Hospice Patients Alliance: Consumer Advocates

Only Medication Needed for the Patient's Clinical Condition Should be Taken!

Note: The following is excerpted and adapted from the chapter: "Reverence for Life and the Approach to Patient Care" from the book, Restoring the Culture of Life: (The Ethics of Life in Healthcare and Society), written in 2013 by Ron Panzer.

Reason requires that we acknowledge that there must be a cause for the effects we observe around us, especially in the patient. When we have reverence for life — for the sanctity of life — we recognize that the patient before us is an amazing, moving, living microcosm of that which exists in the universe, a vital part of this world. When we love that patient, we will take great care in all we do for the patient.

Our patient has a virtually infinite number of intelligently organized biological, biochemical, bioelectrical and other physiological processes occurring simultaneously. In health, all work to the good of that patient, maintaining homeostasis, a stable equilibrium and optimum functioning of the human body. In disease, many processes are affected and a state of imbalance ensues, causing suffering and eventually even death.

When we intervene, the person in his entire body will be affected. The good doctor, nurse (or other healthcare practitioner) will take the time to obtain thorough information about the patient's history. He or she will learn much about the patient's unique clinical condition as well as their home and social setting, employment, psychological status and so on. In so doing, he will be better able to consider what interventions are most likely to help the patient.

He knows that if we administer even one medication, we may cause dozens of biological effects and responses in the body, and we must recognize that simply because we understand some of the biochemical reactions that occur, we do not understand everything that is occurring or will occur as a result of our intervention. What happens when the patient is taking two, five or even ten medications simultaneously?

The reality is that there is no physician, pharmacist, or biochemist who knows exactly what will happen and how all those medications will interact. Information gleaned from research studies can only provide bits and pieces of information that tell us some of what will happen, and only suggest what might happen or what is likely to happen. This is why medicine is an art that must be tailored to each patient's current condition and presenting symptoms, and is not a science that explains everything that will happen to any particular patient.

In the case of a patient taking multiple medications, even if there are no clearly incompatible combinations of those medications, there still could be interactions that might be harmful to the patient. For this reason, prudence demands that we choose medications carefully and give them only if clinically necessary, only in a dosage that is needed to control actual distressing symptoms, and that we perform an ongoing, careful assessment of the patient's responses to any medications given.

In hospice settings, the patient always has the right to retain their own attending physician and does not have to give up that physician's guidance and medical orders. Forcing the patient to only have access to the hospice medical director as his or her physician is a violation of federal and state laws governing hospice. If you have questions about what is being done for your loved one, ask the physician you trust or friends who are knowledgeable about end-of-life care and these medications.

If we have reverence for life, we will consider these questions. If we don't, we will administer medications without even giving it much thought, and the patients will suffer unnecessary adverse effects. "Polypharmacy" — the use of more medications than are clinically indicated by a patient — is quite common in a culture of death healthcare setting, especially in the case of the chronically ill and the elderly.

Visit many skilled nursing facilities or patients in their own home, and you will find patients on eight, twelve, or even more medications, often taking two or three for the same purpose. Yes, sometimes two medications may be needed to manage a patient's medical problem, but in many cases, the extra medications are unnecessary and actually causing various medical problems including sedation, dementia-like symptoms, and even damage to the kidneys and liver that process these medications.

When an attentive physician removes some of these extra medications, patients often improve. Some patients who were thought to have dementia, for example, turn out to have been artificially placed in that state as a result of adverse effects from medications that are redundant or actually harmful to that patient.

If we administer one Central Nervous System ("CNS") depressant, and then another and another yet again, it is no surprise that the patient's mental and metabolic functions are suppressed. Sedatives, opioid analgesics for pain, and other medications combine to create an adverse synergistic effect: the respiratory rate and heart rate is slowed; the blood pressure is lowered; the patient's consciousness is reduced to lethargy, stupor and finally, medically-induced coma. What eventually happens in such cases?

We need only look to the notorious untimely deaths of Judy Garland, Elvis Presley, Marilyn Monroe, Whitney Houston, Michael Jackson, and dozens of other famous celebrities. In 2010, "38,329 people died of drug overdoses in the United States in 2010," and "57% of [the] overdoses, or more than 22,000, involved known prescription drugs."

At a minimum, over 22,000 real people died in one year as a result of physician-prescribed medications, and although we do not know if the medications were misused, in many cases they are taken as prescribed and death still results. The total number of deaths from drug overdoses was more than those who died in traffic accidents, and those resulting from prescribed drugs was not far behind it! This is the madness of a culture of death: society's physicians prescribe and we agree to take medications that kill us.

We know that "from 1999 to 2007, the number of U.S. poisoning deaths involving any opioid analgesic (e.g., oxycodone, methadone, or hydrocodone) more than tripled, from 4,041 to 14,459, or 36% of the 40,059 total poisoning deaths in 2007." Opioids alone or in combination with other CNS depressants can be lethal, yet nurses in end-of-life care settings are often trained to think that these medications pose little or no danger at all!

Opioids like morphine, fentanyl, and others are very helpful in relieving the extreme pain that may occur in some illnesses, but not all. Sometimes opioids have no effect on other types of pain and different methods are used to relieve pain.

What does happen in the end-of-life hospice or palliative care setting today? Patients are often routinely given the same drugs that have caused deaths in those famous cases. This is not surprising, because they may be needed for severe pain! However, they receive one CNS-depressant medication after another — almost always morphine or another opioid medication, Ativan (lorazepam) or other anti-anxiety or sedative medications, and Haldol or other anti-psychotics. Patients are sometimes given two or three of each type, sometimes more. When too many medications like this are given, it is not authentic end-of-life care!

Almost all opioid deaths occurring within the end-of-life care setting are never declared as "poisoning" deaths or overdoses and are not listed as such officially. Deaths are expected to occur because the patient is in the end-of-life hospice setting and are almost never investigated through an autopsy. Deaths related to synergistically harmful and redundant medications in a skilled nursing facility or end-of-life care setting are also almost never declared as "poisoning" deaths.

Of course, in end-of-life settings, patients often do have extreme pain and other symptoms, and careful administration of powerful medications is clinically justified in many situations. In the culture of death healthcare setting, though, do healthcare practitioners strive to allow a natural death in its own timing while relieving distressing symptoms? Or, do they in many cases actually seek to hasten death? Family members must be vigilant to allow only medications that are clinically necessary and helpful!

Shockingly, we know from secular bioethicists as well as hospice and palliative care leaders that in many cases they actually do seek to hasten and impose death. It is no surprise that in the widespread culture of death healthcare setting, patients are often quickly sedated into a coma from which they are not allowed to emerge.

Permanent sedation into death also called "slow" or "stealth" euthanasia — is becoming a very common method of imposing death in the healthcare setting! Is it not a form of madness when many of those whose duty is to care for us, actually kill us? Terminal sedation may relieve suffering of a severely agitated patient, but if not needed, it can be a "peaceful-looking" way of imposing death, among several other common methods used. Most famiy members have no idea what is going on when this is done.

CNS depressants are not the only medications that can be misused or overprescribed and lead to patient harm. "Experts from the CDC and FDA estimate that every year, more than 700,000 people visit U.S. emergency departments because of side effects, accidental overdoses, and other adverse drug events." The FDA states that 100,000 patients die each year due to adverse reactions to prescription drugs.

In good healthcare practice establishing the culture of life and in authentic end-of-life care — whether in a hospice or not — many patients' medications are monitored and their responses are evaluated. Insulin for regulating blood sugar, Coumadin (warfarin sodium) to optimize blood-clotting, and thyroid supplements are examples of medications that must be regularly adjusted to patient conditions. Give too much or too little of any of these, and the patient may eventually die.

In the culture of death with rogue hospices that do not honor the patient's sanctity of life, the choice to stop monitoring and properly adjusting such medications has become one of many methods of hastening death in the patient. The healthcare practitioner need not inject a patient with a lethal agent to assure death. If the patient has any chronic condition, mismanagement of the medications needed can and does result in destabilization of the patient and consequent death. If the patient acquires an infection, the choice to not treat that easily-treated infection results in an unnecessary death in just the same wa, but in good hospice settings, infections that are not related to the terminal illness are treated!

Doing what is not helpful for the patient is what is meant by a culture of death setting. Staff who are not pro-life and who have abandoned the original hospice mission subscribe to a perverse worldview, and allow harm to patients without taking effective precautions to prevent that harm. They actually intend harm! They discard the unwanted patients without the slightest concern, knowing they have other patients to take their place. The agency does not lose any funding.

When reverence for life flourishes in society, these intentional, knowing acts of harm causing death to so many are recognized as crimes and those who commit them are prosecuted. However, the hospice industry has been infiltrated by secular leaders who have tainted the mission, the training, and the practice so that disguised medical killings or "stealth euthanasia" is practiced.

How many other medications do we administer that may also increase the risk of death? Aside from the well-known risks of the opioids like morphine, Haldol, one antipsychotic medication, is known to double the risk of death in the elderly, yet it is increasingly administered to them. End-of-life care practitioners argue that in that healthcare setting its use is justified, and that these studies somehow "do not apply" at the end-of-life. They are right in some cases and wrong in others. Some patients need it while others don't!

Except for those patients who are clearly demonstrating several signs of the clinically active phase of dying, we must ask ourselves, "Do we truly know for sure when the "end-of-life" will come if we do not hasten it?" It is clear that no matter the care setting, the effect of Haldol physiologically is to double the risk of elderly patient deaths. We must ask: "What are we seeking to accomplish with our care?"

Adherence to the precautionary principle would give us pause to consider whether administration of this particular drug, or any other, is truly justified, and whether or not other less-lethal medications might be utilized with a much better outcome. When it is known that this drug's use has increased dramatically as the culture of death has infiltrated end-of-life care especially, is this medication's widespread use today so common precisely because of its increased risk of death?

The healthcare practitioner with reverence for life will ask these questions and take time to research and re-evaluate his or her practice. While Haldol may be quite helpful to some patients who actually do have severe psychological problems or hallucinations, how many other patients may be harmed unnecessarily? Sometimes, medications like this may cause the exact opposite effect that is desired.

Many other medications also have potentially serious adverse effects, so their use needs to be carefully considered before we choose to administer them to our patients. Pharmaceutical industry history shows us that we cannot simply trust the marketing and the hype. Famiy members and patient advocates need to make the effort to know exactly what medications are being taken, why, what dosage is being given, how long any medication's effects lasts, how often the medication is being given, and check independentlyon everything that is told to you! Don't simply believe everything you are told. "Trust, but verify!"

When it comes to healthcare services and hospice especially, the culture of death is a counterfeit of the culture of life practice. Healthcare professionals use language that implies they will provide whatever the patient needs, but they don't meet the patients' needs in many cases.

In the end-of-life setting, they promise the full range of services, but once the patient is enrolled, visits are few and far between; medications are given as part of a death protocol and not tailored to the patient's unique needs. When the patient's right to "self-determination" and "autonomy" is promoted, it is only promoted so that treatment can be refused (or denied), not so that treatment can be guaranteed when the patient chooses it!

If the patient requires physical or occupational therapy, the once promised services are not made available. If the patient has an easily treated infection, they refuse to treat it. By denying it, they manipulate care so that an early imposed death occurs from the infection, not from a terminal illness! If the patient's bowels are impacted (a medical emergency when stool cannot pass) staff will place an ineffective suppository to give the appearance they are doing something, but they know it will accomplish nothing. They refuse to take the time to disimpact the bowel with an oil-retention enema, and other repeated enemas over time. They therefore assure that an unnatural death will occur.

If the patient complains that he is having difficulty breathing, rather than sit the patient up in bed, provide oxygen, perform a nebulizer treatment to open the airways, administer medications to reduce fluid in the lungs, suction fluids out of the airway, or other treatments, morphine is given "to help" the breathing. Hospice staff all around the world are being taught (incorrectly in most cases) that morphine helps the breathing, and then do almost nothing else to help the patient's breathing!

Well, a low dose does help when combined with a diuretic for those suffering from pulmonary edema related to end-stage heart failure (it diverts blood away from the pulmonary circulation). But they misapply this for those who have no pulmonary edema and don't give a diuretic to the patient if he does have pulmonary edema! In such a case, morphine only "relaxes" the patient into a permanent coma and increasingly works to shut down their breathing. The patient sleeps into death.

This type of "relaxation" offered by the culture of death is similar to the total relaxation accomplished by shutting off the patient's access to air, a method of imposing death used by many in the pro-euthanasia community. The culture of death mixes a little truth with a lie or deception and manipulates interventions to hasten death. Some are unaware they are actually hastening death; others know very well what they are doing!

When the patient complains that they are not getting water, staff throw up roadblocks of all sorts, may provide token amounts of water that do not replenish the patient's required needs for hydration, and continue to make excuses and delay. When the conscious patient wants to eat, they sedate him enough so that a "choking" problem is created and suddenly "discovered."

Obviously, you don't want to give food and fluids orally to someone who can't swallow, so they tell the family, "He can't swallow!" "Do you want to cause aspiration pneumonia?" But without food and fluids, any of us will die, and over days, the patient does die an early death. They have manipulated the patient's consciousness so that he cannot swallow, and manipulated the family so they do not see the deadly deception!

Give the sedated patient a stimulant (even tiny drops of coffee just like a medication under the tongue) or Narcan to reverse opioid adverse effects, and the supposedly "comatose" patient who "cannot swallow" may be able to eat and drink whatever is given to them, just like they did before they were drugged. Of course, if the patient truly does have a swallowing problem, giving oral fluids or food is not advised. Some patients have tube feedings, while others are truly dying and they slowly take in less and less food and water.

Again, family members and patient advocates must make sure that only medications that are actually needed are given, and given only in the dose needed, in the right timing or interval between doses, and through the right route to be effective and not harmful.

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