Can a person live forever on a vent?

  1. Now this really bothers me. We had a resident who was transfered to a medical facility just to be placed on a vent. Scenerio: Contracted, stage IV decubes on both hips, heels, GT, S/P tube, trach, vegatative state, 80m y/o male. Family never came to visit, yet wants him vented. Has had pneumonia so many times that it's inhumane. I realize it's none of my business what the family wants for him, but is this not right? I'm sure if he could speak he wouldn't want to be kept alive like this. Sometimes my heart just breaks for my residents and this is one time that it broke. There is only one reason I could come up with for his of plan of care. What do you think it is?
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  2. 15 Comments

  3. by   gwenith
    Night owl it comes down to where is the money? Who is going ot gain from this? I am glad I work for state health because we don't have anything to gain and the family usually does not have anything to gain. Our Doctors are so good at expalianing this sort of thing normally. However having said that we recently had a admit of a CP 23yo who never had a very interactive life. Very supportative family though. He was tubed as emergency and then normal doc said he would not have recommended tubing if he had been asked. NOthing written in the chart - patients family denying that they were ever told he may one day die of pneumonia. Honestly if you had seen how deformed his chest was - I do not know how he made it to 23!!

    Yes unfortunately the answer is a long time on a vent. This is where you pray for an overwhelming sepsis.

    Death is not the worst.
  4. by   Tink RN
    Sad but true my friend. I see this scenario time and time again. Patients transferred to the ER ... no DNR status ... no living will ... we have no choice but to aggressively intubate and put them on a vent. You never walk away from a situation such as this feeling as if you have "made a difference" or beat the odds. Often you feel guilty, and wonder, "What have I saved?" As cold as this may sound, sometimes the most loving thing you can do is "let go".
  5. by   VivaLasViejas
    It has long been my opinion that the "care" we give people when they have not indicated their choices regarding end-of-life issues is inhumane at best, and savagely cruel at worst. I'm not even talking about quality of life here: I think it is immoral to keep people alive indefinitely with feeding tubes, ventilators etc. when their use merely prolongs suffering.

    I cannot imagine anything worse than spending my final days or weeks strapped down in an ICU bed with tubes running into (or poking out of) every orifice, being unable to turn myself, take care of my toileting needs or even tell someone I'm in pain.

    Having cared for many such patients, I've come to believe that anyone who would force a loved one to endure such indignities after having the realities of the situation explained to them either is incredibly selfish, or they have a sadistic streak. In fact, I feel so strongly about this that I've informed my entire family that they are to respect my own DNR status should I end up in a hopeless situation, regardless of my age or former state of health.

    My prayers are with your resident, nightowl; I wouldn't wish what he's being put through on my worst enemy!
  6. by   gwenith
    It is interesting to look back on the history of CPR in the early days a cardiac arrest was defined as a "sudden unexpected death" I can live with that one. It gives us an out for all those patients in slow demise.
  7. by   Katnip
    Maybe the family wants to keep the social security check coming in?
  8. by   KARRN3
    I TOOK CARE OF MANY PATIENTS JUST LIKE THIS IN THE ICU.ONE OF THE OPTIONS THAT WE HAD IN THE HOSPITAL WAS THE ETHICS COMMITTEE.IS THERE ANY WAY TO PURSUE AN ETHICS CONSULT AT THIS MEDICAL FACILITY?THAT A FAMILY THAT DOESN'T PARTICIPATE IN HIS CARE GETS TO MAKE THESE DECISIONS IS SAD. I THINK THAT BEFORE A FAMILY COMMITS A PATIENT TO THIS SUFFERING ,THEY SHOULD HAVE TO SPEND A FULL DAY WITH THAT PERSON TO KNOW WHAT LIFE ON A VENT IS REALLY LIKE.
  9. by   Scotty
    Keeping someone alive on a ventilator indefinately does not happen very often in the UK. There are some patients in the community on home ventilation, but they are not in a persistent vegetative state and do have some quality of life (some of them probably make better use of their time on this earth than I do).

    Like Gwenith's docs, ours are good at explaining the futility and poor quality of life to family members and most relatives are willing to accept this (although I did have one patient's son tell me that dying "is not an option" when his mother was definitely dying - and she did).

    In your situation Night -Owl I hope the docs are scared of being sued and the relatives are scared or too clueless to decide to stop life support. It's horrible to think people will do this to a patient so they can get money. I feel sorry for the patient and all of you nurses who have to care for him. KARRN 3 your suggestion of an Ethics Committee review of the situation is an excellent one. What about a family meeting? (But I suppose you'd need the doc's agreement for that.)
  10. by   night owl
    Thank you for all of your responses. It is above and beyond the realms of "horrible" to me to think that people would do this to a human being just for money. This is a pt. who was given up for dead when his body was thrown in the back of a truck with the rest of the deceased soldiers during battle. When they unloaded the bodies, he was found to still be barely breathing. Twenty years ago when he was with us, the family made that known perfectly clear by leaving xeroxed copies of newspaper articles taped on the wall by his bed and medals of honor on top of his bedside table. There was a time when he was very rambunctious but totally confused and would climb over the bed rails and fall on the floor and sustained a broken shoulder, and another time sustained a nasty laceration on his head. Family toyed with the idea of a soft chest restraint. When we placed one on him, (when it was allowed to use them) the family had a fit because it was too restraining. Got rid of that and tried an enclosed bed because it was less restrictive yet he could still move around, family thought we were inhumane and had him transferred to another unit so he could receive "better and proper care." Through the years while off our unit, he was placed on other units for the same reason as described previous and in the meantime the family came to visit less and less. He was trached and became vegatative and eventually returned to us because he had made his "tour" of the facility! We had him for about six months where he was given the utmost of care, but despite all the turning and all the care given to him developed pnemonia over five times that I could remember, but remained a full code throughout. Two weeks ago he was transferred to a medical facility for again pneumonia where he was basically at death's door and was then placed on a ventilator.
    Isn't it ironic how he was such a hero when they found him barely breathing on that truck and did everything possible to keep him alive only to be made to suffer for many years while at our facility and to end up suffering to an even greater extent in his condition and then to be forced to stay alive. What other reasons could there possibly be for this man to be kept to suffer like this? All the money in the world couldn't make me do this to another human being. He is the biggest hero I've ever come across in all my years of nursing. May God hold him close as I'm sure he is and take him with him (soon) where his suffering will finally end and where he will finally be at peace.
    Last edit by night owl on Aug 10, '03
  11. by   renerian
    When my mom was dying from that flesh eating infection, she was tubed, lines everywhere, 2 surgeries, bleeding everywhere then went into DIC. The Doc refused to take her off life support, She was in horrible pain. I demanded an ethics committee meeting NOW and within 15 minutes another doc came and extubated her. She died in 15minutes.

    renerian
  12. by   fulwood
    Renerian, I didn't know about your mum - sorry... Glad to hear you had the cajones to go to ethics committee. Did she have living will etc? How could doc refuse to take her off life support when you are daughter?Without instructions do doctors have final say or family?
  13. by   nurse51rn
    In most institutions, an ethics committee can only make recommendations. In my hospital, a few of the doc's will follow the recommendations, but unfortunately, many more of them don't. Many days, I feel the doc's are just out for all the money they can sqeeze out. Example: a 90+ y/o with prostate CA, mets to colon and lung, having an open heart. Pt. "allowed" doc and his family to talk him into it. Is this ethical?
  14. by   gwenith
    Night owl I know you have talked of this before but can I get it clear - if the patient is in your facility the relatives get the social security cheque?

    If that is so I would ring the department of social security because if this is allowed it should not be and it is a big loophole that needs to be plugged.

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