Ethical dilemma - page 4

by GooeyRN

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On friday, I was taking care of a very elderly person, who was knocking on death's door. Pts respirations were 5 per minute. Pt has had these breathing episodes a few times over the last few days. Family stated pt was in pain,... Read More


  1. 0
    OP - you did the right thing, I think. Especially involving the priest and the doc. That was very wise.

    Keeping a patient comfortable is merciful, not doing so is unmerciful.

    Feel easy, I'd say.:icon_hug:
  2. 0
    What you did was right, and you put a lot of thought into it. My own experience was a Dr that wouldn't let my MIL come home on hospice......his stance was life at all costs, so he finally had to d/c her home, but only gave enough meds for two days, making sure we brought her back to the hospital.....we contacted hospice and they helped us locate a Dr that would take her on as a patient and assist us in caring for her, with dignity, and with the amount of pain meds she needed. She also was breathing 5 times a min, and for a while only 4 times a min, and we felt for sure we were going to kill her with the pain meds, but she actually slept all night, breathing easier and woke up and ate breakfast.......granted it was the last good spell she had, but it was nice to have it.
  3. 0
    Gooey,

    I, too, agree it was right to give the med. Your intention was to ease the pain you thought the pt. was in. Such palliative care is absolutely ethical in end of life situations, in spite of risk for depressed respiration.

    You said it was your "gut feeling that the patient was not comfortable." Many others have written encouragingly about following your gut. I suspect a careful and thorough examination of all you observed, combined with all you knew at the time about your patient's history would show that you actually had enough clues for your 'gut' to pick up on, causing you to believe your patient was not comfortable, even though your conscious mind was not picking up on those same clues.

    Wouldn't this sort of situation be so much easier for caregivers to deal with if all patients had written out advance care directives/living wills addressing this issue directly? Mine says I request pain control even if it should hasten my dying. Although no one can force people to write out their final instructions, both health care professionals and chaplains can encourage and assist them to do so before the time of crisis. We all ought to be educating and encouraging people whenever we get an appropriate opportunity.

    Gooey -- do not misunderstand. This call for education and encouragement is not directed at your deathbed scenario. It needs to happen much earlier, while the pt. can still express an informed decision. You did the right thing for your pt.
  4. 0
    Quote from GooeyRN
    I did give it. But not before discussing it with the priest. (I did call him in, since the pt belongs to our parish, and the priest has been there to visit him daily) I still felt pretty sick afterwards. The pt did not die that evening, I don't know if he will still be there tonight. At the weekend mass, the priest did stop me after mass and we discussed it in quite detail. (not breaking hipaa, the priest probably knew more about the pts condition than I did) Basically, the priest picked up the same feeling about the family. But since MY intent was to make him comfortable, it was ok to give. It would have not been ok if my intent was to end his life. Unfortunatly, its a very small hospital, with no ethics group or hospice or anything like that.

    Thank you all for making me feel better about my decision to give the med.
    in my opinion it was still a hippa violation - if the priests name was not on the contact list we use for those that need to be told stuff- no matter what the priest knew from the family - it was not your place - especially out in public to tell the priest anything - if he is on the list then you have the right to talk to him at the placce the resident is at not out in public.

    most people will say the same thing - i know i might - in distress not really meaning to "kill" someome but that they just really want to see the patient comfortable and if that means they die in the process many people are more aware that that is OK - they know it "may help it along" but to not do it and let them be in pain to live a few more days would be cruel.

    i would anbd have many times done the same thing you did - i used toi get teased at my last job as i had quite a few hospice pts and i had like 4 people in 2 yrs die at shift change shortly after i had given em morphine supp - the night nurse would say its ok " you killed them with kindness and comfort" - noone truly meant anyone "killed" anyone- it is hard to let pts go though - so i undestand your feelings.


    (ps) i am sayig i agree that you did right giving the med - and i understand your feelings cause after many yrs it is still hard to "let go" for me - though i do - i just feel that discussing the pt with the priest after mass without family permission or family being there was not the proper thing to do, no matter how much the priest knew from the family. it could in some instance cause a nurse trouble if it had been done with the wrong people - i guess im just saying be careful what you say and to who.
    Last edit by twotrees2 on May 9, '07 : Reason: clarifying


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