Is it End of Life Care? Or is it Euthanasia?

I was watching one of the weekly videos that David Icke posts and the subject of end-of-life care was discussed.  I believe he was referring to the Liverpool Care Pathway designed to improve the experience in the last days of life.  This whole topic struck a chord with me because of the large of amount of Intensive Care Unit experience that I have.  For the record, I found myself asking myself many times, if end of life care was simply just Euthanasia, while working on the ICU. 

I do not actively work in the medical field now, but I have worked in the field, in many aspects, for over 25 years; this has brought a large amount of experience with end of life and death of the patient population.  I worked in a specialized burn unit, where the patient population was generally experienced a lot of pain, trauma, suffering and death.  It was not unusual to watch patients on the unit die, and it got to the point where most of the staff had become numb to the death event.  The high level of trauma and pain came with large doses of pain medication and sedation administration.  Nurses that floated to our floor to help with coverage, were almost always extremely surprised at how much pain medication and sedation that was ordered and administered to our patients.  Some of these nurses refused to give that much medication because it was exponentially more than they have ever administered. 

Discussed by David in the aforementioned video, was an administration of a sedative to older people.  Sedation is a very nice thing to have when you are in pain, or going to have surgery, because you certainly do not want to remember the experience.  The ICU that I worked in administered a very high level of sedation, for good reason, due to burns being one of the most painful experiences a person can have.  Sedation generally reduces your consciousness to a point where you have no, or very little memory, of what is happening while under the administration of that sedative.  The burn ICU used that method to allow patients to heal from grafts, and other procedures, by keeping them from moving under sedation.  During surgery, an anesthesiologist is trained to maintain a patient at a very low and tenuous level of consciousness, to keep the patient from moving or remember anything that is being done to them.  I had surgery once, and I can tell you with great certainty that I am glad that I did not remember any of the procedure!

Pain medication can provide many of the same effects of sedation, and both are often used together for procedures.  Even though both modalities work well, there are times when they do not work.  One of the patients that I first worked with in the burn unit, told me something very disturbing.  This person informed me after his 30^th surgery, that no matter how much pain medication and sedation he was administered, he was always fully conscious and could feel every bit of the pain from his procedures.  The only thing that they could not do was move or function.  Sometimes when my patients were under sedation, they remembered every conversation that happened in the room.  There have been instances of staff being fired for conversations that were remembered by sedated patients.  One patient that I worked with for months on the ICU, who was under sedation, remembered everything I talked to her about and even inquired about some of the situations I had mentioned when working with them. 

However, pain medication and sedation can be administered at doses too high and can often result in the inhibition of the body’s drive to breath.  When it was decided by the family, or the doctors in case there was no family, that end of life measures were to be initiated, all the stops seemed to be pulled.  I have watched as some patients died within minutes and others that lingered on for weeks.  In almost all the cases, massive amounts of pain medication and sedation were administered, all while the administration of other necessities such as feeding, and oxygen were turned down or turned off.   Watching someone die is quite an experience, to say the least, but I often questioned the medical process of “helping” them die. 

I am not accusing the medical system, nor the medical providers, of the purposeful assistance for the dying process, but it surely seemed to be what was happening.  I remember a nurse stating one time, are we simply just euthanizing our patients, or really trying to make them comfortable in the process?  That statement stayed with me for a very long time, and it still bothers me to this date to repeat that phrase.  Since I have firsthand experience that pain medication and sedation, does not always squash the consciousness or the pain, it is evident that some of the dying are not any better off with the administration of paint medication and sedation.  I guess I understand that it might appear to be the civil way of assisting with the passing of a person, but we may want to really assess if we are crossing the line sometimes. 

So, the question still remains.  Did the older folks that were administered sedation medication during COVID need or want this medication?  Were they purposely being hurried along towards death?  Or was this just the “normal” paradigm of the medical system that we find ourselves in?  I can only speculate, but I do know that this kind of medical practice should be monitored and investigated to ensure proper procedures were followed, for the right reasons.