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

  1. 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.
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  2. 69 Comments

  3. by   canoehead
    That would not be done at my hospital. I noticed that the order was "as needed" so if he was not showing signs of pain we would not give it. I would refuse to give it even if it was scheduled if his respirations were below 12, or if he couldn't maintain his oxygen level and he wasn't showing signs of pain. If he was in pain though, and the situation had been discussed with him and his family I would give him as much medication as he needed regardless of his vital signs.
  4. by   CCU NRS
    Quote from Love767
    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.
    Well number one you did not list a drug name so we can't tell if the dose would be lethal secondly a student should never be asked to this. If a person on staff is comfortable with this dose and can get the order then i guess it is up to that person but no one has to carry out any oreder they deem dangerous or unethical.
  5. by   CHIRN
    Often, when a family decides to remove a patient from the ventilator and all other life sustaining medications we have morphine standing by ready to push. Most families that want to be in room when their loved ones die have great difficulty with the agonal breathing that occurs right before death. Most doctors order this pushed to spare the family. I have ethical questions about this practice but I have never refused to push the morphine. If this is active euthanasia then I suppose I am guilty. However, I will continue to help those in need (patient and family) ease the burden of dying.
  6. by   prmenrs
    I believe this assignment is inappropriate for a student. Whether or not this was an appropriate course of action for the pt. is hard enough for working RNs to figure out, students should NEVER be put in such a position.
  7. by   Love767
    I don't know the trade name only that it was IV continuous infusion morphine at 2mg/hr with initial bolus of 10mg/, and optional additional bolus (I'm not sure how much). Is there a difference in action between trade names? I just wondered how many other people had experienced similar situations. I worry about patients who could make a recovery, but are not offered the opportunity because 99% of time the prognosis is one way, but every once in awhile the patient makes a recovery that is unless something like this occurs. Maybe this is just a weird situation not seen very often.

    Our insturctor actually pushed the drug. She also explained that this is something that she has often seen, but which is just not talked about. She said it was something that was necessary, but which couldn't really be discussed very much because of the implications. The analogy she offered was that in our books it says that a patient is never to have a full set of bed rails without a doctors order (because it is considered a restraint) however, in practice if we didn't leave the bed rails up and a patient fell, we would be in big trouble.
    Last edit by Love767 on Apr 11, '04
  8. by   SmilingBluEyes
    Quote from prmenrs
    I believe this assignment is inappropriate for a student. Whether or not this was an appropriate course of action for the pt. is hard enough for working RNs to figure out, students should NEVER be put in such a position.
    took the words right out of my mouth!
  9. by   caroladybelle
    Quote from Love767
    I don't know the trade name only that it was IV continuous infusion morphine at 2mg/hr with initial bolus of 10mg/, and optional additional bolus (I'm not sure how much). Is there a difference in action between trade names?

    Our insturctor actually pushed the drug. She also explained that this is something that she has often seen, but which is just not talked about. She said it was something that was necessary, but which couldn't really be discussed very much because of the implications. The analogy she offered was that in our books it says that a patient is never to have a full set of bed rails without a doctors order (because it is considered a restraint) however, in practice if we didn't leave the bed rails up and a patient fell, we would be in big trouble.
    That actually is not that high a dose of Morphine and probably wouldn't kill someone, even though it really depends on the patient and whether they had been taking opiates for a while.

    It is a highly inappropriate assignment for a student, though.

    But no one (instructor/student/staff) should ever commit an aact that cannot be discussed due to "implications". Like the bit with the side rails, if they are restraints, then the MD better darn well write an order...or better yet explain to the public why enacting "restraint free" laws impair our ability to protect the elder population. To turn a blind eye to such things, just leads to more really stupid legislation. I have a problem with an instructor that would do something that she did not think was 'discussible" - that I find inappropriate.

    As far as the situation, we do "terminal weaning" from the vent, and use meds to ease the discomfort. And many of us give meds to patients in severe pain when it is clearly their wishes, despite some impaired BPs, if they are DNR and clearly terminal. But no one should be put in the position of doing something that goes clearly against their belief system.

    I also have a problem with using MS to kill someone. Keeping them comfortable, preventing pain, even if it impairs some functions, fine but if there is no comfort issue indication, then it crosses a fine line into euthanasia. In terminal care, we frequently know that the drugs that we give for comfort, will probably contribute to the patient's death. But that is not the purpose that we use them. I've given a lot opiates, but I have and will never give them for the express purpose of euthanasia,

    I think that the instructor has some 'splaing to do...
  10. by   Tweety
    Excellent post above by Carol. I agree 2/hr is not much at all, but could provide comfort. If I'm comatose and there is nothing further to be done, please please please give me drugs, even if it kills me.
  11. by   KMSRN
    I work in palliative care and would like to refute your moronic nursing instructor (assuming your account is accurate). In my experience and in communication with others in palliative care and hospice, PATIENTS ARE NOT EUTHANIZED, ROUTINELY OR ON AN INDIVIDUAL BASIS. And if they are, it is murder and needs to be reported as such.

    Morphine at 2 mg/hr is not a very high dose and would probably not kill someone (it might zonk them), although I am concerned about a 10 mg bolus if the patient was opioid naive. But tolerance to opioids can be built up fast. In my opinion, morphine is almost always a prn dose that can be adjusted to suit the patient's needs. In dying patients, I would not be worried too much about the respiratory rate being <12. Sometimes that happens naturally without the morphine and reducing medication could cause distress. But that is a matter to be addressed with each individual patient and to be made by an experienced health care team.

    I believe you and your nursing school have a big problem with that instructor (again, assuming your account is accurate). First of all she is an intellectual moron. She is not knowledgeable and is giving you inaccurate information. Second, she is a moral/ethical moron. She believes she is murdering someone, and yet does it anyway. And, finally, I agree with others on this thread - it was an inappropriate assignment for a student. And where was this patient's assigned nurse?? She should be reported to the hospital where she is "teaching" the clinical program and to the school of nursing. Nursing has enough trouble without incompetent instructors. (However, having said that, even is she was reported I doubt much would be done.)

    Palliative care is such a difficult area because of lack of knowledge and training and the misconceptions so many people have. Palliative care does not kill patients. It provides comfort and support to the patients and families who are dealing with death and terminal illness. It is a highly specialized area of nursing (and medicine) that requires education and experience to do well. I think it should be part of nursing school curriculum and annual competencies for all nurses.

    This link is the End of Life Nursing Education Consortium (ELNEC) site and this page gives access to the AJN series of articles about palliative care.

    http://www.aacn.nche.edu/ELNEC/ajn.htm


    Thread: My best friend in nursing school was ordered to terminally se
  12. by   Steph in Boston
    I read about a case that I believe occured in the 1990's when a registered nurse gave a suffering cancer patient a gradual does of painkillers in order to help ease her into death. They called this technique "snowing" and the article claimed that it happens more than most people think. The nurse was tried for murder when it was discovered what she had done. She maintained that hers was an ethical decision, and that she made the right one. I tried to find a link to the case online, but was unsuccessful. Now that I think about, I think I might have read about it in a book about nursing...

    --stephanie--
  13. by   sbic56
    Alot of you are saying this is not an appropriate patient for a student. What better time than now? I would have welcomed the opportnity as a student when I was expected to be asking the hard questiuons. I don't see that the OP said the primary nurse was not involved. She says nothing about that one way or another. I think alot more is being read into this. The OP may or may not understand all the details. It is not unusual for MS to be give in this way to a terminal patient and certainly does not describe euthanasia in my mind. Someone please explain why they believe this instructor is so wrong, immoral , etc...
  14. by   jnette
    Quote from sbic56
    Alot of you are saying this is not an appropriate patient for a student. What better time than now? I would have welcomed the opportnity as a student when I was expected to be asking the hard questiuons. I don't see that the OP said the primary nurse was not involved. She says nothing about that one way or another. I think alot more is being read into this. The OP may or may not understand all the details. It is not unusual for MS to be give in this way to a terminal patient and certainly does not describe euthanasia in my mind. Someone please explain why they believe this instructor is so wrong, immoral , etc...

    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.

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