Doctors that think they are god... - page 2

I am increasingly becoming sickened by a group of docs where I work. They seem to keep their pts alive at ALL costs. I have heard one of them tell the daughter of my pt that the pt didn't have... Read More

  1. by   Mags4711
    AHA! I thought of something. I never think of what i've done in the past as "euthanasia." Is my turning off the pressors and dialing the vent down to 21% and starting a Morphine gtt after the family or the patient requests to be let go in peace really considered euthanasia? I disagree with this: " I think that perhaps you are in the wrong area of nursing because unless the patient is a DNR that is what we do in hospitals ...keep people alive at all costs. Until we have legislation that makes euthenasia mandatory at a certain age we will continue to keep old people alive at all costs too."

    I would hope that we as professionals do not blindly keep people alive at all costs. I would hope that we all can recognize when there is a futility and we need to step in and encourage the physicians to see what we see and to help the family work through their grief and to discuss with them what their wishes really are. I think so many times what the patient/family wants gets lost in the shuffle.
  2. by   bosnanurse
    How much subjective comes in the play here!! Wow. I gues I do not have my point of view about death or dying . We are learning that death supposed to be dignified and that everybody decides in their name how to come to that scary moment.If this old patient was ready to die I believe that there is no doctor or daughter to stop that process but hope is the only thing we got after Pandora opened that box ( Why she did it for God sake!. SO , maybe for some of us it is very emotional to watch our family to die and think that something else could be done to stop process and there are those who are asking why all of that had to be in first place ? We are comming from different cultures and homes and philosophies that we are living by. What is in my opinion OK maybe some of you would think it is not . If I sugested to some of you to have some plants with smell or drink some special tea how many would tell me that I am not for this field of high technology nursing and yet I am using technology to help. So , I think that every nurse has to see where she or he standing before looking how to interfere .Some burdens from past could be a reason to resent tretmenat or to try everything under the SUN to help. It is human nature and of course we are humans. Just try to find your own strength and not to judge before the end of show.
  3. by   Mags4711
    Okay, this is going to sound bad, and I do NOT mean it in a snide manner, I am NOT trying to be rude, I sincerely want to know: burn out and gingersue, what did you think about the Terry Schiavo case? Should she have been allowed to die in a somewhat peaceful manner (as she sort of was, other than the bitter fighting in Congress), or could there have been a miracle (as burnout said)?
  4. by   JeanettePNP
    Not GingerSue here, but the difference between the Terri Schiavo case and other "die peacefully" cases is that she was not attached to any tubes or machines, nor was she on a strong regimen of medications keeping her alive. The only thing she was dependent on was a feeding tube. Of course she needed constant care and attention but her family was willing to provide that for her. So I don't consider that to be "keeping her alive". To me, "keeping someone alive" means that if interventions are withdrawn, death will occur very shortly--their heart will stop, their breathing will stop, etc. In that case I would support letting nature take its course depending on the details of the case. Any one of us, if deprived of food and water, will eventually die like Terri did. Obviously other than nutrition and hydration there was nothing else she needed to "keep her alive" because otherwise she would have died a lot sooner than she did.
  5. by   burn out
    Quote from faithmd
    Okay, this is going to sound bad, and I do NOT mean it in a snide manner, I am NOT trying to be rude, I sincerely want to know: burn out and gingersue, what did you think about the Terry Schiavo case? Should she have been allowed to die in a somewhat peaceful manner (as she sort of was, other than the bitter fighting in Congress), or could there have been a miracle (as burnout said)?
    The part about the Terry Schavo case that really bothered me was not so much stopping the feeding as much as her parents (the people who gave her life) now were not given any consideration to terminate that life. If I remember correctly her husband had gone on with his life . I think if someones parents are still alive that they should be considered the closest relative instead of the spouse. Personally, both of my ex's would have had my plug pulled a long time ago. Yes I think it was sad that her parents were not allowed to continue with their daughter if that is what they truly wanted. I believe we starved her to death which is how my father died-he never got the option of a feeding tube that I really wanted for him. I was very difficult to see him die just as I am sure it was difficult for the Shiavos. She was still breathing on her own and had her own heart beat we just quit feeding her.

    Perhaps I was a bit to harsh earlier but just the other day the new nurse I was following told me the same thing about our patient and used it more as an excuse to sit on her a-- and not call the doctor (he was not ready to die nor was the family willing to make him a DNR they wanted everything done) I could not get up in the morning and go to work if I had the defeatest attitude (Well they are going to die anyway, why even try?)
    Last edit by burn out on Feb 6, '07 : Reason: to add
  6. by   burn out
    Quote from faithmd
    AHA! I thought of something. I never think of what i've done in the past as "euthanasia." Is my turning off the pressors and dialing the vent down to 21% and starting a Morphine gtt after the family or the patient requests to be let go in peace really considered euthanasia? I disagree with this: " I think that perhaps you are in the wrong area of nursing because unless the patient is a DNR that is what we do in hospitals ...keep people alive at all costs. Until we have legislation that makes euthenasia mandatory at a certain age we will continue to keep old people alive at all costs too."

    I would hope that we as professionals do not blindly keep people alive at all costs. I would hope that we all can recognize when there is a futility and we need to step in and encourage the physicians to see what we see and to help the family work through their grief and to discuss with them what their wishes really are. I think so many times what the patient/family wants gets lost in the shuffle.
    At what dollar limit do we stop? Is it the same for the medicaid patient (they already get treatedlike crap in the ER) as for the insured patient and should we even try to save the uninsured?
  7. by   CrunchRN
    Wow!

    The OP never said anything about euthenasia. She was talking about futile care in the face of long standing chronic illness and advanced age, and the patients wish that interventions be stopped.

    Everything else that has been said is not related to the issue she has asked for advice about. I am glad that a couple people mentioned ethics committees. The other thing that is needed are advance directives and being sure the family knows her wishes so that they can help her deal with the docs.

    The money thing has nothing to do with it. Just the need to never say never. Probably well intentioned, but not neccesarily right for the patient.

    I think that some of the care given at times is futile,painful,wasteful, and done for the wrong reasons. That is why we need ethics committees.
  8. by   TachyBrady
    Quote from CrunchRN
    Wow!

    The OP never said anything about euthenasia. She was talking about futile care in the face of long standing chronic illness and advanced age, and the patients wish that interventions be stopped.

    Everything else that has been said is not related to the issue she has asked for advice about. I am glad that a couple people mentioned ethics committees. The other thing that is needed are advance directives and being sure the family knows her wishes so that they can help her deal with the docs.

    The money thing has nothing to do with it. Just the need to never say never. Probably well intentioned, but not neccesarily right for the patient.

    I think that some of the care given at times is futile,painful,wasteful, and done for the wrong reasons. That is why we need ethics committees.
    Very well said. The other thing we can do is support the pt/family in their decisions. Offer any information about further testing and procedures so that their decisions are informed. Try to be there when the doctor talks with the pt/family to ensure good communication and understanding of both parties.
  9. by   sister--*
    Sometimes I think the way you do...

    And then just last December I had a little old 90 something lady from an assisted living facility come in at deaths door. She held on, and on, and on. As she gasped and struggled through each hour her family arrived at her side. They just wouldn't listen to her wish to be allowed to die. The poor lady begged for days to deaf ears.

    Finally, the daughter was so saddened to see her Mom in this physical and mental condition that she turned to the nurses. After a long discussion about listening and acknowledging her mother's wishes the daughter went back into her Mom's room and told her that if she wanted to die that she had her permission. This was the first real communication this poor woman had with her family since they arrived. From that point on you could feel the love between them.

    A few days later this little old lady was transfered to a nursing home to live out her days.

    Low and behold about 4 wks. later I see this BEAUTIFUL old woman well made-up, hair coiffed, and dressed very well walking unassisted down the hall while smiling and laughing in conversation with a P.T. assistant.

    Holy smokes! This was our little old 90 something lady! I spoke with her for a few minutes and learned that at the nursing home they admitted another pt. to share the room with her. Well, she was never one to share her space AND she revealed that she was so relieved when her family gave her back the power to make her own decisions.

    She's now back in her apartment.

    Imagine that! I can only hope to look, walk, and speak so well at my age and on my very best days!
  10. by   NicoleRN07
    If you feel this strongly, you should talk with the ethics committee in the facility in which you work. I think it would help you feel better about the situation.
  11. by   DebRN06
    burn out...i never said anything that could amount to ""they are just going to die," and that that i would want treatment withheld because someone was 70, 80 or whatever age stated by those of you that do not understand my point. you're trying to accuse me of not caring, writing people off and having a desire to become some kind of "rn kevorkian." you are so far off the mark it is laughable.

    burn out...you stated you "want one of those doctors that will treat me no matter what the cost." really??? even at the cost of your own autonomy?? because this is what i am talking about!!

    this situation i brought up included
    1) a woman who was stating her wish to go home with her daughter to die and
    2) a daughter that was being made to feel as if she was contributing to the death of her mother if she carried out her mother's wishes.

    i had this wonderfully loving daughter crying to me, and completely torn up inside because she felt as if her mom was essentially trying to "commit suicide" because the doc has convinced her (the daughter) he could "cure" her mother and that her mother was "not terminal." this was not the case! this woman was very ill and wished to go home to die. she was instead d/c'd back to ltc (where she has only been for last couple months) and readmitted 4 days later. she did not want any more treatment. she didn't want to be "poked." she had started refusing to eat/drink at the ltc....and guess what... doc convinced daughter to basically "force" mom to get a picc and tpn was started. last i heard was going to get a feeding tube placed.

    i am writing this post because i do care. i am asking,.. what can i do? what should i do? i did call the chaplain for the daughter and she spoke with him at length a few times. that was all i knew to do besides be there for the both of them.

    i am newer to nursing. i am nervous about "stepping on" the docs toes. what is being an advocate and what is being out of line? what do i say to families in turmoil like this? how do i learn what to say? how do i know what is appropriate?

    to those of you that have replied....thank you!
    oh, btw...my comment """[font='comic sans ms']also...would you agree that it is more the docs are $$greedy$$ and need to keep their bankroll alive to get the medicare payments than that they are "trained to save lives" and can't give up??????"""
    [font='comic sans ms']i don't necessarily believe this...just a thought that was typed out!
  12. by   arizonanurse
    What a difficult situation. I think it is simply that the doctor doesn't want to "fail." But his actions are totally inappropriate. It is wrong to be unrealistic like that, it is wrong to not listen to your patient's wishes, and it is wrong to try to turn family members against each other. I cannot believe she is on TPN with a PICC...that is absolutely ridiculous. The poor lady.

    Unfortunately, there's not much you can do. It's up to the daughter. She's going to have to stand up on her own and defy the doctor, which obviously is an incredibly hard thing to do. If she asks for your advice, I would simply say that she needs to do what she believes her mother would want in that situation (after all isn't that what POAs are for?). Not what she wants, not what the doctor wants, but what her mother's true wishes would be if she was not incapacitated. And it sounds like this is quite clear.

    The issue of prolonging death has always been a big one for me. I cannot ethically accept how much suffering we put people through so they can live another six hours on a vent. Now, I know I'm going to get flamed for this - every time I share these sentiments, I get stories of someone's 120 year old grandma who is still living at home and doing her own shopping. I'm not talking about those people. I am talking about terminally ill individuals who want to be left alone to die, but they are kept alive because their family - or their doctor - doesn't want to let them go.
    Last edit by arizonanurse on Feb 6, '07 : Reason: typos
  13. by   carlarn
    [font="century gothic"]wow! this has been a very passionate thread. there have been some good thoughts here. i would like to add you could also call for a "care conference". that brings the family and care givers together to come up with a plan for the patient.
    for the op, you don't seem like you are "writing everyone off". i do understand that you are trying to assess each individual for their own needs. keep plugging away and don't forget you are the patient advocate.
    btw, for all of the people who read this, whether you are in the medical field or not: dnr does not mean do not treat. as most of us in the medical field know, there are many illnesses that are treatable in someone who is a dnr. please don't confuse these. and i am not singling anyone out, i am just reminding all of us of the difference.

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