My best friend in nursing school was ordered to terminally sedate a stroke patient. - page 2

He was comatose and given little chance of recovery (but was breathing on his own). His family wanted nothing to do with the guy because they said he was a child molestor. A medical review board at... Read More

  1. by   KMSRN
    Quote from jnette
    I happen to agree, sbic.... and actually, I just finished reading Echo Heron's books and in her first one (as still a student) she describes her instructor giving her a similar situation, only her patient was in severe pain... yet the intention was to increase the ms to bring about an end to a hopeless and painful life expectancy.

    I remember her describing how she felt about this at the time, and that she actually told her instructor she could not/would not do this... and thereby failed her assignment.

    Years later she understood that this, too, was part of good nursing care, and our responsibility to ease the pain of our patients and bring them to a more peaceful death.

    The principle you are describing is double intent. And I agree, if a person is in major distress and the amount of medication needed to control symptoms causes death it may be ethically justifiable. However, that is not the situation described in the original post. And I have cared for many dying patients and have always been able to control symptoms without killing the patient. I understand there may be circumstances where it would be necessary but it is not common.
  2. by   jnette
    Quote from KMSRN
    The principle you are describing is double intent. And I agree, if a person is in major distress and the amount of medication needed to control symptoms causes death it may be ethically justifiable. However, that is not the situation described in the original post. And I have cared for many dying patients and have always been able to control symptoms without killing the patient. I understand there may be circumstances where it would be necessary but it is not common.
    I don't know........ from what I have been given to understand, it is FAR more common than expected or previously thought.

    As are the "slow codes" or "walking codes".
  3. by   prmenrs
    I agree w/sbic56 about the learning opportunity, but I think it should be presented in class as a 'scenario' type lesson to be discussed, perhaps w/some sort of assigned reading in preparation.

    If I had been the floor RN assigned to that pt., or the charge nurse, I would have not permitted a student (or the instructor) to be involved w/the case, aside from conference or classroom discussion. JMHO.
  4. by   KMSRN
    Quote from jnette
    I don't know........ from what I have been given to understand, it is FAR more common than expected or previously thought.

    As are the "slow codes" or "walking codes".
    That may be. I can only speak from my knowledge and experience. I would be interested in where your "from what I have been given to understand" knowledge comes from.
  5. by   mattsmom81
    I have a problem with the way the order was written...as needed but the student was 'told' it needed to be given every hour. Where is the liability here?

    If a patient is terminal and uncomfortable I have no problem with a drip being started to ease suffering. But let's see a real doctors order for that....not an order that is potentially incriminating and ethically questionable.

    The instructor should have told the student this is not how a smart nurse protects herself, and should have insisted this ethics committee take responsibility for what THEY decided to do instead of turfing it to a nurse.
  6. by   CCU NRS
    One other thing that bothered me is the mentioning of the Pt being a child molester, this does not factor into care in any way shape form or fashion, we are not here to judge Pts we are here to provide care, If you know of a situation that needs to be reported about child molestation that is one thing but to with hold care or perform euthanasia (sp) because someone is purported to be a child molestor is a little too much like playing God. I stick to my original statement that a student should not have been involved with this at all!!!
  7. by   Blackcat99
    For crying out loud people the patient was a child molester! If someone kills a child molester that's a good thing! I wish I could have been the one giving him the drug. What's wrong folks Don't we have enough child molester's already! What a lucky student to be able to do such a wonderful service for humanity! :hatparty: :hatparty: :hatparty:
  8. by   VickyRN
    Quote from prmenrs
    I agree w/sbic56 about the learning opportunity, but I think it should be presented in class as a 'scenario' type lesson to be discussed, perhaps w/some sort of assigned reading in preparation.

    If I had been the floor RN assigned to that pt., or the charge nurse, I would have not permitted a student (or the instructor) to be involved w/the case, aside from conference or classroom discussion. JMHO.
    ITA. Some "learning situations" are just not suitable for students.
  9. by   CCU NRS
    Quote from Blackcat99
    For crying out loud people the patient was a child molester! If someone kills a child molester that's a good thing! I wish I could have been the one giving him the drug. What's wrong folks Don't we have enough child molester's already! What a lucky student to be able to do such a wonderful service for humanity! :hatparty: :hatparty: :hatparty:
    So can we assume that you may kill anyone in your care that you believe to be a child molester? Or would you include murderers? How about spouse abuse will be the one to go ahead and deliver a lethal odse to a guy that just beat the crap out of his wife and in the fray broke his hand and when he comes to seek medical attenion you can just give him a lethal Potassium injection! Just go ahead and play Judge Jury nd executioner not to mention God! You see this is exactly the attitude I was talking about one the say so of some family member you are ready to execute this person you know some people think spanking a child is abuse or molestaton perhaps this was a strict parent and his children resent him and have always wanted him dead but lack the courage to do the deed themselves and here come Joe Nurse with his lethal injection.
  10. by   orrnlori
    Quote from CCU NRS
    So can we assume that you may kill anyone in your care that you believe to be a child molester? Or would you include murderers? How about spouse abuse will be the one to go ahead and deliver a lethal odse to a guy that just beat the crap out of his wife and in the fray broke his hand and when he comes to seek medical attenion you can just give him a lethal Potassium injection! Just go ahead and play Judge Jury nd executioner not to mention God! You see this is exactly the attitude I was talking about one the say so of some family member you are ready to execute this person you know some people think spanking a child is abuse or molestaton perhaps this was a strict parent and his children resent him and have always wanted him dead but lack the courage to do the deed themselves and here come Joe Nurse with his lethal injection.
    Uh......I think this post was in jest, was it not?
  11. by   sbic56
    I still like the reality based approach that was used here by this instructor. Too many times students are merely shown the basics and the "ideal" as opposed to the real life way in clinicals. Then they crumble in real situations once they become RN's and are thrust into a position of total responsibility in situations in which they have no experience. I do agree that this would have also been a perfect classroom opportunity for the rest of the class to benefit from. This scenario was not unusual, but is difficult. Much easier to assign the student a routine med/ surg patient, but not nearly as benefical in preparing her/him to be a real life nurse.

    Perhaps, I have a personal interest in this, too. My mom was dying of Ca and a nurse withheld her MS because hers resps were 6 or 8. Her pain was obvious to me, but not the nurse and she was sticking to her guns to not be the one to give this last dose. I was so angry, I cannot say. Luckily, the shift was ending and the next nurse understood what the truly right thing to do was; mom got her MS. Sometimes being right means doing the "wrong" thing.

    As far as the child molester part; I skipped over that piece altogether as it was not pertinent to the case at all. (And, yes, I am sure Blackcat was using a bit of dark humor...you were, right?)
  12. by   bluesky
    I don't see how a student would be allowed to a)use a PCA or b) IVP morphine. Most programs I know prohibit both. Something sounds fishy with this story...
  13. by   sbic56
    Quote from bluesky
    I don't see how a student would be allowed to a)use a PCA or b) IVP morphine. Most programs I know prohibit both. Something sounds fishy with this story...
    Ya know, you are absolutely right, bluesky! With all the moral/ethical debate, I totally missed the part where a student was being allowed to push morphine!

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