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After watching my father die with COPD, it because obvious that euthanasia happens in the US all the time. He opted out of lung-reduction surgery and was ready to die. So the hospital withheld IV hydration and provided a morphine drip and he was gone in 36 hours. How long can one live without water, a few days max? So that's what killed him. My sister-in-law who's a physician told me that's how it's typically done. I was horrified at the time.

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> So the hospital withheld IV hydration and provided a morphine drip and he was gone in 36 hours.

I watched loved ones die this way. It's cruel, absurd and grotesque. A doctor will look you dead in the eye and say "your loved one will be dead within a few days" and instead of killing them mercifully you are forced to watch them die of dehydration. A maddening and indefensible relic that I believe younger generations will abolish. There's obviously far more complicated end of life situations, but this particular case is extremely common.

Death by dehydration, at least for an old sick person, is rather natural and though it sounds awful it’s not really painful for the dying person. Before IV hydration it’s how most people died.

I believe younger generations will abolish.

I wouldn’t count on it. I’ve learned young people are just the same as everyone else. I hope I’m wrong but I used to think they had more empathy. Let’s see.,

My BIL is a head hospice nurse.

If it helps, they don’t ever deny people fluids who want or need them. What happens towards the end is the body stops being able to process fluids due to failing organs. Pushing fluids into someone in this state makes them less comfortable. People aren’t thirsty or suffering from a lack of fluids.

As far as putting someone out of their misery, there’s a reason that they put them on high dosage opioids. If you want to keep someone out of pain while helping their heart and lungs stop peacefully, you couldn’t pick a better drug.

Thank you for this comment. I have also worked a bit with hospice. Unfortunately, there is a lot of misinformation regarding this issue. I find it sad that some are left with the incorrect notion that their loved ones were denied care at their last moment. I.v. fluids may somewhat alleviate sedation of a dying person, but they can increase swelling, formation of pleural fluids and cause shortness of breath. If a dying person won’t drink anything anymore, it’s mostly a sign that they don’t need any extra fluids.

I don't see drugging someone out of their gourd to be a plus in this situation.

It’s still all based on consent.

Doctors are mandated to obtain informed consent, and patients have the right to refuse any treatment or medication they don’t want.

It appears that you may not be well-informed about end-of-life care protocols. Once a patient is admitted to ‘hospice care,’ the focus shifts from extending and preserving life to enhancing their quality of life.

At a hospice literally right now for a loved one (who is sound asleep). The nurse working there quoted something like this: ca. 95% of the people admitted will die of dehydration since they can't take in fluids after a certain point.

My knowledge of anatomy is poor, so I am unsure how I feel about this. It isn't helped by the morphine, which seems to further separate the loved one from reality in a manner that seem premature (compared to the other painkillers that the person has been on that have been having a high degree of efficacy).

And to be clear, I am 100% behind the idea of hospice and medically-assisted suicide. Just feel very torn right now with the impending loss of the loved one.

That sucks.

I hope it brings you peace to know just how much all of the hospice workers I know care. Everything they do is about comfort and dignity, and there are chaplains, and medical workers that can help you with these concerns.

I mean you’re on morphine the whole time, you’re not going to feel a thing.

If only drugs worked that way.

    it because obvious that euthanasia happens in the US all the time [...]

    So the hospital withheld IV hydration and provided a morphine drip 
    and he was gone in 36 hours

I had a family member with late-stage terminal COPD opt out of further treatment. They were in respiratory crisis and were going to be intubated for the nth time with no real hope of recovery, and so they said "fuck it" and delined further intervention.

The hospital (a Catholic hospital, even) provided a morphine drip and they were gone within an hour.

I was never really clear on what killed them in the end, if it was the morphine or the COPD. I guess technically it was the COPD.

Anyway, as somebody who went through something similar: I'm so sorry. COPD is such a slow and crappy way to go. Have you been able to find some peace in the years since?

I have, thanks. I'll always remember his last words to me, "You're a prince."

I'm so glad to hear that. We were able to have some closure as well, similarly... it was a comfort...

That's a beautiful memory. I'm sorry for your loss.

That teared me up

> The hospital (a Catholic hospital, even) provided a morphine drip and they were gone within an hour.

FWIW, Catholic ethics are actually fairly well thought out on this issue. You're not allowed to withhold basic nourishment (food, hydration, non-invasive breathing support), but you are allowed to opt out of invasive procedures such as intubation and provide pain management if the patient or the patient's guardian decides that it would significantly affect quality of life and the patient doesn't have long to live. Obviously there is discernment involved in the last bit, but Catholicism is all about discernment.

Here's the National Catholic Bioethics Center on the topic: https://www.ncbcenter.org/resources-and-statements-cms/summa...

Thanks for that information. I have some major disagreements with the Catholic church but more knowledge and understanding is always a good thing. Appreciated.

Of course! I'm biased (as a Catholic), but I personally find the Church's moral stances to be fairly well thought out and systematic. But well thought out people starting from different axioms will often disagree with each other's conclusions!

It’s hard to ask this in a non-confrontational way, so I’ll just come out with it:

How do you square that with the modern Catholic church’s systemic support of sexual abuse of minors?

I mean this in the most inquisitive way possible. An organization’s what it does; the modern Catholic Church (leaders) have supported some horrible things. How do you separate out the good bits from the bad bits?

For me it boils down to this: the Catholic Church exists as a body of members who are all sinners- laymen and women, priests, bishops, cardinals, and the pope included. The clergy are simply functionaries within the church who serve very important roles, but are not sinless, perfect humans by any stretch of the imagination.

The way of life the Church offers along with its teachings, are what you might be able to consider the "good bits".

The "bad bits" are the members, who are sometimes clergy, who sin against God and against their neighbor.

I appreciate it, but there's no need to be delicate: sexually abusing minors is evil. It's especially evil when a priest does it, since they hold positions of special influence and, of all people, should be best acquainted with how evil sunders the soul from God (priests are specifically trained to hear confessions, absolve people of sin, and advise them on how to avoid sin).

So that's the categorical statement.

More concretely, every adult in our archdiocese receives training on the risks of sexual abuse and I regularly hear the sex abuse scandals addressed during homilies. So it seems like the church, as an organization, is taking steps to address the issue.

But to step back and take a wider view, I think Catholicism acknowledges the brokenness of human beings, but reserves eternal judgement for God. So most serious Catholics are not going to walk away from the church because there is evil inside of priests. There is evil inside all of us. But we are called to do battle with evil. For most of us, that battle is within our own hearts, but certainly we must also root out systemic evil within the Church.

And finally, I see this line of thinking a lot from atheists wrt religion, but I think it is more widely applicable. Which is this: "people have done evil in the name of (or under the banner of) this religion and I will choose to only consider that one particular thing when measuring the moral worth of this religion." So in this case, it would be "the Catholic Church facilitated the mass sexual abuse of minors, therefore it is evil and should be done away with." But I think we have to consider the good that people and groups do when measuring their moral worth. In this case, I would point to all the charitable works done by the church and its faithful as worthy of your consideration.

To see how essential this expanded consideration is, I think it helps to slot in institutions which have less emotional valence than the Catholic Church (or Christianity or whatever). For instance, there have been many cases of school teachers sexually abusing students. Yet I don't think anybody would argue that the entire institution of school should be done away with or that adherents to schooling should walk away from it. After all, school is a crucial institution where many children thrive and where most teachers are grinding out good acts on a daily basis.

> So most serious Catholics are not going to walk away from the church because there is evil inside of priests. There is evil inside all of us. But we are called to do battle with evil. For most of us, that battle is within our own hearts, but certainly we must also root out systemic evil within the Church.

I'm shooting from the hip here and I don't have CCC citations to back me up, but I want to say that the Church herself is not (and cannot be) inherently corrupt, because it is the mystical body of Christ. We must remember that actions of individual members of the Church (no matter how influential or high up they may be, even to the utmost) may be evil or disordered, but the Church will persist.

Christ included Judas among the twelve. The shenanigans some folks in the Church get up to these days don't exactly compare. Indeed, seeing that the Church has persisted these 2000 years despite schisms, etc, was a small part of what convinced me that it is the one true Church.

Every single organization that interacted with children pre-2000 has sex scandals. Boy Scouts, myriad public school districts, the Congressional page system, youth sports. It attracts pedophiles. Now we are all much more aware of the dangers.

https://x.com/rothmus/status/1828751103955292508?s=46

> How do you square that with the modern Catholic church’s systemic support of sexual abuse of minors?

I'm the first to criticize Catholicism given a chance, but ... I'm not sure that's actually a valid claim to make outside of the particular case of ... I think it was New York in the 1990s, which is a statistical outlier (at least in English-speaking countries).

There are a lot of Catholics and therefore it's unavoidable for a lot of pedophiles to be Catholics, but the same is true about teachers. Can you reasonably say "how can you support the school system given that teachers systematically sexually abuse minors"?

Remember, there are 4 kinds of lies:

  - lies
  - damned lies
  - statistics
  - things somebody said on the Internet

That’s an odd comparison to make. The ‘school system’ isn’t a monolithic system that is actively refusing to acknowledge or take action against sexual predators. Is there an example of a school district that has been shielding predators on an ongoing basis and refusing to take remedial action?

I'm an atheist and no fan of any church (or, y'know, sexual abuse) but I don't love this line of discussion because it's a real case of whataboutism.

The Cathlolic church's actions w.r.t. sexual abuse are certainly worth talking about. Their views on euthanasia (which I disagree with) are too. I don't know that they can be meaningfully discussed simultaneously within the same discussion.

The church used to be powerful. Being a priest included some sacrifices but it was balanced with significant social perks and power. Normal men were drawn to the role.

The church got less powerful, but they kept the restrictions on priests. Who wants to be a person with no power and no sex? People who are strange or who have ulterior motives.

If the power of the church was restored, I think the abusive priest issue would be gone in a generation. Or if they remove the sex prohibition, of course.

Thanks for the link. It affirmed my understanding of church teaching. Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be excessively burdensome for the patient or would cause significant physical discomfort.

Yes, "when they cannot reasonably be expected to prolong life" is key, since there's some discussion in other parts of the thread about withholding nutrition as a form of euthanasia, which Catholic teaching is very much not okay with.

I think there is a ton of wiggle room in the words prolong, burdensome, or discomfort

Not as much as you'd think. Catholicism is very much has what is essentially statutory law and common law, and common law removes many of the ambiguities. It's the Protestants who are like "we all have the same book let's talk about how we interpret it" while Catholics have a canon interpretation over which much blood has been spilled to arrive at.

Here's the link to the OG https://www.vatican.va/roman_curia/congregations/cfaith/docu... It's some legalese.

From the url: When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger.

We're in a weird spot where the secular world asks us to simultaneously cause death (the euthanasia folks) while also asking us to evade it altogether (the Brian Johnson types).

Catholicism embraces natural death, which is what your family member (RIP) chose. Interventions that hasten death are fine. Just can't cause it.

Reminds me of this experience of someone from the UK: https://jameshfisher.com/2017/05/19/granddad-died-today/

"Terminal dehydration is a way to skirt the Suicide Act, because we can claim that withholding water is just like withholding treatment. Ramping up painkillers and sedatives is a way to skirt the Suicide Act, because we can claim that the medication helps the patient cope with their death, rather than inducing their death."

My dad has COPD and continues smoking. I'm going to go through this sooner than later. I've already made peace with this, I've seen the alternative in other family members and ultimately its the decline in dignity that pushes my moral compass to accept self-euthanasia as a humane option.

Yes, I think that is not well understood.

When my father-in-law passed, in a rural assisted living facility, we found they had stopped feeding him despite saying they were and our requests that they continue.

We were stuck in this uncomfortable position of not being able to move him somewhere else, being completely blindsided by his (bone and bladder) cancer and how quickly it progressed, and not knowing what standard of care to advocate for understanding that he was passing.

One of the things that was also frustrating is that when we would ask for more pain medication, they would refuse as it might lead him to stop breathing (I thought, ‘so what?’), yet they were making decisions that ultimately accelerated to his demise.

Looking back, I don’t know that ceasing nutrition was a bad choice, but it wasn’t their decision to make. When I talked to friends in healthcare they effectively gave me the ‘oh, you sweet summer child’ talk.

My FIL, while he could communicate, could not wait to be out of pain and I wish he had the agency to make the decision before having to go through endless pain in the delirium of opioids.

There are, of course, details I’m leaving out, but my general takeaway is that in at least some cases the euthanasia debate is not about whether the call is being made, but who is making the call.

That is not alone reason to support one side of the debate or another, but it is an important nuance that I was naive about until I witnessed it first hand.

Edit: what I described does not appear to meet the traditional definition of euthanasia, but I will leave the post in its original form and just clarify that I mean making decisions that hasten someone’s death either passively or actively.

The setup for 'Living Wills' and directives to doctors, at least in the US as recently as ~4-5 years ago, suck. I remember thinking at the time that I saw what family was filling out that they failed to express the nuance that I would like for my own directives.

Generally if there's still hope for recovery to a not-shitty life then I'd prefer to proceed towards that. Even as extreme as E.G. that Leadale anime's setup where the protag's broken from the neck down but can live in a VR gameworld (deeper immersion so they can still move, taste, etc). If there's still real hope for reaching that, it might be worth toughing it out and waiting.

However that sort of nebulous criteria that requires a human to evaluate isn't present. I can't empower the doctors with such vague goals and say 'make your best call as a HUMAN doctor with that vague goal'.

If that good route isn't an option, then I wouldn't want to stick around either... and the lack of a clear legal euthanasia option in much of the US pushes people to roundabout failures for lack of food / water intake, or just giving in to inevitable statistics when a cold or stressed body complication like a heart attack happen. Heck, if my brain's the part that's fraying apart and I want to die anyway, please harvest the working organs as my method of death so someone else can live better.

Both my grandfather and my aunt were palliative care towards their end. Their respective care providers kept asking them if they'd like to increase dosage of their medicine (can't remember what my grandfather was one, but my aunt was on morphine). Despite both of them at the time said that they didn't want to increase dosage, but the care provider kept trying to increase. My family's theory is that they were trying to speed their passing. Both cases were in Canada.

It's ethically childish that we use roundabout measures like that instead of just putting someone out of their misery overtly.

It creates a drawn out process where the family has to wait around until they pass at some unknown point instead of coming together in one moment, making peace, saying their farewell, and witnessing the finality together.

It took my girlfriend's vegetative mother a week to die as she struggled to breathe that whole time, put on just enough morphine to supposedly feel no pain and not a drop more. By the time she finally croaked, most of the family that had shown up to see her out had left because nobody has time to wait around days or weeks for death to happen. And it was emotional hell for her two daughters.

They could've just given her a nice dose of morphine, but our ethics are too infantile. Instead we do make-believe.

> It's ethically childish that we use roundabout measures like that

Dogmas and tabus might be there for a reason. Culturally I think we need to pretend thing we don't think are true.

Comments here made me realize how heterogeneous our worldview actually is. There is a rather clear split between Canadian and American comments. The first group talks about euthanasia positively, but the second group is largely cautious, looking for negatives but not rejecting the idea altogether. I did not expect there would be such a dramatic rift.

We need to be clear on terms here.

Killing someone with a drug intended to stop the heart / prevent respiration is unequivocally euthanasia.

Withholding treatments is not euthanasia. Nor is pain medication that hastens death. Those are things we can have an ethical discussion about.

As for IV drip.. that's another discussion. I personally would not ever do that. Water is a basic thing for humanity, and should be provided. Unless he explicitly refused the water. Then, that's his choice.

I think I ultimately reject the idea that this is not well-understood, because the largest organizations opposed to euthanasia (the Catholic church for example) has given endless thought to this, and explicitly accepts the situation you described. Opponents of euthanasia are not ignorant.

Why can someone make the choice not to have water in their IV, but can’t make the choice to have a fuckton of morphine in their IV?

I think a lot of it comes down to deontological logic and morality versus consequentialist morality.

It is recognized that the outcome is the same. The difference lies and how you get there

I was thinking that the divide probably lines up pretty well with people who think the Trolley Problem is a great moral quandary versus people who think it’s obvious you pull the lever and don’t understand the fuss. Which is basically what you said.

I completely agree. I thought about bringing it up in the post, but opted for brevity.

Also, I am genuinely amused that my post is getting downvotes. People are fascinating

They can make both choices.

But if the person is non responsive and we are left to make a choice, we have to presume they want water.

Morphine is debatable

Both the lack of hydration and morphine were his choice, and he was lucid. My brother was angry that Dad decided to "give up." I wasn't, but was horrified at the ease with which the staff complied and knew exactly what to do.

I’ve heard it’s even more common per capita than in Canada, the difference being that it’s not on the record, so no statistics are collected about it.

Withholding aid is morally fundamentally different than proactively ending someone's life.

In the sense that it's worse?

My dad also spent days dying from extremely aggressive cancer, being in unimaginable amounts of pain, with all of his organs slowly shutting down, his limbs becoming swollen from pooling blood, unable to drink, unable to eat, crying about how much pain he's in and how much he wants to go home. And all the hospital could do was give him enough morphine to knock him our and we waited by his bedside for 4 days until he finally drew his last breath, probably due to lack of fluids at this point.

Tell me - where does the "morality" stand here compared to him proactively ending his own life with a drug before all of this happened, if he had such an option and decided to take it? How is what he went through morally better like some people say it is compared to euthanasia(I don't know if you think that, but it's a common argument). There's no dignity in any of this.

This is not at all decided.

This is just the trolley problem rephrased.

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