My best friend in nursing school was ordered to terminally sedate a stroke patient. - page 4

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   sbic56
    caroladybelle

    I was not so sure there was no suffering. I'd rather give it and be sure the patient was pain free than not give it and risk the terminal patient being in pain of any kind if I could make it otherwise. Kind of goes along with the idea that we know people can feel pain in their sleep, thus we medicate, so why not in a "comatose" state? The OP said nothing about what the patient was dying of, only that they were terminal. It is my job to ease the end of life; if it means shortening it a little in the process, I can live with that, too. I'm not quite sure who you meant was the wimp, the nurse or the patient, but at any rate I disagree with this statement totally:
    And "slow" codes and "snowing" patients is a wimp's way out.
  2. by   PMHNP10
    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:

    Here is the thing (and I'm not agreeing/disagreeing with you) but as you said "kills a child molester" is murder regardless of who the person killed is; esp since the nurse wasn't the original victim. Second, and in all sincerity I'm curious...from your point of view, wouldn't it have been better to let the patient die a slow agonizing death, than make the pt comfortable. I'm not flaming, but inquiring.
  3. by   DNRme
    WHAAAAT?????
    First of all, thank goodness that as students, you are questioning this. You seem to be showing better judgement than your instructor.

    We, as registered professional nurses, are all responsible for our own actions. Just because a physician orders somenthing done you are expedted to act as any "prudent" nurse would do in the same situation. If you have any question about the ethics or appropriateness of something you can, while following the appropriate channels, refuse. For example, an order is written for 650 mg of Tylenol for a 2yr old. While the MD is held to account for writing the order, you are expected to know the appropriate dose of any med you are giving. You must also document, document, document.

    The fact that the man is a child molester should have no bearing on the care we render. While I would probably feel the same way the family does, if he is my patient I am to help him to his "greatest potential for wellness."

    Finally, the physician can give the med if he/she wants to. Just be veerrrrryyy clear in your notes about it.
  4. by   PMHNP10
    So many things are going through my mind about this one. I say medicate for comfort. I'll not claim to be an expert at this time, but I don't know that there is any sure fire way to determine if a person is in pain/discomfort without them telling you--only indicators. Also, I came close to posing this question as a new thread, but I wonder what people would say if we assume the role of the pt? I for one say medicate me, even if death mercifully results. Very sticky subject for sure, because as pt advocates/caregivers, we cannot project our feelings. As for the experience...what an opportunity for a student to have.
  5. by   KBnursestudent
    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:
    WOW, i hope this was in jest. I was molested as a child for many yrs along with my sister by my mothers husband. It ruined me inside but I would never want him to be murdered. I for gave this man. I do not forgive what he did but I forgive him. We shouls never think things like this lightheartedly. When we become nurses we take an oath to save lives to the best of our ability. We are never to wish someone dead no matter what they have done or who they are.
  6. by   caroladybelle
    Quote from sbic56
    caroladybelle

    I was not so sure there was no suffering. I'd rather give it and be sure the patient was pain free than not give it and risk the terminal patient being in pain of any kind if I could make it otherwise. Kind of goes along with the idea that we know people can feel pain in their sleep, thus we medicate, so why not in a "comatose" state? The OP said nothing about what the patient was dying of, only that they were terminal. It is my job to ease the end of life; if it means shortening it a little in the process, I can live with that, too. I'm not quite sure who you meant was the wimp, the nurse or the patient, but at any rate I disagree with this statement totally:
    As one who works with the terminally ill and very generous with the meds...even if they shorten life IF THEY ARE INDICATED. But I do not kill people.

    As a general rule. if there is pain, there will be some indication (moaning, elevated vital signs, twitching, writhing, sweating, tightening of muscles, rapid respirations).

    And if you are worried about the patient not "showing" pain, there are plenty of drugs for pain that will not "terminally sedate" them. Yet there is no indication of any of those drugs being used or tried...just straight to the MSO4 drip.

    And there is no indication of the patient having any pain whatsoever!!!!!!!

    The title of the thread includes the phrase "a stroke patient". Therefore we do have a diagnosis.

    And the wimp phrase is in regard to nurses/MDs/family that will not be honest about what they are doing. If the MD wants the patient to be a no code but is too gutless to address it with the family or to write it, code them and make the MD deal with the aftermath - don't play stupid con games with "slow" codes and things that we are afraid to voice. We need to give appropriate pain relief, but not play G-d. If the family wants the patient dead...let them take him home and do it themselves. Let us be honest about what we do or not do it at all. Anything else is childish and demeans us as a profession...it is also unprofessional and a lie.

    As onco nurse, I have enough difficulty getting people to accept DNRs, hospice and comfort care..they worry enough about being oversedated or treatable conditions ignored, and consigned to the"they are dying let's just drug them up, get it over with and ship the body out" body pile - they voice these concerns to me on a daily basis. It is makes it even harder when people play little semantic games with crap like "terminal sedation" and "snowing".

    There is a difference between pain control that may result in death and euthanasia.
  7. by   PMHNP10
    Quote from Love767
    His family wanted nothing to do with the guy because they said he was a child molestor.
    Keep in mind also that just because his family had nothing to do with him in life means nothing about what they'll have to do with him in death. In other words, this wreaks of a possible lawsuit.
  8. by   IowaKaren
    Quote from 3rdShiftGuy
    Students can't push morphine??????????? Been so long I forget, but I'm pretty sure in my surgical rotation I pushed narcs.
    Yes, student's can push morphine/opiods, change PCA pumps when ordered/needed but ONLY with an instructor present. If there is a medication waste, it must be noted by another nurse along with student and instructor. I experienced this during my 3rd semester in my program anyway.
  9. by   sbic56
    caroladybelle

    OK...sorry, missed the stroke piece. I'll let this go as, I know I am too heavily influenced by my own experiences and biases. Quality of life issues are huge to me and this man has none left. If I were in this state, I would wish for the nurse to give the MS. To me, lying in bed, unable to move and waiting to die for days on end would be far worse than death itself. (I guess you know where I stand on the euthanasia debate!)
  10. by   Blackcat99
    :angryfire :angryfire :angryfire You're absolutely right Psychrn03!
    Why are we wasting good morphine on that worthless SOB! A slow agonizing death would have been much more appropriate. I hate child molesters and yes I am very happy when I hear of a dead child molester. :hatparty: :hatparty:
  11. by   sbic56
    Quote from Blackcat99
    :angryfire :angryfire :angryfire You're absolutely right Psychrn03!
    Why are we wasting good morphine on that worthless SOB! A slow agonizing death would have been much more appropriate. I hate child molesters and yes I am very happy when I hear of a dead child molester. :hatparty: :hatparty:
    Whoa...you were serious! As long as you are merely using this board as a way to vent and would not practice with the venom you so obviously feel toward this group of people, I suppose no real harm done. But, it would behoove you to be careful; remember that as a nurse, you have been entrusted in giving approprite care to all your patients, leaving your judgments and biases at the door.
  12. by   CCU NRS
    Quote from sbic56
    caroladybelle

    I was not so sure there was no suffering. I'd rather give it and be sure the patient was pain free than not give it and risk the terminal patient being in pain of any kind if I could make it otherwise. Kind of goes along with the idea that we know people can feel pain in their sleep, thus we medicate, so why not in a "comatose" state? The OP said nothing about what the patient was dying of, only that they were terminal. It is my job to ease the end of life; if it means shortening it a little in the process, I can live with that, too. I'm not quite sure who you meant was the wimp, the nurse or the patient, but at any rate I disagree with this statement totally:
    To me the points are that a student was asked to perform this task with an instructor saying it happens all the time, which may or may not be true but it is as far as I am concerned left up to each nurse to make these decisions I will not give a lethal dose and I wil not ive any dose if as mentioned there are no S/S of pain/distress

    Quote from love767
    OP 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 the hospital made the decision. Here's what bothers me. My friend was ordered to give 2mg/hr IV. (as needed), but told that he would need the medication every hour. Our instructor said that this will kill most patients within a couple of days, and that respirtory depression wasn't "such a bad way to go". She said that this is done in hospitals everywhere only it's just not called what it is. I'm not sure how I feel about euthanasia (there are good arguments on both sides), but the point is that I thought that it was currently illegal in the United States. Is this true or is my instructor just wrong about this dose killing most people within a few days? If it is true is this really common or what? Seems like an attempt to implement a policy (euthanasia) without a public debate on the issue.:
    It is euthanasia if the Pt dies one minute before they would have with out intervention and a Morphine drip of 2mg hr continuous will eventually build up to a dose that is not safe.
  13. by   CCU NRS
    The original post was

    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! :
    This is dangerous thinking in my point of view and shows considerable mental anguish and possibly a need for psychiatric intervention, especially if you were molested and have not gotten help and even more certainly if you were not molested but have famly or friends that were and are carrying this type of hatred and anger over this issue. I do have experience with molestation I am a father to two step daughter who were molested by their bio father and I left it to God and the man is now going to die in prison he was sentenced to 60 year without parole and I am also certain that his prison time will not be without torture, I do not hate him I pity him most molestors were moleted themselves but he will surely die in prison and probabbly after being used badly by others in that situation.


    Quote from Blackcat99
    :angryfire :angryfire :angryfire You're absolutely right Psychrn03!
    Why are we wasting good morphine on that worthless SOB! A slow agonizing death would have been much more appropriate. I hate child molesters and yes I am very happy when I hear of a dead child molester. :hatparty: :hatparty:
    The continuation of you hatred and anger gives me much reason for concern, you seem to be a very concientious person in other posts i have seen you reply to so I would just ask you to seek assistance with the issue you have over this particular issue, I wish you the best of luck in finding peace. I will leave you with one thought Charles Cullen and many others like him thought/felt they were doing the right thing as well, It is a dangerous trap to get into thinking you should decide who lives and who dies.


    http://news.bbc.co.uk/1/hi/world/americas/521904.stm

    http://www.itechnology.co.za/index.p...9B253&set_id=1

    http://www.nursingadvocacy.org/news/2003dec16_nyt.html

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