Feeling Guilty

  1. 4
    I work on a Telemetry floor (only 1 year of nursing experience) and I recently had a patient post Burr hole surgery for a subdural hematoma. She didn't recover well and was basically in a vegetative state, although she was awake. She could barely talk or move, just stared at me and her family, and was fed via OJ tube feeding. Her family made the decision to stop the tube feedings and send her to hospice care. Her husband did have power of attorney and a copy of her living will was present on the chart, which was in accordance with her husband's wishes. I then removed the OJ tube and she was given comfort measures only at that point until she was transported to a hospice facility.

    Maybe it's just the fact that I haven't been doing nursing long enough and this was my first patient like this, but I felt so guilty about stopping her feeding and when I left that day I cried. I know it was her wishes to not be kept alive by "artificial" means, but I feel like I was killing her. I feel like I killed another person!!!! I know it's silly to feel this way and that to the patient and her family I was only respecting her dignity as a human being, but my conscious feels guilt that I contributed to the "death" of someone. I know that medicine is not always about "curing" the patient and that she didn't have much quality of life at that point, but I can't help feeling this way.

    I tried explaining this to my family (none of whom are in the medical field) and they just don't get it. I was depressed for a week after that happened, and my family doesn't understand. Anyone ever face anything similar? Is this something that will get easier with over time?

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  2. 16 Comments...

  3. 14
    Hi, there. I am so sorry you're experiencing this level of inner turmoil. Some of our patients are heartbreaking, but the pain will ease with the passage of time.

    I guess I'm opposite because I do not believe in prolonging care or providing futile measures for patients who will never benefit from it. The circle of life ends with death, so I know I'm not 'killing' anyone when a family or physician decides to stop prolonging the inevitable.

    I wrote about some issues surrounding death and dying a year ago: http://allnurses.com/nursing-activis...ng-773839.html
  4. 6
    Might I suggest requesting a replacement nurse the next time you have such an encounter? Ethical dilemmas are never easy. You have to be at peace with yourself before you can fulfill those particular expectations. This is one of the reasons our Code of Ethics exist. You have the right to examine your own feelings about such things and make an informed decision for your well-being.

    I had a patient with Locked-In Syndrome who communicated with his eyes as his caregivers, we, spelled out every single word in every single sentence of what was left of his life. It was extremely time consuming but he was a home-health patient, of sorts, but not living at home. We took him on as a special case in a veteran's facility.

    After a year of living as he was, with a trach, foley, and peg tube, being transferred from one extended care facility to another simply because the facilities hadn't thoroughly assessed the magnitude of the care required, he made the decision to end his life by refusing his feedings. At that point, he was residing in a nursing home because even the VA felt his care was too expensive, even though he was a veteran. They were apparently looking at the 'big picture' as, other than those issues listed above, he was a healthy, 30-year-old, young man. Although I personally believe he would have lived for many years to come, being placed in a nursing home as a young man who still had his young wife, made for a grim outlook for him. After all, he was a soldier in the Army and was an avid hunter in his spare time. It was a very sad case for him as well as the life that it would have made for his wife.

    Eleven days after he began refusing the feedings, it was over.....his wishes were honored by respecting his right to refuse care. Otherwise, he had no quality of life to look forward to. Because he made that decision, dilemmas were minimal and his wife was with him every step of the way.
  5. 16
    Allowing a natural death is not the same as killing someone. You did not contribute to your patient's death, it was going to happen anyway. What you did was not prolong the inevitable and did your best to ensure your patient's suffering was minimal.
    I know it's hard, especially if it's the first patient like this you've dealt with, but you did what was in the best interest of the patient - your job. You were not the mechanism of death - the subdural hematoma was.
  6. 8
    You honored the wishes of the patient, as had been expressed in her living will, and the wishes of her family, who were clear in their desire to give her a natural death. You did the right thing and did not kill this patient.

    My grandfather had to be removed from a ventilator after lung surgery when he was no longer responsive. The care given by the compassionate nurses and physicians was excellent. Removing him from the ventilator meant he would only live a few hours/days but they honored his, and my grandmother's, wishes. It was the very best thing they could have done.

    If you're still struggling with this, you may want to talk to someone. Does your company have benefits that include counseling for free? If so, that would be an excellent resource to take advantage of.
  7. 9
    You did good. I have the utmost respect for families who are able to follow their loved one's wishes and say "enough is enough". I'd much rather be the nurse to remove an OJ tube on a patient in a persistent vegetative state than I would be the nurse who has to place said tube because the family "wants everything done".
    SNB1014, Nurse_Diane, imintrouble, and 6 others like this.
  8. 2
    As KelRN said very well.

    And before her, it was suggested that you might want to consult someone re your understandable emotions. Some facilities have an EAP/grief counselor on staff. Perhaps a chaplain?

    Wishing you all the best with your feelings.
    imintrouble and TriciaJ like this.
  9. 1
    I agree with the above posters, you did not cause or contribute to a death. Keeping the tube in would not have been prolonging life, either, because it wasn't a life. You would have been keeping someone in a terrible limbo. Please check out your hospital's pastoral care department. They can be worth their weight in gold.

    Peace and healing.
    nrsang97 likes this.
  10. 5
    Yes, I did.

    I was my mother's primary caregiver for the last 4 years & 2 months of her life. I was with her every night for the last 2 weeks of her life. I was one of 2 people who's signatures authorized the removal of the vent, the discontinuance of meds (other than morphine & Ativan for comfort care), and I was the last family member to see her at the hospital before she was transferred to the funeral home. So, yes, I'd say that qualifies me to speak on this.

    It's a hell of a thing to have to go through - the second-guessing, the waves of guilt, the feeling that you're taking a human life. Been there, done that.

    What I can say is that, with time, it will pass. As others have mentioned (and I'll spin a little differently) you're acting in accordance with the family's wishes, and those wishes are in accordance with State and Federal law. It's distasteful, it's heart-wrenching...and it's all perfectly legal. And, ultimately - it's right; because it's what the patient wants. It's their choice to make, not yours. To do any differently would not only be illegal, but frankly is over-the-top disrespectful. You don't have the moral right to second-guess a decision of this magnitude, and it's not your decision to make - only the patient and their duly appointed representatives have that right. You're there for the sole purpose of providing care according to their wishes - that's it.

    Other than requesting reassignment in future instances, I don't have any professional recommendations to make. What I would do (and, what you're in fact doing right now) is to sit down with a favorite adult beverage & consider the circumstances where death might be preferable to life. There's quite a few if you think about it - MCS, PVS, anencephaly, strokes, various diseases (ALS for one); do you really want to be the one to be doing extreme life-saving measures that could be interpreted as medical torture? It works both ways, as most things in life do.

    No, it's not an easy thing to face - but, you'll be a better nurse for it; and a better human being as well.

    Welcome to the world of the survivors. Peace be unto you.

    ----- Dave
    imintrouble, nrsang97, FEAOMOEATA, and 2 others like this.
  11. 8
    I have a serious illness. I definitely want a nurse who will honor my wishes, not one who flinches. The are much worse things you can do to a patient than allow him/her to die.
    nrsang97, i_love_patient_care, wooh, and 5 others like this.

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