- Thread starter cobraboy
- Start date
End of Life: The Shot
They call it la injeccion here but in the case of Lala it was injected and here something was put in a drip followed by an injection.
Well this is exactly what they use in Canada for what they call "Medical assistance in dying".
https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html
Available options
There are 2 types of medical assistance in dying available to Canadians. They each must include a physician or nurse practitioner who:
directly administers a substance that causes death, such as an injection of a drug
this is becoming known as clinician-administered medical assistance in dying
it was previously known as voluntary euthanasia
or
provides or prescribes a drug that the eligible person takes themselves, in order to bring about their own death
this is becoming known as self-administered medical assistance in dying it was previously known as medically assisted suicide or assisted suicide.
Without getting into the ethicality debate about end of life options, I do not think this is a legally or medically sanctioned treatment option in the DR. I have no trouble believing that some doctors are not adverse to providing this service in the campo under the right circumstances, however, I do not believe one can check themselves into a primary care facility here and pursue "the shot" as a course of treatment for their terminal condition.
Might be possible to get a prescription that is supposed to be taken over a period of time that a patient might opt to take all at once if they were so inclined and very insistent. What happens outside of hospital between some doctors and specific patients might be a different scenario.
Might be possible to get a prescription that is supposed to be taken over a period of time that a patient might opt to take all at once if they were so inclined and very insistent. What happens outside of hospital between some doctors and specific patients might be a different scenario.
I have totally misunderstood the concept of "The Shot."
My paradigm is being a Hospice provider for many years and with thousands of patients, primarily HIV/AIDS when that diagnosis was a death sentence. I've witnessed all the Kübler-Ross stages of death and dying first hand in real life more often than I care to admit. In fact, I became jaded.
Many of our clients opted for varying form of assisted suicide and had Advance Directives of DNR. In fact, many clients arranged their deaths/suicide to be a social event where they could relay their last respects to those they love while still physically able before crossing to the other side. End stage AIDS is a horrible death. These events were well planned and coordinated. When one of my Hospice nurses asked to be on duty for a specific patient at a specific time, my nurse coordinators knew what the request meant. A Hospice nurse in FL can pronounce death and when an ambulance is called it doesn't come with lights flashing and sirens blaring, and the paramedics are not required to institute "heroic methods." A non-Hospice nurse cannot pronounce death, and when he/she calls an ambulance the entire neighborhood is witness to a spectacle. My nurse may work for both the Hospice and non-Hospice side of my agency with the same patient, but she could only pronounce death while working with the Hospice. When the patient dies his friends could "sanitize" the area to remove evidence of what happened. I always figured the EMT's knew it and understood, so they did not request police investigations for a crime scene.
When I heard of "The Shot" in the DR I assumed this was a form of consented "advance directive" as what william webster has described for himself (and I would do for myself.)
But after reading Lindsay's interesting experience, I have been haunted. Certainly, a serious stroke is a bad thing and comes at no opportune time. And once a victim of a stroke that person may be a living shell of themselves. But we don't know. There is much evidence of a patient locked in their body unable to respond, but fully conscious.
Not that Lindsay's experience was a person trapped in their body. Not sure we know, but props for reaching out with comfort. Often there isn't much else to do, and a person needs comfort on their last journey. Compassion goes a long way.
But now I see that it was not the patient who requested The Shot unless the request was made before the stroke and in an unofficial, verbal AD. None of that was mentioned in the story, and never mentioned in general discussions on the topic.
Make no mistake: I am a strong advocate of assisted suicide for the right reasons. I have dealt with hundreds. But giving someone The Shot when they never requested it while cogent and lucid is no different than putting a sick dog down. But unlike a pet, this time it is murder.
It seems The Shot was given for convenience of the family---we can't muss up their vacation, after all---and not for the patient. And also seems a physician was a party to this act and the request of the overly imposed family member.
Such an act may be described as a "mercy killing." But make no mistake: unless the request was made by the person, in writing with a clear mind, and witnessed by others, a "mercy killing" is still murder.
I've asked around some more. Almost nobody has heard of The Shot. At least not among the Dominicans I deal with daily. Granted none are among the poor in the campo, but everyone I ask is similarly appalled. I do not contest it does not exist. I just doubt The Shot is as prevalent as the stories make then to be.
My paradigm is being a Hospice provider for many years and with thousands of patients, primarily HIV/AIDS when that diagnosis was a death sentence. I've witnessed all the Kübler-Ross stages of death and dying first hand in real life more often than I care to admit. In fact, I became jaded.
Many of our clients opted for varying form of assisted suicide and had Advance Directives of DNR. In fact, many clients arranged their deaths/suicide to be a social event where they could relay their last respects to those they love while still physically able before crossing to the other side. End stage AIDS is a horrible death. These events were well planned and coordinated. When one of my Hospice nurses asked to be on duty for a specific patient at a specific time, my nurse coordinators knew what the request meant. A Hospice nurse in FL can pronounce death and when an ambulance is called it doesn't come with lights flashing and sirens blaring, and the paramedics are not required to institute "heroic methods." A non-Hospice nurse cannot pronounce death, and when he/she calls an ambulance the entire neighborhood is witness to a spectacle. My nurse may work for both the Hospice and non-Hospice side of my agency with the same patient, but she could only pronounce death while working with the Hospice. When the patient dies his friends could "sanitize" the area to remove evidence of what happened. I always figured the EMT's knew it and understood, so they did not request police investigations for a crime scene.
When I heard of "The Shot" in the DR I assumed this was a form of consented "advance directive" as what william webster has described for himself (and I would do for myself.)
But after reading Lindsay's interesting experience, I have been haunted. Certainly, a serious stroke is a bad thing and comes at no opportune time. And once a victim of a stroke that person may be a living shell of themselves. But we don't know. There is much evidence of a patient locked in their body unable to respond, but fully conscious.
Not that Lindsay's experience was a person trapped in their body. Not sure we know, but props for reaching out with comfort. Often there isn't much else to do, and a person needs comfort on their last journey. Compassion goes a long way.
But now I see that it was not the patient who requested The Shot unless the request was made before the stroke and in an unofficial, verbal AD. None of that was mentioned in the story, and never mentioned in general discussions on the topic.
Make no mistake: I am a strong advocate of assisted suicide for the right reasons. I have dealt with hundreds. But giving someone The Shot when they never requested it while cogent and lucid is no different than putting a sick dog down. But unlike a pet, this time it is murder.
It seems The Shot was given for convenience of the family---we can't muss up their vacation, after all---and not for the patient. And also seems a physician was a party to this act and the request of the overly imposed family member.
Such an act may be described as a "mercy killing." But make no mistake: unless the request was made by the person, in writing with a clear mind, and witnessed by others, a "mercy killing" is still murder.
I've asked around some more. Almost nobody has heard of The Shot. At least not among the Dominicans I deal with daily. Granted none are among the poor in the campo, but everyone I ask is similarly appalled. I do not contest it does not exist. I just doubt The Shot is as prevalent as the stories make then to be.
You are correct CB in your assumption that - at least in my experience- it is not at the request of the patient. It is a means of saving money for those who cannot afford it and who have already gone into debt for previous medical expenses and will go deeper into debt with funeral costs. In the cases I have seen, stroke and diabetic coma, the patients were unable to make any requests. As far as to how often it happens, I have no idea although speaking to a doctor with a medical mission she has told me of several more cases. Yes it is illegal but something being illegal in the Dominican Republic does not mean it does not happen. Another neighbour died in her late 40s from a particularly nasty form of bone cancer. She was in tremendous pain for over a year but she made it clear she did not want 'the injection' and the murmurs around the village were that it would be better for her and the family if she would agree to have it. She died of pneumonia.
Matilda
Matilda
This is one of the reasons it is important to discuss your treatment wishes with family before you find yourself in hospital unable to communicate. Putting those wishes into writing and filing them with your lawyer and attached to any medical power of attorney documents that exist is probably prudent.
I've asked my family to give me a reasonable amount of time to ask for a beer and then to pull the plug. I'm not too keen to lie in bed soiling myself pondering the intricacies of the universe year after year - that's my choice and others may feel otherwise.
I have no doubt that the medical system is under resource constraints that tend to favor some sort of a resolution to each case rather than prolonged and indeterminate maintenance of life support.
I've asked my family to give me a reasonable amount of time to ask for a beer and then to pull the plug. I'm not too keen to lie in bed soiling myself pondering the intricacies of the universe year after year - that's my choice and others may feel otherwise.
I have no doubt that the medical system is under resource constraints that tend to favor some sort of a resolution to each case rather than prolonged and indeterminate maintenance of life support.
WW
I think DNR and end of life mercy shot are two different issues.
I had 2 heart attacks this past December. The second one was violent and scary.They did have to resuscitate me. In the US now when something like that happens they make you declare rather or not you want a DNR order added to your medical record. I chose to have the DNR added. I had to sign a paper. My children were pizzed to say the least. I explained to them that I never wanted to go through that nightmare again. I do not want to come that close to death without actually crossing over.
My sister, on the other hand, died from pancreatic cancer. She was under hospice care for 6 weeks before her death. In the very end the hospice nurses did administer " the cocktail". A mixture of 3 medicines to cause her death. She did not authorize the shot nor did she know when she got it. In the US we have health care proxies. In her case the hospice nurses made the decision along with the suggestion of her family doctor. She passed away peacefully by going to sleep.
I totally agree that everyone at any age should clearly discuss with close family members what their wishes are. It is not an easy subject. When there is a medical crisis and emotions a running high is not the best time to make those decisions. With medical technology today they are able to keep people artificially alive for years. No way do I want that to happen.
I do not know about the DR but I think they also use " the cocktail". I sure hope they do. I am not liking the idea that they use it for the convenience of the family vacation.
I think DNR and end of life mercy shot are two different issues.
I had 2 heart attacks this past December. The second one was violent and scary.They did have to resuscitate me. In the US now when something like that happens they make you declare rather or not you want a DNR order added to your medical record. I chose to have the DNR added. I had to sign a paper. My children were pizzed to say the least. I explained to them that I never wanted to go through that nightmare again. I do not want to come that close to death without actually crossing over.
My sister, on the other hand, died from pancreatic cancer. She was under hospice care for 6 weeks before her death. In the very end the hospice nurses did administer " the cocktail". A mixture of 3 medicines to cause her death. She did not authorize the shot nor did she know when she got it. In the US we have health care proxies. In her case the hospice nurses made the decision along with the suggestion of her family doctor. She passed away peacefully by going to sleep.
I totally agree that everyone at any age should clearly discuss with close family members what their wishes are. It is not an easy subject. When there is a medical crisis and emotions a running high is not the best time to make those decisions. With medical technology today they are able to keep people artificially alive for years. No way do I want that to happen.
I do not know about the DR but I think they also use " the cocktail". I sure hope they do. I am not liking the idea that they use it for the convenience of the family vacation.
If you want to ease your going or that of a loved one, a better option that a shot, imho, is inert gas. You breathe normally from a bag with a steady flow of inert gas. You exhale carbon dioxide, so you do not suffer from the pain and stress of CO2 build-up in your bloodstream - but the inert gas causes oxygen levels in the blood to drop rapidly. Unconsciousness is very quick, and breathing stops within minutes, along with heartbeat. An inert gas used in the past was helium for party balloons, but in many places they began adding 15% oxygen to make it non-fatal. I don't know about in the DR. The most commonly available gas now would be R-134a automotive freon at any hardware or refrigeration shop. A 16 oz can released to atmospheric pressure and room temperature has a volume of about 200 liters - plenty to keep a kitchen trash bag inflated for a few minutes at low flow. But even after breathing stops, don't take the bag off for a good while - you don't want someone to start breating again and be "alive" but brain-damaged from lack of oxygen. In respect for the soon-to-be-departed; practice gas-bagging with an empty bag first; maybe more than once. I have not performed this operation, only read about it in various websites (for future reference).
This is how many of our HIV/AIDS clients went out, but they used nitrous oxide in increasing volumes vs air. Prior to the bag...really, it was a full-face scuba mask and not a bag...the soon-to-be departed would consume heavy doses of barbituates and oxy to be in a fully relaxed state.
This topic is very sensitive for me... I am in the process of creating an 'advance healthcare directive' here in the Dominican Republic. I'm working with the Guzman firm out of their Sosua office. This is challenging for many reasons. First, I have no relatives here but a relative is important here. My daughter had to sign a paper to say I could be cremated when I pass away. I have prepaid Blandino in Santo Domingo and they will recover my body, get it to Santiago for the autopsy, prepare and distribute the death certificate and coordinate with the US embassy for the proper forms etc. and return the ashes where I designate. All paid for and my preferences noted. First snag! My daughter does not have a passport. I gave the lawyer a copy of her Alabama drivers license but a passport is the only recognized form of ID so I'm waiting on my daughter. Second snag: My doctor has to be on board...she's pretty radically Christian so I don't know that she'll comply. I'm asking for no intervention no matter what! No feeding tubes, no cpr, no ventilator, nothing but pain meds if necessary. I have two incurable illnesses and when my bone marrow fails to respond to therapy, it's bad. I want to be able to refuse transfusions too. I don't want to live at a hospital! Third snag: I needed a local person to be my advocate if my daughter can't be here. She lives in the US. I finally asked the son of a good friend here. He's not too happy about it but he'll do it. I'm waiting on my daughter now. I'd love "the shot" option if it comes to that but I doubt it will. I just have no interest in lingering. I've lived a full life and although I'm not rushing things, I am ready when the time comes.
Oh Judy....
you are the prime candidate - anywhere in the world- for what are discussing here.
As I and others have earlier, it's no snap in any country - but it IS possible.
Navigating the course seems to be the hardest part.
If ever I can help - send me a message
I am a huge believer in this.
you are the prime candidate - anywhere in the world- for what are discussing here.
As I and others have earlier, it's no snap in any country - but it IS possible.
Navigating the course seems to be the hardest part.
If ever I can help - send me a message
I am a huge believer in this.
I only posted because the topic was "the shot" as if only one shot, and someone related a tale of shouting or wailing by persons unknown. If there were only one shot given, and that shot were potassium chloride - that is surely fatal but not a good way to go. It is excruciating and would quite possibly cause the sufferer to shout or wail: That suffering is the whole basis of the "cruel and unusual punishment" debate over capital punishment in the USA. Better options for a single shot would be high dose morphine, heroin, or other opioid.
I think you are confused. The shot as it was called is three - one to relax, second to make you unconscious and third to stop the heart. The screaming and wailing is not by the dying patient but the relatives once the person is dead. Standard Dominican behaviour when someone dies.
Sorry, I didn't read the whole thread, so forgive me if I hit a discordant note.
First, let me just say that I've been a long term believer in Euthanasia as my grandmother died in horrible pain. She had an heart aneurysm which dropped her blood pressure to the point where she developed gangrene. Easy right? Just lop off that limb as she won't use it again. Easy Peasy , but the doc didn't use any pain medication. None. He didn't want her to die due to her heart condition.. (I rattled on her for long time about his character, tax evasion, fantastic income, daughter that I grew up with, etc, and in the end being sued by the Social Security Administration. But, I deleted it It didn't do my grandma any good. ).
However, that said, I've been appalled by the Dominican version of Hospice care. I first encountered this when I saved my neighbor's life. She's an aging Haitian/Dominican woman that owns her life and is full of zest and love. She also has diabetes and when she on her deathbed, dying from hyperglycemia, I flew in with a blood sugar monitor, insulin and syringes.
She lived. Good, right? I mean I'm not looking for thank yous or IOU's. However, her family was murderously angry with me. This was a new thing for me, but apparently, these people traveled to this woman's death bed with the expectation of a pay out and ready muscle out anybody that tried to get to a cut. They didn't know what to do with some Gringo that didn't expect any compensation at all. However, I made myself scarce, my girlfriend had the PN check in, the families departed, and I eventually talked with my neighbor. She was weak, but grateful that I saved her from her family. She actually said that. (And, she's still alive and doing well today).
Second Act, my girlfriend's grandfather died. He was definitely elderly, thin, but strong. He had pneumonia. He survived the hospital, had trouble at home, back in hospital, home, and hospital and died. I was immediately suspicious that this wasn't right. I helped my girlfriend and uncle travel for the funeral, but I shared my suspicions. She completely confident in the doctor that he did the right thing. However, her family protested immediately that she was attending the funeral. It was only after they said that they didn't want any inheritance that they were accepted on friendly terms. I let it go, but I definitely left a foot note in my mind to pay attention in the future.
Third Act, is another neighbor. She's very ill with diabetes. A light breeze could easily blow her away. She owns her house, but has no money and no income. Being a dumb gringo, I thought her light weight was from insulin insufficiently, but given that her blood sugar was low, I quickly discarded that idea as well as her diabetes diagnosis. This woman was starving. Her family, nada. Simply put, she's poor. No money. Her family just wants her to die so they can have her house. Needless to say, we feed her and adopted her as grandmother. She's really a sweet woman. Her family is less than happy, but I just feel sorry for them. I know better than to just hand out money (she'd reject it if I did), but she cooks meals, makes me coffee, and we spend time talking. She's more scared and lonely than anything. Which is tragic given how close her family is.
I'm not in the DR to judge, but adolescent belief in euthanasia has definitely been replaced by some caution.
First, let me just say that I've been a long term believer in Euthanasia as my grandmother died in horrible pain. She had an heart aneurysm which dropped her blood pressure to the point where she developed gangrene. Easy right? Just lop off that limb as she won't use it again. Easy Peasy , but the doc didn't use any pain medication. None. He didn't want her to die due to her heart condition.. (I rattled on her for long time about his character, tax evasion, fantastic income, daughter that I grew up with, etc, and in the end being sued by the Social Security Administration. But, I deleted it It didn't do my grandma any good. ).
However, that said, I've been appalled by the Dominican version of Hospice care. I first encountered this when I saved my neighbor's life. She's an aging Haitian/Dominican woman that owns her life and is full of zest and love. She also has diabetes and when she on her deathbed, dying from hyperglycemia, I flew in with a blood sugar monitor, insulin and syringes.
She lived. Good, right? I mean I'm not looking for thank yous or IOU's. However, her family was murderously angry with me. This was a new thing for me, but apparently, these people traveled to this woman's death bed with the expectation of a pay out and ready muscle out anybody that tried to get to a cut. They didn't know what to do with some Gringo that didn't expect any compensation at all. However, I made myself scarce, my girlfriend had the PN check in, the families departed, and I eventually talked with my neighbor. She was weak, but grateful that I saved her from her family. She actually said that. (And, she's still alive and doing well today).
Second Act, my girlfriend's grandfather died. He was definitely elderly, thin, but strong. He had pneumonia. He survived the hospital, had trouble at home, back in hospital, home, and hospital and died. I was immediately suspicious that this wasn't right. I helped my girlfriend and uncle travel for the funeral, but I shared my suspicions. She completely confident in the doctor that he did the right thing. However, her family protested immediately that she was attending the funeral. It was only after they said that they didn't want any inheritance that they were accepted on friendly terms. I let it go, but I definitely left a foot note in my mind to pay attention in the future.
Third Act, is another neighbor. She's very ill with diabetes. A light breeze could easily blow her away. She owns her house, but has no money and no income. Being a dumb gringo, I thought her light weight was from insulin insufficiently, but given that her blood sugar was low, I quickly discarded that idea as well as her diabetes diagnosis. This woman was starving. Her family, nada. Simply put, she's poor. No money. Her family just wants her to die so they can have her house. Needless to say, we feed her and adopted her as grandmother. She's really a sweet woman. Her family is less than happy, but I just feel sorry for them. I know better than to just hand out money (she'd reject it if I did), but she cooks meals, makes me coffee, and we spend time talking. She's more scared and lonely than anything. Which is tragic given how close her family is.
I'm not in the DR to judge, but adolescent belief in euthanasia has definitely been replaced by some caution.
I really appreciate your courage.
I had two parents that resisted the end to the point of absurdity. Of course, it's their right and I can't fault them for it, but from my vantage point, it created a lot of pain and duress for them during their last years. To me, it's bizarre that we fear death so much.
I guess anybody not on the edge can talk big about how they would navigate these waters. I'll find out for myself someday, but I hope I do it with love and courage as you have shared with us here.