Medicated Patient for Husband's Sake?

  1. I was taking care of a patient yesterday who was extubed and care withdrawn. She's going to die from liver and kidney failure. She didn't die from extubation. In fact was alert and at the time of my assessment breathing easily. The husband said "she seems comfortable", she shook her head no when I asked if she was in pain, and even smiled when I talked of her marriage for 47 years.

    Apparently she complained to her husband she was hungry, (she has a trach, so I guess somehow he figured this out). He then was a little torn if he was doing the right thing.

    His kids wanted me to sedate her to sleep so she isn't suffering with hunger, but also to help the dad cope.

    The chaplain who is on the ethics committee even asked to medicate her.

    It was ackward because at the time of my assessment a few minutes ealier we decided not to medicate. She's terminal and will die soon, but was not in an active dying process and alert and didn't report pain, or give nonverbal cues, and I felt I was medicating only to help the family, not the patient.

    I am a big advocate for pain/sedation at the end of life during the dying process and realize this patient will need those meds soon.

    Any advice. I did call hospice and ask them to come see the family again, although they had just been there earlier in the day.
    Last edit by Tweety on Dec 22, '05
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  2. 13 Comments

  3. by   ZASHAGALKA
    Tweety, family is part of your treatment and so, your treatment plan.

    I have medicated terminal pts because it put their family at ease.

    But there is a reason you have concern here and I would go with your gut feeling: The family might be part of the process, but the pt is your priority. You did not want to deprive this woman of her few remaining lucid moments.

    As long as she wasn't in pain, those moments BELONGED to her. Hunger is not a rationale to sedate: if you are hungry enough, your body releases endorphins to deal with that.

    I think you are right to question medicating away the woman's remaining lucid moments because it would make the family feel better if they didn't have to deal with an uncomfortable situation. Their concerns take a back seat.

    ~faith,
    Timothy.
  4. by   Messink
    If the patient didn't report any pain, I wouldn't medicate solely for the family's comfort. If she is indeed comfortable I would let her enjoy her last moments on Earth and with her family.

    The patient's welfare and interests are more important than those of her family.

    Hope this helps.

    Bye, Michiel Messink
  5. by   CrunchRN
    Can you offer it to the patient and let her decide? You said she was aware so I thought maybe you could tell her that her family thought she might be more comfortable that way and let her decide. I am glad you are her nurse.
  6. by   elkpark
    I agree with the other posters.
  7. by   grannynurse FNP student
    Your first responsability is to your patient. You can offer her medication but you should not medicate her, if she refuses. And you or someone shoould talk to her husband about his feekings.

    Grannynurse
  8. by   angel337
    the dying process can be more difficult for the family than for the patient because it is difficult to see a loved one go and very often the best way families deal with it is to not accept that the person dying isn't exactly suffering. i have seen this many times where a patient is alert and oriented, appears comfortable, but nonetheless dying. the family does not fully understand that concept, so they think sedating the patient will make them more comfortable or in their minds the patient will appear as if they are truly dying as opposed to alert and talking to them which makes letting go more difficult. i think you handled the situation well and you seem like a very compassionate nurse.
  9. by   leslie :-D
    you stated hospice had been in earlier? it would seem they didn't see the need to medicate either. working in hospice, i often find myself working more with the families than w/the pt! alot of education is needed for them regarding the dying process.
    if you have her again, just monitor her vitals, assess for pain (as you already did), ask her if she would like anything to relax her...but as others have already said, you always medicate for the pt and not their families. you sounded sooo compassionate tweety.

    leslie
  10. by   Sis123
    I am assuming that this patient has decided to not take in any nourishment so as to avoid prolonged suffering. Am I right? If she has, she my want to have some very low cal or calorie free thing to drink, like a diet soda.

    My dear cousin, Julie, when she was dying of breast cancer, refused to eat because she didn't want to prolong her suffering, but she drank diet sodas. This might be an option for her.

    Tweety, you sound like a very good nurse....
  11. by   Tweety
    Thanks very much for validating my concerns. I appreciate it.

    She did leave this world this afternoon. Funny how one can be lucid one day and dead the next, with her husband at her side.
  12. by   Sis123
    Thank you, Tweety for your kind and compassionate care. I'm glad she had you for her nurse.
  13. by   Darlene K.
    Tweety, so sound like a wonderful nurse! I think you did the right thing.
  14. by   chris_at_lucas_RN
    Quote from CrunchRN
    Can you offer it to the patient and let her decide? You said she was aware so I thought maybe you could tell her that her family thought she might be more comfortable that way and let her decide. I am glad you are her nurse.
    This was my thought too. If she could communicate about her marriage and (maybe) about her being hungry, she could decide if she wanted more meds.

    I bet she wanted to be "there."

    I too am glad you were her nurse, Tweet. You are one terrific guy.

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