A20 Euthanasia request/discussion (ICD-10:Z71.8)

Introduction

Euthanasia is a highly controversial topic that involves the deliberate ending of a person’s life to relieve their suffering. This guide aims to provide healthcare professionals with a procedural framework for discussing and evaluating euthanasia requests^[1]. It is important to approach this topic with sensitivity and respect for the patient’s autonomy and values^[2].

Codes

• ICPC-2 Code: A20 Euthanasia request/discussion
• ICD-10 Code: Z71.8 Other specified counselling

Symptoms

• Suffering: The patient may express feelings of physical or emotional pain, distress, or hopelessness^[3]
• Loss of quality of life: The patient may experience a significant decline in their ability to perform daily activities or engage in meaningful relationships^[4]
• Terminal illness: The patient may have a diagnosis of a progressive, incurable disease with a limited life expectancy^[5].

Causes

• Terminal illness: The primary cause of a euthanasia request is often a terminal illness that causes significant suffering and loss of quality of life^[6].
• Incurable pain: The patient may be experiencing severe and unrelenting pain that is unresponsive to conventional treatments^[7].
• Loss of autonomy: The patient may feel that their illness has robbed them of their independence and control over their own life^[8].

Diagnostic Steps

Medical History

• Gather information about the patient’s medical condition, including the diagnosis, prognosis, and treatment options^[9].
• Assess the patient’s physical and psychological symptoms, including pain levels, functional status, and emotional well-being^[10].
• Explore the patient’s values, beliefs, and goals of care to understand their perspective on euthanasia.

Physical Examination

• Perform a thorough physical examination to assess the patient’s overall health and identify any physical signs of distress or suffering.
• Evaluate the patient’s functional status and ability to perform activities of daily living.

Laboratory Tests

• There are no specific laboratory tests to diagnose a euthanasia request. However, it may be necessary to perform routine blood tests to assess the patient’s overall health and rule out any reversible causes of suffering.

Diagnostic Imaging

• Diagnostic imaging is not typically required for evaluating a euthanasia request. However, if there are concerns about the presence of an undiagnosed condition contributing to the patient’s suffering, imaging studies may be considered.

Other Tests

• Additional tests or consultations may be necessary depending on the specific circumstances and the patient’s medical condition. These may include psychiatric evaluations, palliative care consultations, or second opinions from specialists.

Follow-up and Patient Education

• Provide ongoing support and follow-up care to the patient, regardless of the outcome of the euthanasia request.
• Offer resources and education about palliative care, pain management, and end-of-life options to ensure the patient is well-informed and supported in their decision-making process.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Euthanasia request/discussion:

1. Opioids (e.g., Morphine, Fentanyl):
   • Cost: Varies depending on the specific medication and dosage.
   • Contraindications: Allergy to opioids, severe respiratory depression.
   • Side effects: Sedation, constipation, nausea.
   • Severe side effects: Respiratory depression, addiction.
   • Drug interactions: Benzodiazepines, alcohol.
   • Warning: Close monitoring for respiratory depression is required.
2. Benzodiazepines (e.g., Lorazepam, Midazolam):
   • Cost: Varies depending on the specific medication and dosage.
   • Contraindications: Allergy to benzodiazepines, severe respiratory depression.
   • Side effects: Sedation, dizziness, confusion.
   • Severe side effects: Respiratory depression, paradoxical reactions.
   • Drug interactions: Opioids, alcohol.
   • Warning: Caution in patients with compromised liver function.
3. Antidepressants (e.g., Sertraline, Escitalopram):
   • Cost: Varies depending on the specific medication and dosage.
   • Contraindications: Allergy to antidepressants, recent myocardial infarction.
   • Side effects: Nausea, headache, sexual dysfunction.
   • Severe side effects: Suicidal ideation, serotonin syndrome.
   • Drug interactions: Monoamine oxidase inhibitors, St. John’s wort.
   • Warning: Regular monitoring for changes in mood and behavior is required.
4. Antipsychotics (e.g., Haloperidol, Olanzapine):
   • Cost: Varies depending on the specific medication and dosage.
   • Contraindications: Allergy to antipsychotics, severe central nervous system depression.
   • Side effects: Sedation, extrapyramidal symptoms, weight gain.
   • Severe side effects: Neuroleptic malignant syndrome, tardive dyskinesia.
   • Drug interactions: Benzodiazepines, anticholinergic medications.
   • Warning: Regular monitoring for changes in mental status and movement disorders is required.
5. Barbiturates (e.g., Phenobarbital, Pentobarbital):
   • Cost: Varies depending on the specific medication and dosage.
   • Contraindications: Allergy to barbiturates, severe respiratory depression.
   • Side effects: Sedation, dizziness, confusion.
   • Severe side effects: Respiratory depression, addiction.
   • Drug interactions: Opioids, alcohol.
   • Warning: Caution in patients with compromised liver function.

Alternative Drugs:

• Cannabinoids (e.g., Dronabinol, Nabilone): May be considered in patients with refractory pain or nausea.
• Ketamine: An anesthetic agent that may be used for its analgesic and sedative properties.
• Anticonvulsants (e.g., Gabapentin, Pregabalin): Can be used for neuropathic pain management.
• Muscle relaxants (e.g., Baclofen, Tizanidine): May help alleviate muscle spasms and promote relaxation.
• Sedatives (e.g., Diazepam, Zolpidem): Can be used to manage anxiety and promote sleep.

Surgical Procedures:

• There are no surgical procedures specifically indicated for euthanasia. However, in some cases, the patient may undergo procedures to alleviate suffering or manage symptoms associated with their terminal illness. These may include palliative surgeries, such as nerve blocks or implantation of pain pumps.

Alternative Interventions

• Counseling and psychotherapy: Provide emotional support and counseling to help the patient cope with their suffering and explore alternative options for managing their symptoms. Cost: Varies depending on the therapist and duration of therapy.
• Spiritual support: Offer spiritual guidance and support to address existential concerns and provide comfort during the end-of-life journey. Cost: Varies depending on the religious or spiritual organization.
• Palliative care: Involve a multidisciplinary team of healthcare professionals to provide comprehensive symptom management and psychosocial support. Cost: Covered by most insurance plans.
• Voluntary euthanasia organizations: In countries where euthanasia is legal, there may be organizations that provide guidance and support for patients considering euthanasia. Cost: Varies depending on the organization and services provided.

Lifestyle Interventions

• Comfort measures: Focus on providing a comfortable and supportive environment for the patient, including pain management, hygiene, and assistance with activities of daily living. Cost: Covered by most insurance plans.
• Music therapy: Use music to promote relaxation, reduce anxiety, and enhance emotional well-being. Cost: Varies depending on the music therapist and duration of therapy.
• Pet therapy: Introduce trained therapy animals to provide companionship, comfort, and emotional support. Cost: Varies depending on the organization providing the service.
• Massage therapy: Use therapeutic massage techniques to promote relaxation, reduce pain, and improve overall well-being. Cost: Varies depending on the massage therapist and duration of therapy.
• Aromatherapy: Utilize essential oils to promote relaxation, reduce anxiety, and enhance emotional well-being. Cost: Varies depending on the specific oils and delivery methods used.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. Additionally, the effectiveness of alternative interventions may vary from person to person, and it is essential to consider the individual needs and preferences of the patient when exploring these options.

Conclusion

This clinical procedural guide provides healthcare professionals with a framework for discussing and evaluating euthanasia requests. It is crucial to approach this topic with empathy, respect, and a commitment to patient-centered care. The guide outlines the diagnostic steps, possible interventions, and alternative options to consider when addressing euthanasia requests. Ultimately, the decision to proceed with euthanasia should be made in accordance with legal and ethical guidelines, while prioritizing the patient’s autonomy and well-being.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – A20 Euthanasia request/discussion (ICD-10:Z71.8)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Euthanasia request/discussion effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Euthanasia request/discussion. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Emanuel, E. J., Onwuteaka-Philipsen, B. D., Urwin, J. W., & Cohen, J. (2016). Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA, 316(1), 79-90.
2. Quill, T. E., Back, A. L., & Block, S. D. (2016). Responding to patients requesting physician-assisted death: physician involvement at the very end of life. JAMA, 315(3), 245-246.
3. Gamondi, C., Pott, M., Forbes, K., & Payne, S. (2015). Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: a qualitative study. BMJ Supportive & Palliative Care, 5(2), 146-152.
4. Dees, M., Vernooij-Dassen, M., Dekkers, W., & van Weel, C. (2010). Unbearable suffering of patients with a request for euthanasia or physician-assisted suicide: an integrative review. Psycho-Oncology, 19(4), 339-352.
5. Rodríguez-Prat, A., Monforte-Royo, C., Porta-Sales, J., Escribano, X., & Balaguer, A. (2016). Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography. PloS One, 11(3), e0151435.
6. Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliative Medicine, 27(1), 13-26.
7. Steck, N., Egger, M., Maessen, M., Reisch, T., & Zwahlen, M. (2013). Euthanasia and assisted suicide in selected European countries and US states: systematic literature review. Medical Care, 51(10), 938-944.
8. Ruijs, C. D., Kerkhof, A. J., van der Wal, G., & Onwuteaka-Philipsen, B. D. (2012). The broad spectrum of unbearable suffering in end-of-life cancer studied in Dutch primary care. BMC Palliative Care, 11(1), 1-10.
9. Monforte-Royo, C., Villavicencio-Chávez, C., Tomás-Sábado, J., Mahtani-Chugani, V., & Balaguer, A. (2012). What lies behind the wish to hasten death? A systematic review and meta-ethnography from the perspective of patients. PloS One, 7(5), e37117.
10. Quill, T. E., Back, A. L., & Block, S. D. (2016). Responding to patients requesting physician-assisted death: physician involvement at the very end of life. JAMA, 315(3), 245-246.