japanese war crimes-- was hiroshima

Using an alcohol swab, ostensibly to prevent infection, on someone
who will be dead in an hour seems to speak for itself

Well, perhaps it's for the sake of the doctor, either to reassure him
that what he's doing is a normal medical procedure, or perhaps only so
he won't get out of the habit of disinfecting when he's dealing with
people he's trying to save!

Thank you, Howard, for a sane and reasoned take on a difficult
subject.


all the best -- Dan Ford
email:

see the Warbird's Forum at www.warbirdforum.com
and the Piper Cub Forum at www.pipercubforum.com

In article , Cub Driver
wrote:

Using an alcohol swab, ostensibly to prevent infection, on someone
who will be dead in an hour seems to speak for itself

Well, perhaps it's for the sake of the doctor, either to reassure him
that what he's doing is a normal medical procedure, or perhaps only so
he won't get out of the habit of disinfecting when he's dealing with
people he's trying to save!

Thank you, Howard, for a sane and reasoned take on a difficult
subject.

The subject gets truly weird at times. One anti-lethal-injection legal
campaign, rejected by the courts, pointed out that thiopental sodium,
pancuronium bromide and potassium chloride had not been given an FDA
"safe and effective" approval for the indication of execution.

It turns out that the FDA does, in fact, approve drugs for the specific
purpose of veterinary euthanasia, and, in keeping with the regulations
on drug approvals, designates them "safe and effective" for the marketed
purpose.

Think about that one for a while. Moderate consumption of ethanol, in
your choice of flavor, is usually safe and effective for the resulting
brain tilt.

It turns out that the FDA does, in fact, approve drugs for the specific
purpose of veterinary euthanasia,

Isn't that sodium pentathol? (I'm not sure about the spelling.) We
once put down a St Bernard who weighed almost as much as I do, and at
the time I marveled what an easy death that was.

all the best -- Dan Ford
email:

see the Warbird's Forum at www.warbirdforum.com
and the Piper Cub Forum at www.pipercubforum.com

Cub Driver wrote:

Isn't that sodium pentathol? (I'm not sure about the spelling.) We
once put down a St Bernard who weighed almost as much as I do, and at
the time I marveled what an easy death that was.

I've done the "final visit to the vet" on several occasions. It's
the downside of the wonderful experience of owning a pet [dog].

The end comes so quickly and quietly, it really makes me wonder.
Is it "inhumane" to apply on humans? Would it really be "unethical"?

As opposed to often months of watching someone you care for die
with the aid of "advanced medicine".

Sometimes "ethical" and "humane" seem antagonistic.


SMH

In article , Stephen Harding
wrote:

Cub Driver wrote:

Isn't that sodium pentathol? (I'm not sure about the spelling.) We
once put down a St Bernard who weighed almost as much as I do, and at
the time I marveled what an easy death that was.

I've done the "final visit to the vet" on several occasions. It's
the downside of the wonderful experience of owning a pet [dog].

The end comes so quickly and quietly, it really makes me wonder.
Is it "inhumane" to apply on humans? Would it really be "unethical"?

As opposed to often months of watching someone you care for die
with the aid of "advanced medicine".

Sometimes "ethical" and "humane" seem antagonistic.


It's a terribly difficult question. I did feel a deep emotional bond
with my last cat to die, who seemed to tell me when he still wanted to
go on -- and there were, indeed, treatment options for his bladder
cancer. He wound up not being euthanized but dying at home. Before he
died, he spent a long time in my arms, and I'd swear we agreed that it
was OK for him to go. To my surprise, as opposed to my other cat, be
chose not to die with me holding him. I had fallen asleep from sheer
exhaustion, but I (and my ex-wife) sat bolt awake at the same moment,
which probably was close to what we can reconstruct was the time of
death.

It was much more difficult with my mother, although there were
significant differenes. She had metastatic breast cancer in 1975, and,
while she was in active treatment, I wound up in role beyond the usual
surrogate responsibility -- a fair bit of the staff didn't tell her
things but would want me to break news and get decisions.

She phoned me at one point, telling me that the nurses were annoying
her, asking her to put in several IVs to "build up your strength, dear."
It fell to me to tell her the truth: that the IVs were very
specifically to counter a drug reaction that would, untreated, kill her
painlessly in 48-72 hours. I felt I had to give her the options --
there was one more treatment that might have any hope, although the
chance of it working was low. I explicitly told her I would suppport her
decision either way, and didn't consider it cowardly if she chose to
refuse the immediate treatment.

The long-term outcome was bad. She did respond to the immediate
treatment, but the new treatment was ineffective. She was then
transferred to a VA hospital (she had retired medically from the Army
Reserve), and the VA staff was far less willing to accept any input from
someone even named in an advanced directive. She crumbled for several
months, including a phase of brain metastasis where she felt her
consciouness and memory slipping away. At that point, I told her staff
comfort measures only -- do not attempt to cure potentially fatal
complications such as pneumonia. They refused, and, indeed, insisted on
intense life support even when she certainly was no longer conscious,
and was not going to wake up.

Howard Berkowitz wrote:

It's a terribly difficult question. I did feel a deep emotional bond
with my last cat to die, who seemed to tell me when he still wanted to
[...]

Definitely the tough side of having a pet.

It was much more difficult with my mother, although there were
significant differenes. She had metastatic breast cancer in 1975, and,

[...]

consciouness and memory slipping away. At that point, I told her staff
comfort measures only -- do not attempt to cure potentially fatal
complications such as pneumonia. They refused, and, indeed, insisted on
intense life support even when she certainly was no longer conscious,
and was not going to wake up.

Sounds like you've been through the wringer. Been there myself so I
can sympathize.

Problem is, medical people are trained to "keep people alive". You
know, "do no harm", at least in a physical sense.

Technology can drive a glimmer of hope in immortality. "It's not
*fair* to die; we can *fix* it!" We all know we die. We just
don't believe it.

Death is natural. But sometimes, it seems the medical community,
and the consumer of medical services, looks upon it as a cop out
or a failure.

Irrespective of our feelings, eventually, it's simply time to go!


SMH

On Mon, 19 Jan 2004 07:22:44 -0500, Stephen Harding
wrote:

Cub Driver wrote:

Isn't that sodium pentathol? (I'm not sure about the spelling.) We
once put down a St Bernard who weighed almost as much as I do, and at
the time I marveled what an easy death that was.

I've done the "final visit to the vet" on several occasions. It's
the downside of the wonderful experience of owning a pet [dog].

The end comes so quickly and quietly, it really makes me wonder.
Is it "inhumane" to apply on humans? Would it really be "unethical"?

As opposed to often months of watching someone you care for die
with the aid of "advanced medicine".

Sometimes "ethical" and "humane" seem antagonistic.


SMH

I have problems with actual termination of humans-- it opens so many
cans of worms, legal and ethical alike.
But...
I've seen friends and family kept alive long past the point where
they woudl naturally die. Long past the point where there was any
hope that they would get better-- in extreme cases where you just had
a mindless husk being kept alive by machines.
I think the problem is that the idea that the doctor will do
everything to keep you alive has ignored the fact that we *are* going
to die at some point, and that as medical technology gets more
advanced that point that be delayed long past where it should happen.
But on the other hand, that's a terrible decision to make-- and there
have been cases of criminal or ethical charges being brought against
doctors who have done so, even with the cooperation of the family.
Dr. Kevorkians antics didn't help the debate any either, of cousre.

Charles Gray wrote:

I have problems with actual termination of humans-- it opens so many
cans of worms, legal and ethical alike.

Definitely so. It should always be difficult concept to wrestle with,
or we've gone terribly wrong.

I think the problem is that the idea that the doctor will do
everything to keep you alive has ignored the fact that we *are* going
to die at some point, and that as medical technology gets more
advanced that point that be delayed long past where it should happen.
But on the other hand, that's a terrible decision to make-- and there
have been cases of criminal or ethical charges being brought against
doctors who have done so, even with the cooperation of the family.
Dr. Kevorkians antics didn't help the debate any either, of cousre.

Totally agree.

There may have once been a time when a physician, in agreement with
patient or family, would quietly "speed" the process of dying.

But litigation, a looser bond between patient and physician (no more
Dr. Welby's it seems), and grandstanders like Kevorkian haven't helped
in the debate.


SMH

In article , Stephen Harding
wrote:

Charles Gray wrote:

I have problems with actual termination of humans-- it opens so many
cans of worms, legal and ethical alike.

Definitely so. It should always be difficult concept to wrestle with,
or we've gone terribly wrong.

I think the problem is that the idea that the doctor will do
everything to keep you alive has ignored the fact that we *are* going
to die at some point, and that as medical technology gets more
advanced that point that be delayed long past where it should happen.
But on the other hand, that's a terrible decision to make-- and there
have been cases of criminal or ethical charges being brought against
doctors who have done so, even with the cooperation of the family.
Dr. Kevorkians antics didn't help the debate any either, of cousre.

Totally agree.

There may have once been a time when a physician, in agreement with
patient or family, would quietly "speed" the process of dying.

To say something of a middle ground, which I think is perfectly ethical
medicine -- and I can point to such things as extensive supporting
writings by Catholic theologians steeped in right-to-life -- is what St.
Thomas Aquinas called "the principle of double intent', and has all
sorts of applications and misapplications in medicine.

We have a political environment that says "narcotics (an imprecise
term)" are EEEEVIL. Yet there are chronic pain states where long-term
use of incredibly high dosages can return someone to normal enjoyment of
life, without sedation, cravings, etc. Perhaps the most dramatic
personal experience I have had is a woman with severe sickle cell
disease, which can be incredibly painful.

To a person with no acquired tolerance, a lethal dose of injected
morphine can start at around 200 mg and is pretty certain at about 600
mg. She has a surgically implanted pump that delivers, hourly, over 1000
milligrams of morphine, bypassing the blood-brain barrier so greatly
increasing the effective dose. If I were to be given that dose in a
vein, much less in the spinal fluid, I'd probably be dead before the
needle could be removed. In her case, very careful adjustment of the
dose let her go back to full intellectual capacity and workload as a
chemical engineer, wife and mother, active in her community and church,
etc.

On the other hand, in, say, a pain crisis in terminal cancer, it has
been understood there is no absolute maximum dose as long as pain
exists. If you bring up the dose quickly in a debilitated patient,
however, morphine is going to interfere with breathing. It may be
possible to compensate for some of these side effects, but at some
point, that may mean intubating the patient and making them respirator
dependent. The reality is that in certain pain management situations,
absolutely ethical and humane medicine will do things that hasten death,
but improve the quality of remaining life.

But litigation, a looser bond between patient and physician (no more
Dr. Welby's it seems), and grandstanders like Kevorkian haven't helped
in the debate.

Don't be so sure some of the Welby tradition doesn't endure, if in
changed form. Balancing grandstanders like Kevorkian are thoughtful
physicians like Timothy Quill. Some searches are useful -- Quill,
clearly from the heart, wrote an extensive article on how he had chosen,
after long reflection and consultation, to provide the means of assisted
suicide to a long term patient. This patient was not terminal, but had
made a quality-of-life decision that she didn't want aggressive
treatment for her leukemia. An academic physician (SUNY Albany, IIRC),
he's a very respected speaker in ethics discussions, recognizing the
answers are not clear-cut.

In article , Cub Driver
wrote:

It turns out that the FDA does, in fact, approve drugs for the specific
purpose of veterinary euthanasia,

Isn't that sodium pentathol? (I'm not sure about the spelling.) We
once put down a St Bernard who weighed almost as much as I do, and at
the time I marveled what an easy death that was.

The standard used to be sodium pentabarbitol (Nembutal), although
thiopental would work in lower dose, it is more expensive. My
understanding is that some veterinarians use barbiturates specifically
compounded for euthanasia, rather than a standard drug.

The amount of overdose (corrected for the particular drug) and the speed
with which it's injected may have as much to do with the soeed of effect
in veterinary use. I've seen cats have their life functions stop almost
instantaneously from a large intravenous dose of pentobarbital. In
general medical practice where death is not desirable, you wouldn't give
it that fast. Pentothal and related ultrashort acting drugs like
brevital naturally act extremely fast when being dripped in at a slower
rate, which is probably safer for anesthesia.

In anesthesia, if something goes wrong, you don't want instantaneous
onset -- you want something slow enough such that if something goes
wrong, the anesthesiologist has time to react.