Do you think removing an NG tube is "killing someone"?

[krenee]

I am a nursing student and at my patient the other day at clinical was comatose, after a stroke and has been in the same condition for several weeks now. The nurse told me he was being place on hospice and the doctor ordered removal of his NG tube and d/c's most of his meds. I was going to remove the NG tube, but the nurse became uncomfortable because I hadn't done it before, so she did it herself. So while I realized basically what was going on, I clarified with my instructor . . . he now has no feeding tube, and he has no IV fluids going in . . . obviously they are going to let him die. I was talking to my mom on the phone later on and mentioned the situation, and she said, "I'm so glad you didn't kill that man", meaning I didn't remove the NG tube myself as I was going to.

IDK, I really hadn't thought about it that *I* would be killing him by doing that . . . first, the family made the decision, then the doctor gave the order . . . but I guess I can see her point.

Just curious how other nurses feel and deal with situations like that.

[stta11]

I usually read through all responses before replying, but don't have time this morning. Sorry if I'm being repetitive.

Tell your Mom that an NG tube is not appropriate for long term placement. The tube would have had to be removed soon even if all efforts to prolong this man's life were going to be made. The tube can cause damage to the nasal passages and esophagus if left in too long. Pulling the NGT had nothing to do with causing his death; the deciding factor in a literal sense is not the pulling of the tube, but the decision to not replace it with a more permanent solution.

I think that's a reasonable response... But I think that's where a lot of it goes on intent here. If you know they are not intending to provide a more permanent solution in the end you should refuse to remove the feeding tube. However, if you are simply removing it because of the irritation it is causing and the patient will still be fed... of course that is fine. I think it was an important distinction for you to make though. Much appreciated.

Also, I should mention that in this case... the original poster explained later that the man was not tolerating feedings and that is why the tube was removed. So I believe for this particular example the point I just made does not directly apply.

[stta11]

Actually, I think that the OP's mother expressed a sentiment that a majority of people feel; which is simply a total ignorance/refusal of death. Americans, somehow; cannot deal with or face the fact of death.

Until this cultural denial is addressed, (And I think Obama's medical insurance plan made a BIG attempt), we are faced with LOTS of ICU beds filled with 90 ear olds in ESRD undergoing futile proceedures. It's no longer about saving lives, it is about no one wanting to stop futile care until Grandaughter Jennie feels "okay" about it.

I suppose the issue though is that the morality and the science is complex in these areas. Because we have come so far with technology people just don't understand what is happening.

I think that's the issue... its so difficult for someone just thrust into that environment to be able to comprehend as quickly as some may like. Especially, when patients who look so similar actually can have a completely different prognosis.

Anyway, I agree there are some problems that need ethically sound solutions.

[Rose_Queen, BSN, MSN, RN]

Here's my opinion om this: if the family, physicians, and patient (if able or living will/advanced directives) all agreed that its the right thing to do in that particular situation, I'd have no problem doing it. I think that people in this country put far more emphasis on quantity of life rather than quality. If I'm in a persistent vegetative state with no hope of recovery, I hope that my family follows my wishes and lets me go. Removing an NGT is no different than removing other forms of life support like mechanical ventilation. My view of death is that it is nothing to be afraid of, it is simply the next great adventure.

[PMFB-RN, RN]

Here's my opinion om this: if the family, physicians, and patient (if able or living will/advanced directives) all agreed that its the right thing to do in that particular situation, I'd have no problem doing it. I think that people in this country put far more emphasis on quantity of life rather than quality. If I'm in a persistent vegetative state.

*** Persistant vegetative state is a pretty high standard. Very few of the people we withdraw life support on are there. They will likely get there in a few weeks or months if we persist in continual invasive measures to keep them alive.

Our medical director HATES the term "persistant vegetative state" with a passion. Those exact words are in many people's advanced directives. As a result many people suffer through days, or weeks or months of discomfort and pain becuase they are clearly dying, maybe in multi organ failure, and yet since they are not in PVS as their advanced directive states and their family members are unable to make the decision we must continue to cause them pain and suffering. The longer I do this the less willing I am to do it. I have refused to provide anything but comfort care for a couple people in the last year or so and also refused to code some patients who were not DNR. So far nobody in managment has said anything to me. We will see what happens.

[steelydanfan]

There's a difference between killing someone and stopping intervention that's artificially keeping them alive.

\

And there is a huge difference between supporting a living human being and flogging a breathing body.

Harsh, yes , but it needs to be said. because we have thousands of pt.s in the ICU who are beyond hope but are not allowed to 'die" because of fear, religion, guilt or emotional instability on the part of the family.

Very, very sad.