Burst Ketamine: A N-Methyl-D-A

In addition, consideration should be given to corticosteroids, especially in the elderly population. This would be given at 40mg qd, with a taper of 5mg qd. Postherpatic neuralgia can be treated with medications such a gabapentin, lidocaine 5% patch, or topically with capsaicin

If there was absolutely no possibility of recovery, and the patient was suffering nearly everyday, the avenue of assisted suicide should be presented and given merit. With no possible way to avoid problems, issues arise for every possible situation, as assisted suicide is sometimes viewed as the easy way out. Large amounts of planning, assisted suicide by no means is easy though the drugs are roughly one hundred dollars (ProCon). The patient must come to terms with what will happen if they do not take this path, and also assess what will happen if they go this way. Pain and suffering could follow them around until they die or they could leave their family on a good note. Through assisted suicide, they could spend time with their family

We came to this decision because we felt that if a few professional psychiatrist can render him mentally competent than he should be allowed to make his own decisions because it is moral. This is moral because people should be allowed to do what they want with their body, and as Cowart says it is, “the right to control your own body is a right you’re born with…” (Cowart 2). However, this is refuted when that person cannot make rational decisions because that person would be mentally incompetent. People that are mentally incompetent are incapable of making decisions that are in their best interest. We also discussed his mother and how all she cared about is for him to receive treatment which we thought was a bit selfish. This is a typical parental perspective considering that parents do not want to outlive their children. However, she should have sought out what was best for him and what he was going to be happy with and not her. As a group we also felt that he should have received better pain treatment especially since Cowart found out later that they could have done more for his treatment. If someone is in as much pain as he was and when a doctor is confronted with the request to die, that doctor should be doing everything he or she can to bring down the pain.

The treatments, the side effects are to the point that are not worth fighting for any longer and are just exhausted. They would much rather be healthy again. The patient should be able to proceed with physician-assisted suicide.

Second, the patient needs to have refractory symptoms (Knight & Espinosa, 2010). A third requirement is a “Do Not Resuscitate” order (Knight & Espinosa, 2010). Lastly, the patient must be expected to die within the next few hours or days (Knight & Espinosa, 2010). Informed consent must be obtained either by the patient, or if the patient is unable to do so, a legal surrogate before palliative sedation is initiated (Knight & Espinosa, 2010). Knight and Espinosa recommended receiving a second opinion as to whether the patient is an appropriate candidate for palliative sedation.

In almost every case of a terminal disease, pain is intolerable and seeing someone in such agony is heartbreaking. For example, Brittany Maynard, a 29 year old brain cancer patient who had to move to Oregon so she can avail of the Death with Dignity act. “Maynard knew that her form of brain cancer would be excruciating. She would endure swelling of the brain that would very likely cause seizures, painful headaches and the gradual loss of bodily function. Doctors know that for about 5 percent of the population, no amount of morphine can block the agonizing pain the terminally ill endure” (EDITORIAL: Dying with dignity). Palliative care can often be provided for the dying patients and alleviating pain to provide comfort for the dying has always been the priority. “Palliative care focuses on relieving the symptoms, particularly the pain, of incurable illness.” (Palliative Care) But, in relieving pain through the prescribed medications there are also side effects that are caused by the prescribed pain suppressors and two examples will be lethargy and it compromises breathing. In most cases the effectivity of the pain medication may no longer alleviate the pain. If a patient will be in such agony for the remaining days or weeks the quality of life is no longer present. The agony of pain prevents a patient from performing even just the bodily functions.

CNA Code of Ethics for Registered Nurses (2008) provides guidance in dealing with cases like this by explaining the core nursing values and responsibilities involved which are: a) providing safe, compassionate, competent and ethical care; b) promoting health and well-being; c) promoting and respecting informed decision-making, and d) Preserving dignity; e) maintaining confidentiality, f) promoting justice and g) being accountable. The first nursing value is always expected to be upheld in any case because it is their duty to provide care using appropriate safety precautions and preventing/minimizing all forms of violence (CNA, 2008). The collaboration of the nurses between the physician and Mr. C’s family has been evident since then. This therefore calls Mr. C’s nurses to be more compassionate about his situation and try to recognize where he is coming from as they build a trust-worthy relationship before judging him or jumping into conclusions like he does not want to live anymore. Even if he decides to withdraw from these potentially life-sustaining treatments, health care providers are still obliged to give him the care he need the best way they can up until the end of his life. The second nursing value, just like the first one, still calls nurses to still aim to promote or at least maintain Mr. C’s health and well-being to the highest possible level regardless of the path he had chosen for his life. This can be achieved by continuing to collaborate well with other

A patients suffering cant be relieved all the time despite flawless palliative care, continuing to live causes misery that can only end with death.

In terms of the intensity and duration, the disease is life-long and is accompanied by increasing emotional and physical pain. Most of this pain is derived from slowly loosing major bodily functions like walking, speaking, eating, blinking, and even breathing (Canadian medical journal: http://www.cmaj.ca) The extent of those affected include himself and his family members who are most likely suffering emotionally as well. The degree of pain and the extent to which this pain affects others is greater than the pleasure that could be derived from allowing the disease to progress further in answering no to Rob’s request. Thus, under utilitarian principles, the doctor should uphold Rob’s request for physician-assisted death.

"Improperly managed physical symptoms" can add to physician error and end a life too early when an individuals suffering can be eased in other manners that could prolong life. Death is one of the most feared experiences a person will ever face. The suffering that is associated with death may outweigh the actual suffering the patient feels, and doctors may overlook this due to the façade the patient may play in order to exercise their "right to die".

In “Everyone Deserves to Die with Dignity”, Anita Freeman talks about the agony and struggle her sister went through after being diagnosed with stage four cancer. Freeman’s sister, Elizabeth Martin, was diagnoses with cancer and had limited time to live her on earth. Freeman took on the responsibly of Elisabeth and tried to carry out her every wish. Elizabeth’s biggest fear was dying in pain; this is when Freeman issued palliative care to come in. After multiple visits from palliative care Elizabeth knew this was not the plan for her. The medicine that was issued was not potent enough and would leave Elizabeth in excruciating pain. Freeman lived in California were PAS was not yet legalized, so they had to settle for permanent sedation. Freeman knew that permanent sedation was not what her sister wanted, but based on laws that’s all she could do. After the suffering and pain Freeman felt towards her sister’s situation she became an advocate for Compassion & Choices. Freeman writes in the New York Times that “Currently,

The last resort is to use terminal sedation. Terminal sedation is when a patient is given medications that induce sleep until death occurs. This method is only supposed to be used to provide relief from suffering and not directly induce death. In contrast, the doctrine of double effect says that if doing something ethically good has a morally bad outcome, it's ethically considered appropriate to do it having proof the bad outcome wasn't intended. This also stays true even if one expected the bad outcome to occur. The double effect itself is defined as the administration of sedative drugs with the purpose of specifically relieving pain and suffering in a terminally ill patient. The unintended, but well-known, consequence may be that the drugs could the patient’s premature death. This is a legal way of treatment as long as the intention is only to relieve suffering and not cause death. The death is ultimately attributed to underlying causes of the diseases combined with the removal of survival treatments like feeding tubes and artificial

The oral dosage would be 6 - 10 mg/kg PO (mixed in cola or other beverage) given 30 minutes before procedure.

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.

I have always believed that health cannot be optimized through the treatment of disease only. Rather, health should be addressed on a biological, physical, psychological, social, and spiritual continuum. Palliative care addresses an often-overlooked aspect of the patient experience, which is symptom management of their chronic illnesses. Health care professionals tend to treat acute episodes of