What is so wrong with discussing end of life care?

[imintrouble]

I'm not proposing rationing or coercion. I don't want to make decisions for pts or families. What I DO want is someone objective, to honestly and compassionately provide hard truths about what death and dying looks like.

Doctors, for the most part, are not objective. Some I work with want to keep the pt alive as long as possible because it means a paying customer. End of life is when most of the health care dollars are spent, and that's where MDs and hospitals make the most money.

Death panel? Call it what you want, but our society is sorely lacking in honest accepting discourse about death.

Some people want to live forever and will submit themselves to any test, drug or procedure for that end. I respect that decision.

Some people want to live as long as possible, with quality of life determining how much intervention they want.

Shouldn't these people be given hard, basic information to guide them in these decisions?

[mama_d, BSN, RN]

Where I work the docs are actually pretty good about discussing EOL care with the pts and families. Maybe it's b/c most of our hospitalists are younger docs.

I'm on a tele/oncology floor, so I regularly have discussions about code status with patients. Every new admit gets the "do you have AD/living will/POA" question, and regardless of the answer, I ask "if your heart stops or you stop breathing what do you want us to do?"

I feel like I've seen the extreme ends of the spectrum and everything in between in the last several years. Two that I will never forget were V and A...

V had lung ca with mets, and had become a frequent flyer. She was vented at one point and successfully came off and left, only to come back to my floor a few weeks later. I was there the night she went bad and the intensivist told her ahe had two choices...go back on the vent or die that day. She was adamant that she was not being tubed again. I sat with her for quite some time after my shift ended while she "got her crying out" before we called her daughter, b/c she knew it was going to be hard enough on her dtr and didn't want to make it harder. Her docs were honest with her, she was able to make her own decisions, and her family backed her up.

A had cancer so widespread that they were never able to figure out where the primary site was. By the time he was diagnosed, it was in his lungs, liver, colon, brain, and bones. Needless to say, he deteriorated rapidly and soon was unresponsive aside from constant moaning. His wife was POA and he had an AD saying that he wanted to die pain free with no heroic measures...but one of his dtrs was a total witch and caused such drama that the wife changed him to a full code. I spent for hours one night begging and pleading with the dtr to please let me give him some morphine...she called me every name in the book and told me that I was the only one who thought he was terminal... To make matters worse, she would sit at the bedside with her laptop and google everything and got WAY offended when I commented that she needed to look at reputable sites, like the American Cancer Society. That poor man died two days later, without pain meds, SL atropine, or even a scop patch. But by God his tube feeds were still running.

That man and what he went through and my inability to help him still bothers me to this day.

I truly believe that if we went away from the concept of "DNR", which by it's very name implies that something is being willfully withheld, and instead moved towards "allow natural death" that more people would be willing to disciuss EOL care and opt for less machines and heroics when it becomes time to decide at the bedside.

Sorry so long, this is just something that I feel passionate about.

[FranEMTnurse, CNA, LPN, EMT-I]

I was in hospice care once already, and since God chose to keep me here on earth a while longer, (I believe one of the reasons is so I can enjoy the arrival of my 6th grandchild in July. )I know that dying is a part of living. We are born, we grow up, we hopefully live our lives well, we age, and then we die. So what's so wrong with that. I'm all for hospice care, and I for one refuse to die in a hospital. I long to die at home when the time comes. I don't want to be intubated or tube fed either. I have already mentioned that to my doctor and my family. So they know my wishes. Dying is not hard at all unless you are being tortured to death. I know. I even had an out of body experience once and nearly died in the ER with congestive heart failure with septicemia another time. I just thought I was going to sleep. The monitor over the nurse's desk was what clued them into intubating me.

[imintrouble, BSN, RN]

When I started this thread I had just spent a night caring for a 101 yr old pt. Full Code. Alzheimers. Ref to eat and drink.

The MD cycled this pt from the nursing home to the hopital every week or so with Dx: Dehydration. It seemed so cruel and inhuman to me.

Lab draws, IV sticks, Turn q 2, when the poor man obviously was dying.

I thought if the family only knew what the pros and cons were they would not choose to torture their loved one.

I cared for that pt again last night. Death panel is not a term I like, but the hospital should provide counseling for this family if the MD won't. Not to pressure them into anything, but give them info so they can make an ethical decision.

If the doctor won't, the nurse can't, the hospital doesn't want to get involved, and the family doesn't ask, then (shudder) let the government do it.

[linearthinker, DNP, RN]

Since this country has chosen a fee for service/3rd party payer health care system, in the end, it should be the decision of whomever is bearing the financial burden. Remember the golden rule: He who has the gold, makes the rules.