Discussion Idea - medically induced coma

[TAW122]

This is some idea I had for quite some time. As we know, most states in the US and most countries in the world forbid/ban euthanasia and assisted suicide. However, given some assumptions such that death is basically cessation of life, conscious, and also the person can no longer feel nor perceive anything (sight, touch, smell, taste, hearing, etc.). Then perhaps being in a coma is similar to that state of conscious (or rather unconscious)? If so, then I have some idea for people who wish to stop living.

Since voluntary euthanasia and assisted suicide is illegal in most places around the world, how about instead of putting the patient who is suffering to death, just induce some long term sleep (just to keep it within the laws)? I think this would not count as euthanasia nor assisted suicide due to the fact that the patient isn't 'clinically' dead, but is close enough to be dead. Also, the caretakers and healthcare professionals would still take vitals and just keep the body alive yet the patient would be unconscious the whole time (so essentially death without actually real death) until the patient's true (clinical) death. It should be easier to care for the patient due to having less things needing maintainance and/or treatment. The patient would be unaware of what is going on. IANAL but I think this can bypass the anti-euthanasia, anti-suicide laws since it isn't technically euthanasia or assisted suicide (as the patient is still 'clinically' alive, but just unconscious). Also the patient would not suffer and would be, de facto, experiencing what it is like to be dead. Sure, some anti-suicide, pro-life crowd will always try to find something to gripe about, but since it technically isn't real (clinical) death, this should skate past them.

What do you guys think about this kind of idea, loophole, or whatever you call it?

 

[sleepy dog]

Without even thinking of it too much, I can see reasons it will never happen.
1- too costly
2- nobody will want this because its not death
3- the medical professionals would not be killing, but it would still be damaging, so legal problems

 

[TAW122]

1) Could you explain why it would be too costly? Like do you mean there would be more costs in someone not responsive and conscious, versus being in an unconscious state and only the organs responding?
2) I know it isn't death, so what grounds do the pro-lifers essentially have?
3) I will admit that I don't know all the implications of being in a permanent state of unconsciousness, yet still alive, so if the person is not dead, but just permanently in a coma, how would the damage be relevant? The only one case I can see that happening is if the person is to regain conscious, but I see a permanent coma as something that is as close to death as it can be while not actual death so the anti-euthanasia, anti-assisted suicide crowd can't say that this is euthanasia nor suicide (because the patient isn't dead).

 

[NickStanfield]

Beyond the cost of supporting a body in perpetual medically induced coma, there's some potential side effects you should know.

In April of 2017, my lungs stopped being able to process oxygen and expel CO2. It was like drowning but in air, gasping for breath but getting no value from it. Long story short (sort of) I was intubated and put in a medical coma for 12 days. They used fentanyl and propofal. I went into a state known as hyperactive delerium and for about 10 days I experienced the worst 3-4 months of my existence. Yes, the delirium produced a time shift where I actually felt the passage of 3-4 months where I was tortured, raped and murdered repeatedly. It's not an uncommon experience for medically induced coma patients and the UK has done some extensive studies on this.

Ultimately, because of some insane physical symptoms, a psychiatrist diagnosed what might have been occurring and they "snowed" me using a substantial amount of both fentanyl, propofal and atavan. I ultimately recovered (obviously), but those delirium episodes have never left me and still haunt me to this day.

I know that slipping off into a coma might sound like an escape, but I can personally assure you that a coma isn't peaceful nothingness. I hope death ultimately is.

 

[not.happy201]

I really would like to try being in a comma. They could put you to comma for one week, and then wake you up. If you like being in comma and everything is okay, then they put you into comma again. All of this could keep happening for a time-span of many years, as long as you can afford to pay for this treatment. Obviously, you might need to be in hospital, and pay a few hundred $ a day, for this.

But, I don't think it will ever happen, unless you illegally hire some doctors.. I don't think it would be considered healthy for you, either, because people say that you should eat healthy, exercise, etc.

 

[NickStanfield]

I really would like to try being in a comma. They could put you to comma for one week, and then wake you up. If you like being in comma and everything is okay, then they put you into comma again. All of this could keep happening for a time-span of many years, as long as you can afford to pay for this treatment. Obviously, you might need to be in hospital, and pay a few hundred $ a day, for this.

But, I don't think it will ever happen, unless you illegally hire some doctors.. I don't think it would be considered healthy for you, either, because people say that you should eat healthy, exercise, etc.

Hospital costs for 2 weeks in a coma were $483,000.00 it's not cost effective when a $300 shotgun or <$100 of chemicals/meds can give you a permanent solution.

 

[Meant2Die]

EXTREMELY COSTLY.. think of all the things that would need to be paid for
> ongoing Doc supervision (making sure all vitals, etc is ok) - this would prob have to be checked every few hours
> ongoing anesthesia/pain meds or other? (not sure) that someone has to administer
> ongoing nutrition through a feeding tube bc although in a coma your body needs food/liquid
> ongoing emptying of excrement your body produces from eating
> ongoing nursing care for all the things mentioned above
> payment for all the medical devices being.. RENTED???? - being hooked up to a life monitor, feeding/excrement tubes, other things you may have to be hooked up to in order to monitor if you're okay
> payment for "room and board" (haha) - after all you'd be taking up a hospital bed/room, or a bed SOMEWHERE, and no i really doubt that could be your own bed at home
> payment for possibly some kind of insurance - what happens for ex, if something goes wrong and you die.. but they were suppose to keep you alive but in a coma??? Who's fault is that? ---way too confusing..

Prob a bunch of other things I can't think of... Anyway , yes WAY TOO expensive... if you don't understand why then you must be young or have no experience in dealing with doctors/insurance companies.

Real life example - I have a chronic illness for which I need antibiotics. I receive 2 ABX intravenously meaning I had to have a PICC line port put into my bicep, which is basically a internal line that goes through the vein into the heart. After I had that done, I needed a weekly nurse visit for the first month JUST to check my blood pressure, see how i'm feeling and to change the dressing which is the covering over the entry part in the arm.. According to insurance bill that nurse visit with the supplies (not even the ABX) was about $1,500 (can't recall exact number now but def between $1,400-1,500) PER WEEK! And all they did was rip the old dressing off, sterilize the area, clean the port, apply a skin protector spray, reapply a NEW dressing and change the external extension line to a new one (which is just screwing the old one off and screwing on a new clean one). The entire visit would take 15-20mins.. =$1,500 / week.

 

[ThingWithFeathers]

Medically induced coma isn't as simple as switching off or dimming a light bulb.

First of all, you need to know that coma is induced by drugs like Nembutal. The same drug that is used in lethal injection. It is a strong drug with several adverse effects. In a limited and controlled dose, it literally slows down your brain by decreasing the metabolism in your brain tissues.

The body needs to be active metabolically to sustain itself. Prolonged suppression of brain's metabolism has a catastrophic result in the body:

a) Because you wouldn't be chewing, swallowing or actively digesting food, your intestines slow down.

b) The lungs also slow down to the point that you might need a ventilator.

c) The blood pressure reduces so much that the blood flow to the brain is affected. This blood pressure in the brain has to be maintained in a very tight range
otherwise the patient can die from lack of oxygen to the brain if the flow is too low or the patient can die from too much intracranial pressure.

d) It will be harder to clean the body and poor hygiene increases the chance of getting infection in bed sores. Also, because of intubation, the chances of getting bacterial infection is high. The immune system will be suppressed making it easier for the bacteria to invade the body.

e) Barbiturates such as Nembutal decrease lactate within the cells and increase pyruvate production. This raises pH within the cells as well as the K+ ion concentration. This condition is called dyskalemia and it is very dangerous for the heart. It can cause cardiac arrest.

Hence, a patient is not put on medically induced coma unnecessarily and not longer than 15 days usually.

The primary goal of medical science is to protect the human body from dangers that harm it and to improve the quality of life and enhance the longevity. The medical professionals aren't going to spend their valuable time and expensive resources to appease people whom they can refer to psychiatrists and psychotherapists.

 

[Ame]

What you are proposing here has many similarities with something that already exists in clinical practise, called "palliative sedation" (also known as "terminal sedation"). Like your proposal, the primary objective of palliative sedation is to ease the suffering of patients via pharmacologic techniques which intentionally lowers levels of awareness, often to the point of unconsciousness. However there are some key differences, one of which is that palliative sedation is only administered as a "treatment" of last resort to patients who are under a great deal of distress as a result of their illness and are essentially at the end of their lives (and that only scratches the surface of what must be considered by both the patient and the clinician prior to sedation). Palliative sedation raises a number of ethical concerns and has been compared to euthanasia in multiple publications. It can be expected that your proposal will also be put through the ethics gauntlet if it is ever introduced to a wider audience.

To be perfectly honest, although I can see the allure of your idea (there is that aspect of "having your cake and eating it too"), I don't really see this taking off for the reasons that @sleepy dog had mentioned among other things. The procedure would be prohibitively expensive, especially if sedation is meant to be maintained indefinitely in patients who are not at the end of life. Perhaps you underestimate how much goes into medically induced comas, because it is nowhere near as low maintenance as your post would suggest. There are the tasks of maintaining an adequately sedated state via sedating agents (usually Midazolam, Pentobarbital, Propofol etc) that are to be administered around the clock, keeping the patient adequately hydrated and nourished, regularly moving them to avoid bedsores from developing and a myriad of other vital considerations. Even with the best of care, complications may occur.

Unfortunately, there are no validated and corroborated scales to assess depth of sedation in terminally ill patients nor is there a clear consensus in the medical community as to which agents (or combination of agents) are the best fit for the purpose of palliative sedation.

Still, it is a nice idea on paper...just not so easily executed in the real world.

 

[Jeremy]

Yeah, if you can somehow afford to be kept alive in a medically-induced coma, in a fully healthy state, for an indefinite amount of time until natural death - bearing in mind that no insurance company would ever cover it (and neglecting entirely that no doctor who intends to keep his license would agree to administer it) - you can afford the few thousand dollars it costs to travel to Switzerland and receive euthanasia.

 

[TAW122]

Thanks for all the responses. I have learned quite a bit after reading through everyone's responses here. Therefore, I don't think this is a feasible alternative to death. I think there would have to be another way to achieve death while bypassing the anti-euthanasia and anti-assisted suicide laws. What @NickStanfield suggested is actually much more sensible, going through less than $100 in terms of correct drugs to CTB, and a $300 shotgun for a permanent solution to a chronic problem.

@Ame brought up the idea of terminal sedation, and I would definitely consider adding that to my living will if I could. If in the event that I don't CTB later life and live to an elderly age, or suffering an incurable illness, I would wish to be put out of my misery, even though not directly, like indirect or passive euthanasia (if and when voluntary, active euthanasia is not available).

 

[sleepy dog]

What you are proposing here has many similarities with something that already exists in clinical practise, called "palliative sedation" (also known as "terminal sedation"). Like your proposal, the primary objective of palliative sedation is to ease the suffering of patients via pharmacologic techniques which intentionally lowers levels of awareness, often to the point of unconsciousness. However there are some key differences, one of which is that palliative sedation is only administered as a "treatment" of last resort to patients who are under a great deal of distress as a result of their illness and are essentially at the end of their lives (and that only scratches the surface of what must be considered by both the patient and the clinician prior to sedation). Palliative sedation raises a number of ethical concerns and has been compared to euthanasia in multiple publications. It can be expected that your proposal will also be put through the ethics gauntlet if it is ever introduced to a wider audience.

To be perfectly honest, although I can see the allure of your idea (there is that aspect of "having your cake and eating it too"), I don't really see this taking off for the reasons that @sleepy dog had mentioned among other things. The procedure would be prohibitively expensive, especially if sedation is meant to be maintained indefinitely in patients who are not at the end of life. Perhaps you underestimate how much goes into medically induced comas, because it is nowhere near as low maintenance as your post would suggest. There are the tasks of maintaining an adequately sedated state via sedating agents (usually Midazolam, Pentobarbital, Propofol etc) that are to be administered around the clock, keeping the patient adequately hydrated and nourished, regularly moving them to avoid bedsores from developing and a myriad of other vital considerations. Even with the best of care, complications may occur.

Unfortunately, there are no validated and corroborated scales to assess depth of sedation in terminally ill patients nor is there a clear consensus in the medical community as to which agents (or combination of agents) are the best fit for the purpose of palliative sedation.

Still, it is a nice idea on paper...just not so easily executed in the real world.

My oldest brother got palliative care. He had stage 4 cancer and was hit by a truck. No water, no food, morphine in high doses. It took about a week. Supposedly he was unconscious the whole time. I wouldn't mind that for me if I am out the whole time or most of it. I think he was given mercy. The cancer was horrible. Passing out and blood coming out his mouth and rectum at the same time. The injuries from the truck were severe. The last time I saw him his skin was gray, and he lived in a sunny warm place.

 

[LegaliseIt!]

Where I live, MAID (Medical Assistance in Dying) is legal as long as you are mentally competent, adult, and have and illness that will result in your death in "the foreseeable future".
Since I am mentally ill, and my physical problems are painful but not terminal, I don't qualify. Hence, my username:)
Advocates are working on changing the law, but it is a long road ahead.

 

[TAW122]

@LegaliseIt! Yeah, I agree that MAID should be expanded to cover more situations, not exclusively 'terminally' ill patients or those with terminal illnesses. There are far more people with chronic pain and suffering that could benefit from having the choice to check out. I hope the advocates are successful in expanding MAID not only to more states, but also the breadth of it's application.