Palliative care question.How would you respond?

Nurses General Nursing

Published

Specializes in Aged Care, General Acute,Theatre,Rehab,.

An ethical dilemma has been proposed to me. Someone has asked this question. I think I would know how to respond but are not totally sure.

The quesion was or is;

You are caring for a 14 year old girl who is dying but her family insists she not be told. One day while assisting her in to shower she asks "I'm dying aren't I? Why won't my family talk to me about it?"

What would your response be? How would you respond to the child?

It has really got me thinking as I had trouble answering the question honestly while considering the patient's and families want and needs.

What a predicament to be in?

Luckily it has't happened to me yet in that way.

i have had sev'l family members, request to withhold this type of information.

when i know that children are old enough to understand death, i am always upfront with the parents, stating that their child has an absolute right and NEED to know.

i can say this because my medical director agrees with this.

to not share this information, only serves to isolate the pt further, creating further despair and hopelessness.

it also prevents the pt from making his/her own choices about their life and death.

the only times i wouldn't disclose is when the pt is in such blatant denial, that to tell the truth, would cause more harm than good.

and eventually, there comes a point when they can no longer lie to themself.

it's always a matter of time.

if parents cannot come to terms with truth-telling, they need to find another hospice.

that's how strongly we feel about this philosophy.

i'm thinking your response was the same as mine?

even when we don't want to share such tragedies, our inner truths will gnaw at us until we do.

praying for peace, for all involved.

leslie

My response, because the pt is a minor and the parents do have the right to decide what she is told, would be to tell the parents "I will not volunteer the information but if she asks, I will not lie to her."

My response, because the pt is a minor and the parents do have the right to decide what she is told, would be to tell the parents "I will not volunteer the information but if she asks, I will not lie to her."

then you're still contradicting the parent's wishes, aren't you?

if the concern is about the child being a minor and the subsequent, parental rights, then technically, the child shouldn't be told at all.

leslie

Specializes in IM/Critical Care/Cardiology.

Hey Redneck, Wow, what a position. Personally I'd discuss death with "the"patient" if it was apprpriate in their situation. If hospice is involved, then come on, these patients do need to talk about it. Parents will always be parents, children will always be children. Each deserves the Right to Die treatment as taught to me anyway at the school I went to. If the parents freak, let them discuss it with the Dr., social services, hospice, but not the nurse who is now bathing her, and sounds like she/he really trusted you. Good question.

Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.

Wow what a situation to be in.

I would probably encourage the 14 yr old to say exactly the same thing to her parents. She sounds like she is fully understands her illness to me.

I wonder if a family meeting with the social worker and RN present to facilitate this poor child having her parents be truthful to her. I fully understand they are trying to protect her but in turn are isolating her.

This time needs to be used in useful dialogue.

Time to say the things that are on their minds and in their hearts.

Encourage a family meeting ASAP.

They could use all this energy from hiding the truth and turn it into some beautiful memories for them down the track.

Prayers for all involved.

If that were me, I would not lie to her. That is the worst thing you could do for the nurse/patient relationship. If they find out that you are lying to them, they will not trust them. You could also talk with the parents and say, "She knows she is dying and she needs to talk about it with her." I would guess that they don't want her to give up hope and be sad, but it looks like maybe they already are about the situation. It would be a great opportunity to step in and help this family deal with a horrible situation.

I think I would be all over the parents to be honest, and I would maybe talk hypothetically with the child. Get a chaplain or a social worker o whatever multidisciplinary team members are available together and set up a meeting with the parents about being honest with the kid.

What about saying something like, "This is something you really need to talk to your parents about." Then offer to be there with her when she does talk to them. I hate situations like this! What about asking the girl hypotetical questions. "What if you are dying? What does that mean to you?" Something like that? I don't do the kiddos, so I'm not really sure how apporpriate of a question that would be. Something like, "I'm dying, aren't I?" "You really need to speak with your parents about this. What would you say to them if they tell you that you are dying?" That doesn't feel like it is worded right, but you know what I mean. Can you get her to talk about it without really confirming or denying anything?

The Palliative Care team needs to meet with the parents or needed to meet with them when they made this decision not to tell their daughter. The physician and the chaplain service also need to help out.

As a nurse, I would have encouraged her to talk to her parents and then I would have called the doc, the Palliative Care team leader, etc., to help.

steph

Specializes in Spinal Cord injuries, Emergency+EMS.

a 14 year old young person while legally a child is generally going to be in a position to make his /her own decisions

some of it will depend on the exact local situation over the existance of the concept of a the competenetn minor and how this relates to the 'legal' parental responsibility etc.

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