Ethics

Palliative Care and End-of-life: How it’s Done

San Jose Care Resource Guide:  In End-of -Life decisions, it is important to realize how the “patient”  would  be

1.  Euthanized, or
2. Terminated, or
3. Killed.

 Pick your choice of terms according to your belief system,  (yes, atheism is a belief system too…)

San Jose Care Resource Guide: 

Since a lot of patients are on respirators at the time this would be done. [We use the word "done"  instead of "happen" because this is an active decision on the part of the patient (if conscious), the medical palliative care  team, and of the family.]   We found this article in the  Journal of Pain and Symptom Management .  This study is about  the influence of morphine injection on time to death after withdrawing ventilation from a terminal patient. Click  Here Article is from East Carolina University.

San Jose Care Resource Guide,  quoting:  “…The mean time to death after terminal extubation was 152.7 ± 229.5 minutes without correlation with premorbid diagnoses..After extubation, each 1 mg/hour increment of morphine infused during the last hour of life was associated with a delay of death by 7.9 minutes …”(Extubation: remaval of the respiration devices}

San Jose Care Resource Guide: So,

• 152.7 + 229.5 minutes=382.20min  6.37 hrs:       We are kinder to criminals with lethal injections…see below
• 152.7 - 229.5 minutes=382.20min=-76.8 min:       Negative time a little confusing??

Compare the duration of death by extubation we mentionned above,  to the duration of the death penalty procedure by lethal injection.  

Quoting Medscape Today:   “….According to the North Carolina Department of Corrections, once the ECG monitor displays a flat line for 5 min, the warden declares death and a physician certifies that death has occurred. Execution start times and declaration times were available for 33 of the 42 lethal injections conducted in North Carolina … Mean times to death [for lethal injection ececutions] were 9.88 ± 3.87 min for Protocol A, 13.47 ± 4.88 min for Protocol B, and 9.00 ± 3.71 min for Protocol C…..”

San Jose Care Resource Guide: You can draw your own conclusions…

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Medical Ethics: Consciousness Levels and Palliative Care (Scholarpedia)

San Jose Care Resource Guide  [SJCRG] : Families are faced with very difficult decisions during the last stages of care. The category of palliative care of this blog intends to provide data to help the families navigate this distressing maze. At SJCRG, we are fully aware that this topic is at the boundary of medicine and ethics. Ethics can be personal or clergy directed, with a wide range of very strong opinions and traditions. In line with the SJCRG’s charter, we will provide you with the data for the discussions between yourself and your advisors.

SJCRG: This link is to ScholarPedia, ( A competitor to Wikipedia). It is titled “vegetative state”, but cover our knowledge of the main levels of consciousness of critically ill  patients.  initiated 2009, so recent, last modified 25 jan 2010

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