Question about patient's death and ethical issue

Nurses General Nursing

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I'm in nursing school and we are touching on death, dying and grief. We were given a scenario to think about for discussion tomorrow:

Patient's family goes to cafeteria. While gone, patient dies difficult death and cries out for husband. Family returns from cafeteria, you have to tell them about her death. Family asks if she died peacefully and asks if she asked for any of them.

My thoughts on this scenario are this:

If they didn't ask, I wouldn't specifically tell them the negative details of her death. But, since they did ask specifically, I would be bound by nursing ethics to tell them the truth, difficult as it would be.

Have any of you run into similar situations?

Specializes in Perioperative, ACU, Hospice.

Hospice nurse here and I see this all of the time! The family steps out of the room and their loved one dies. Not only do I omit any stories of suffering, but I tell the loved ones that perhaps this is the dying person's last gift to them. To pass without putting their loved ones through the pain of having to witness their last moments. It comforts them, and as a hospice nurse, the family is just as much under my care as the deceased was.

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Specializes in Critical Care.

I would say they spoke of their loved ones at the last moment, and they were at peace.

It is what I would want to hear, if I were not there.

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what i have heard nurses say and what i have told family myself is that sometimes people wait until their loved ones leave to take their final breath . and it is the truth and on the other hand i have seen patients hold on until a loved one gets there and then die.

I have heard a DON say at a hospice facility that its not their place to make a 'judgment' on the type of death. lol, what she meant was you can say they died peacfully but you shouldn't infer that they died 'unpeacfully' . After they are already gone i can't see how it benfeits them to know that their loved one was calling out for them. :(

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Great ethical issue you bring up. One of the key aspects of ethics is veracity, which if looking at it from an ethics theory standpoint would technically be unethical. HOWEVER, this is where theory meets nursing judgement. Like everyone on this post, in no way do i feel it is right to tell the family the patient suffered. Our duty as nurses as nurses is to care for the patient and the family. What good would it do to let the family live with a horrible sense of guilt for the remainder of their life. The family was probably asking in the first place to be reassured they died peacefully. That's my take on it

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Specializes in ICU.

Had a patient suffer a massive MI one morning after feeling very bad all morning. He was in ICU and had just signed DNR papers the day before. He had a very bad heart and knew that it was going to fail on him. His family had not made it to the hospital. He cried out in pain and suffering agony for atleast 10 minutes while we tried a cardiac drip, it didn't work because he was having a massive MI. We finally got some MSO4 to him, but it didn't help, and then he died.

The family asked me how he died, was it peacefull, etc. I said yes, it was very peaceful and I was there holding his hand while he was taking his last breath, praying for him. (which was the true part)

Never ever tell the family he suffered. ever.

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Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

Your question is asking about how to prioritize ethical decision making.

1) Ethic - honesty is more ethical than lying.

2) Ethic - Harming others (through word or action) is unethical.

3) Ethic - Protecting others from harm when they can't see or decide for themselves is ethical.

So now you have a situation - family leaves and patient dies "badly". When they come back they ask if he died peacefully. You must prioritze the three ethics above and decide if all apply.

If you say he died peacefully you are breaking #1, but possibly fulfilling #2. This is why right and wrong are so seldom black and white. It might be wrong to lie but does telling the truth outweigh the harm you inflict?

In each ethical question you get in class it helps a lot to list the ethics involved - meaning your belief about right and wrong. Once you have them all written down place them in order of most important to least important as "it applies to the question!".

Hope this helps

Pat

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I would talk about how lying would be a form of paternalism to not distress the family in an already stressful situation. I only did my ethics and law exam and I've already forgotten half of the more specific terminology :banghead:. It doesn't really matter what you argue in ethics so long as you can back it up using all the right terms.

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Great ethical issue you bring up. One of the key aspects of ethics is veracity, which if looking at it from an ethics theory standpoint would technically be unethical. HOWEVER, this is where theory meets nursing judgement. Like everyone on this post, in no way do i feel it is right to tell the family the patient suffered. Our duty as nurses as nurses is to care for the patient and the family. What good would it do to let the family live with a horrible sense of guilt for the remainder of their life. The family was probably asking in the first place to be reassured they died peacefully. That's my take on it

Thanks so much for the replies and for sharing your experiences and insights. GodfatherSN is exactly correct....I have had a class in ethics (not nursing ethics) and I suppose I was looking at this initially from a theoretical standpoint.

My gut was saying "hell no I wouldn't tell them those details, even if they asked" but what I learned about ethics made me question what should be common sense!

Thanks again. Your stories were very interesting and informative. Especially interesting was how many of you believe patients hold on and die when family members are not around. Very interesting.

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Specializes in Med surg, Critical Care, LTC.
I've seen it a million times - people leave to get something to eat and that is when their loved one dies. But let me tell you - its a whole different feeling from this side. I still can't help but feel guilty - if we had gone for supper earlier, or waited even 1/2 hour more, I would have been holding her hand when she died. Words can explain my feelings even 16 months later.

Nothing, nothing, can be gained by telling the family the truth.

I agree, there is nothing to be gained by telling the family, nursing is caring for the patient AND family. Once the patient is gone, your focus is now on how to best help the family through the beginning of their grief.

It's also important to note, that not all people WANT their loved one's to see them pass away. Some prefer to die without others watching or hovering about them. This could be the case here - but at the last moment, the patient became frightened and called out. No point in causing the family more grief and guilt.

Compassion dictates "yes, she passed peacefully!" as your answer.

Blessings

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