pnemonia, simply a slowing of the respitory rate until it eventually stops. Further more because morphine is an IV drug (in this case anyway, i know it can be given orally, subcut ect) there is no reason why the pts family couldnt be sitting with them holding there hands, stroking there hair, whatever they wanted to do for both the pt and themselves.
I dont mean to suggest that this should be manditory or replace good quality pt care and palitive care but rather that this should be an option for the pt if THEY chose it.
One last thing to think about, if you were in that situation. Knowing you would be dead with in the week and faced with a choice of "chemical oblivian" (which might not even work, alot of pts wake up from this repeatedly as the doctor tries to assess the level of drugs needed) or a quick painless death which would you chose?
Ethically i cant see a difference between chemical oblivian and doctor assisted suicide