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Comment by kaybe | Hacker News Reader

That makes it sound as if we should let people that only have a few days to live take all the heroin they want, actually. Maybe we should.

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To a lesser extent, that's part of what hospice / palliative care is. Not to the extent that it's purely recreational, but often involve continued use of opiods for pain management.

https://en.wikipedia.org/wiki/Palliative_care#Physical_pain

Wouldn't that be the argument of legitimate medical use though? You're mitigating the pain of people who literally have less than a year to live.

Sadly there's still some prohibition on giving the patient enough to comfortably OD and voluntarily end their suffering in a lot of places. I've heard nurses say that they're instructed to try and keep the patient optimistic, even when all that life means to them anymore is continued suffering. Gotta squeeze every last dollar out of them or something I suppose.

I believe this approach is also present in the UK where the patient isn't paying for their treatment directly. So I doubt it is to do with making money.

The patient may not be paying, but is the question is if the hospital still gets paid for his continued use of their services.

There is a less cynical explanation: if you make it too easy for people to kill themselves then you run the risk of old people being coerced into taking that option by, for example, greedy relatives eyeing their inheritance.

And it could be seen as a perverse incentive for governments to make it too easy for people who are an economic and budgetary burden to end their own lives.

If I get to choose the way I die it will be with an unlimited morphine drip slamming on the button repetitively. I had morphine back as a kid for a ruptured appendix and damn that stuff was good. I'll never forget the day they came in and I was expecting to get my daily shot and they told me I was being switched over to Tylenol lest I become addicted. I was 8, and I still remember thinking of saying "Oh I'm not becoming addicted but can we do it for 1 more day" haha...

> I had morphine back as a kid for a ruptured appendix and damn that stuff was good.

I suppose this varies a lot from individual to individual. I had morphine a few months ago for a shoulder reduction, and I felt horrible enough that I almost wish I'd just done it without painkillers at all.

There is extensive research and clinical practice on the topic of comfort-measure care at the end of life. Opioids are, indeed, often felt to be helpful at the very end.

Depending on the condition of the patient and the specifics of the palliative care prescribed, that's exactly what happens. Just using morphine minus the extra additves used to make heroin. Add pure oxygen to the mix and I'm not sure the patient notices much of a difference - they're high as a kite regardless.

This is already part of palliative care. Fentanyl is synthetic heroine and is orders of magnitude more potent.

Terminal patients are often given lethal doses of morphine near the end.

From what I heard it is a bit of a lawyerish distinction at that point - that euthanasia is never the intent but may be the end result. If they arecterminally ill or mortally injured with instructions to treat by giving enough that they don't have pain. If it is a level that they can just slumber peacefully 22 hours a day they are to go with that. If they are 95% third degree burnt and they need more than that and it eventually stops their breathing it is an unfortunate side effect of treating their pain but still the best option sadly and not malpractice - sometimes needed treatments can kill even when everything is done right.

The evasion and mental gymnastics does have some point at least - it isn't the doctor deciding to take the life of a patient because of a judgement and well any student of the 20th century knows how /that/ can end.

The mental gymnastics are due to the legal environment in the US and in particular on laws in many states that could send physicians who prescribe a drug for the purpose of ending a patient's life to jail.

But there are lots of drugs that have the possible side effect of death, and plenty of patients who decide that the risk-benefit of taking a drug is warranted even though it might kill them.

So therefore, everything has to be described in terms of "pain management" and "comfort" where the cessation of breathing is just a... potential side effect. If that, combined with the patient's standing orders not to intubate or perform any sort of resuscitative action in the event that they stop breathing, leads to death... well...

The euphemism that is frequently used is "palliative sedation" (or "terminal sedation", although that seems to be used mostly by people of the thou-must-maximally-suffer school of thought).

That pretty much already happens with painkillers in many cases.

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