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I often think of what I would do if I were diagnosed with a terminal illness like cancer, especially one that makes you suffer in pain as the disease winds its way to its inevitable conclusion. Unfortunately, pain management in the USA is so bad that according to studies 50 to 80% of patients die in agony because Dr's are either negligent or just plain terrified of prescribing strong narcotics for fear of losing their licenses. I've often thought that if I were diagnosed with something incurable I wouldn't wait around here in the USA, even on a physicians' promises that they'd take care to make sure I wasn't suffering at the end. I just don't think Dr's can be trusted when it comes to something as sensitive as this. I would emigrate to another country that had good hospice care and none of the restrictive laws to easing pain in the last stages.
I often think of what I would do if I were diagnosed with a terminal illness like cancer, especially one that makes you suffer in pain as the disease winds its way to its inevitable conclusion. Unfortunately, pain management in the USA is so bad that according to studies 50 to 80% of patients die in agony because Dr's are either negligent or just plain terrified of prescribing strong narcotics for fear of losing their licenses. I've often thought that if I were diagnosed with something incurable I wouldn't wait around here in the USA, even on a physicians' promises that they'd take care to make sure I wasn't suffering at the end. I just don't think Dr's can be trusted when it comes to something as sensitive as this. I would emigrate to another country that had good hospice care and none of the restrictive laws to easing pain in the last stages.
Any thoughts on anything I've said?
fortunately my state-Oregon has a Die With Dignity law in place, I intend to use this when the time is right.
fortunately my state-Oregon has a Die With Dignity law in place, I intend to use this when the time is right.
I personally could not do away with myself, but I would look to Oregon as a state that possibly has a better attitude about not letting terminally-ill patients suffer. But the dark shadow over all this is the FDA which is vigilant about prosecuting Dr's in any state who prescribe pain medication, to wit:
Quote:
Criminal prosecutions of physicians have increased under Attorney General John ********. Examples of recent important cases include those of Dr. William Hurwitz, a pioneer in the field of pain management in Virginia; Dr. Jeri Hassman, who had the largest pain practice in Tucson, and is being threatened with a 28-year prison term apparently because a small fraction of her patients used the prescriptions in unauthorized way; Dr. Robert Weitzel of Utah, who was convicted of negligent homicide and manslaughter but then acquitted in a new trial after the prosecutor was found to have concealed exculpatory evidence, and Dr. Deborah Bordeaux of South Carolina, who was convicted under a "drug kingpin" statute carrying a mandatory minimum sentence of 20 years, after working a mere two months in a locum tenems position at a clinic treating chronic pain among other ailments.
This report is dated, obviously, but prosecutions continue unabated as a part of the "war on drugs".
The plain truth is that Dr's are scared witless to prescribe medications that alleviate severe pain in the last stages of life for fear of losing their licenses and being sued by the FDA.
It's not just the terminally ill who are being allowed to suffer; the chronically ill are also having difficulty in finding doctors to manage their ongoing pain. Case in point: my sister, who has aggressive rheumatoid arthritis. Her rheumatologist does not prescribe narcotics, likely in fear of the DEA. This means that my sister must attempt to manage her pain (it's never completely gone) with strong NSAIDs and opiods like tramadol. Long-term use of NSAIDs can cause stomach damage and increases a person's risk for cardiovascular events.
My view is that the DEA fails to take into account the patients' autonomy and responsibility for misuse of legally prescribed medications, and assesses the doctors with a higher level of responsibility than may be warranted in many cases. They also fail to take into account that a pain management practice will necessarily prescribe much more strong medication for pain control than, say, your average internist or even surgeon.
How to fix it? Darned if I know. It seems to me that the DEA is trying to keep themselves relevant just in case certain currently illegal drugs are legalized. They should rethink their position on narcotics in pain management; frequently there simply is nothing else that works. For my chronic pain, narcotics work, but they sedate me, so I rarely use them. I'd rather be awake, thanks.
We must be VERY CAREFUL with chronic pain patients, as physicians can be, and have been, tried for manslaughter if someone abuses the meds provided for them. It is very high risk and one is putting thier career on the line if someone does something stupid when a physician is simply trying to help them. A physician in our state has just been charged with eight counts of manslaughter for oral narcotic deaths.
Regarding pain relief for cancer- forget it. The oncologists NEVER refer any patients out for implanted pumps,SQ infusions, or IV infusions. They have always been that way- they always will be. The only way a patient gets a pump is if they know about it already and DEMAND that they be referred. Otherwise, they would never know.
Unfortunately, many chronic pain sufferers do get relief from pain, but then, begin to abuse their drugs. There needs to be a better, non-addictive way to treat chronic pain.
And, there are alot of folks who will manufacture "pain" to get the drugs they want....it happened to 2 family members....they both died due to those narcotics. There's no real way to help them once they become addicted...as a person must WANT help for help to be effective.
My mom died from lung cancer in 2003. We lived in Phoenix, AZ at the time. Hospice of the Valley worked with us and mom was able to spend her last months at home. She was dieing and nothing was going to stop it.
The nurses and I agreed to keep her as pain free as possible. She was on Oxycontin and Oxycodone and was given relief whenever she needed it - even if she just had a pill an hour ago!
There was never a moment when any of us hesitated in managing her pain. Never a thought about addiction. I will be forever grateful to Hospice of the Valley for their wonderful care and support during those very difficult months.
My mom was treated with dignity and her pain treated accordingly. The supporting nurses were also there to help me deal with my own mental pain.
Effective pain management can be had in the US.
I have to agree that doctors are reluctant to give the same meds for pain relief for those not terminal. Heaven forbid someone become dependent on a ''miracle pill'' to see them through their day.
Personally, I hate pain meds that make me groggy. I self medicate with Aleve and weed (although I do have to take Neurotin every day if I don't want to twitch constantly) and am doing okay with pain management for now.
So much to say on this topic. I feel for people who are in chronic pain because they are at greater risk for dependency on narcotics because they have so many years left. It's the rationale of being afraid to treat terminally ill patients by Dr.'s that puzzles me. Of course one should never look for logic from a govt. agency especially an American one, but it seems to me that the pharmacological conglomerate, who just about "own" the FDA, would be putting the screws to it saying, "Hey! Lay off the lawsuits! These prosecutions are hurting our sales because Dr's are terrified of you guys and aren't writing scripts!" Go figure.
It seems to be the luck of the draw, getting an understanding doc. Emeraldmaiden is having a terrible time while tulani had a most satisfying experience, notwithstanding the horrible loss of a loved one. In the case of terminal illness one only gets one shot at this and cases like this make me stand up and take notice:
Hopefully this landmark case will change things for people who are terminal and in great pain. I mentioned travelling to another country in my OP. Great Britain is ranked No. 1 for hospice care. Makes me think it's too dangerous rolling the dice here in America. It's a difficult position to be in.
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