Answer ?s with other ?s?  What if it takes tremendous doses to pallitate?  
What if the patient is beyond communicating?  What if no one knows  
exactly the dosage that will keep one hovering on the living side?  What
are the other choices?  Is it suicide or murder?  Absent an autopsy, how
do we know exactly what pushed the person to the other side?  Wouldn't
autopsy be too late?

I saw this too & wondered, but whatever it took at that point I was
grateful when it happened even though it meant I wasn't there at the
time.  When a person is very close to death, do the moral distinctions
hold?  I sure don't know the answers, but these are issues you want to
consider in advance.  If there is no great pain, there would be no
problem. Socks' pain was unbearable & it sounds like Penny's was too.  We
could not know the extent of consciousness, but there seemed to be none
or little.  The look of peace on his face after death following days of
torture made me glad he was able to go,  In Socks' case, he was still
living after taking far larger doses than anyone had ever heard of of
several pain & sedation drugs.  Most people seem to slip quietly into
death, but what if it is not that easy?

Maybe Mike has some thoughts.  Have you found any writings on this?

Thinking of you,
Fig

I think some back door promises are made between patient and physician
when to call it quits. The doctors give the patients access to the
medications and let the patient decide when the time is right. I often
wrestle with this issue myself, it doesn't seem right to end one's own
life as a matter of convenience. But in the long run the cancer is
killing them, the choice is do you take medication to keep yourself
comfortable or  die a very painful death. So in answer to your
question, I think it is wrong to purposely take a  dose of whatever
drug you want for the sole purpose of ending it all but equally right
to take as much pain medication to keep yourself comfortable even if
it will hasten your own demise.

Alex

46erjoe schreef:

I don't think you can call it  suicide if  the effect of keeping  pain
under control with morphine can be one  "forgets" to breath. If it feels
like that for you you can choose to be in pain and not take morphine
an/or sleeping pills  to slip away from life unconsciously. In Holland
there is a strict line between palliative sedation and euthanasia and
for the religious people the same is true, though euthanasia is legal.
Where as with euthanasia you choose for an active ending of your life,
with sedation the goal is not to suffer. The side effect can be that one
passes on a few days earlier than without the high doses of sedatives.
There a very different goals, I think that is a crucial   difference
from a moral point of view.

Anne

If a doctor or anyone else kills a patient it is
murder/manslaughter/negligence or accident. If a person takes his own life
it is suicide or accident. Euthenasia is a euphemism for
murder/manslaughter. Assisted suicide is a contradiction in terms.
 There is no need, in a well run, caring health system for anyone to suffer
unbearable amounts of pain.
While a large proportion of cancer patients suffer pain it is almost always
possible to alleviate this to acceptable levels with conventional
analgaesics and almost all of the rest can be treated well with more
unconventional methods.
Where pain and other symptoms cannot be adequately controlled then the
patient has the choice to be sedated out of it but morphine would not be the
drug used to do that.
For anyone who is used to opiates, and that would be almost every cancer
patient with moderate to severe pain, it would be very difficult to attain a
lethal dose orally and the injectable dose would also need to be very large
to be certain. Despite what doctors say I am loath to believe that they kill
patients as often as they would have us believe.

 Being in the business of palliative care it happens that occasionally a
carer will ask if we have killed a patient or even accuse us if the patient
dies shortly after an injection of morphine given for pain relief. This is
just coincidence. A person in the terminal phase is likely to die any time
and this is often the time that symptoms are needing more aggressive symptom
control.

To put things into a little perspective there are many people out there
with chronic pain conditions suffering very much more pain that is often
much more difficult to control than cancer pain. The cancer patient, at
least, has an imminent end to his suffering. A 20 year old chronic back pain
patient may have no end in sight and options are less because of this.

I hope this helps.

MIKE

Who is to say if palliative care shortens or lengthens a life.

I can only see withholding available drugs that relieve suffering, as
a form of torture, a cruel and horrible thing to do to someone in the
last stage of their life.

Does torture shorten or lengthen a life?

isi

Whatever, and I mean whatever, makes it more comfortable is the route I
choose. Let those not in the situation theorise about it all. At the very
blunt end the theories are just meaningless crap.

Ian

We're biochemical beings, Joe.
Each time we breathe, there's a chemical reaction.
If this is accurate, it's the chemical makeup of the body.
http://en.wikipedia.org/wiki/Chemical_makeup_of_the_human_body (some of
them are listed in our foods)
Our brain releases chemicals.
There's probably chemicals involved in the sperm fertilizing the egg, the
embryo implanting itself so it can grow and come into life.  And involved
in daily life, http://en.wikipedia.org/wiki/Apoptosis
"Between 50 billion and 70 billion cells die each day due to apoptosis in
the average human adult."

Cancer creates chemicals. I had a list somewhere but I can't remember
where, at the moment.

If chemicals help us live, why not let them help us die (when our bodies
can't go on anymore) ?

How'd you find the replies, Joe. Any help?
J

It's in your lungs, Joe.
Morphine helps with air hunger  - gasping /labored breathing.
I'm sorry. I must have a mental block - I just can't see palliation as
suicide.
I see it, but can't see it as wrong. Or unethical.
If you choose a different way, you're still making an active decision.

I've seen many of these http://www.filmakers.com/Bioethics.htm
Might be available through hospice or library

The decision might be taken from you - someone recently posted about a
cerebral bleed.
Lowkey died that way, in hospital (wasn't his wish but he was rushed there
and they operated) but could not stop the bleed.    Should such happen to
you, Joe near July 1, you might want to switch instructions, prolong as
long as possible, but we can't plan for everything.

Other parts could bleed and you (or family) could choose to do nothing to
try to stop it, but you're still "choosing"...

J