Ethics???

  1. So if you read the threads prior to this one, you all know Hospice is a whole new art for me! I saw my first patients today, with another nurse of course. And I have aquestion but didn't want to look silly, by asking her, so I'll ask all you seasoned hospice nurses.

    I saw a patient today in end-stage alzheimers. She has been bedfast for quite some time (years) now, and on the 14th her children came to a decision to d/c all tube fdings and flds. I assessed her, she was partly comatosed, barely opening her eyes, but all her VS were WNL, her skin was in great condition, she did have contractures, and some muscle wasting. Do you all think it is ethical to be starving someone to death, or if at least not giving nourishment, what about flds (water). I feel like they are making her suffer worse as it has been 9 days now without anything. I ask myself, Am I going to make it as a Hospice nurse?
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  2. 7 Comments

  3. by   aimeee
    Try turning your own question around....Is it ethical to artificially PROLONG her life and SUSPEND her in a state where she is bed bound and unable to interact in a meaningful way with her loved ones and her environment? Allowing her shell of a body to die is probably the greatest gift that we can give her at this time.

    Good mouth care will take care of the dry mouth and Roxanol can eliminate any pain or discomfort associated with hunger. Her body has already shifted its catabolic state though and it is doubtful that she feels any discomfort. The dehydration actually helps her comfort by reducing the fluids that might otherwise overwhelm her during the dying process.

    Please read the article I have linked to below. Although the focus is a patient's voluntary choice not to receive food and fluids, I think it will reassure you, and allow you to reassure your families, that this is a very humane process.

    http://www.dyingwell.com/prnh.htm
  4. by   love4neos
    Thankyou SO much aimeee. I just needed a little reassurance.
  5. by   renerian
    No it is not inhuman. I know this is a big topic. JMHO. That is what I would want done for me in that state-nothing.


    renerian
  6. by   MandyInMS
    Not a hospice nurse here..but working in a rural hospital, we see the same pts over and over frequently...It kills me to see families prolong the agony of some of these poor folks.Even after explaining the pros/cons by nursing and MD's some families insist on having everything done...I try to see things from both sides..but, end result seems to be prolonged suffering...I could never let my family member continue to suffer needlessly...would be selfish on my part, just wanting them to be around for ME.
  7. by   Spidey's mom
    DyingWell.org Articles and Interviews




    "" Patient Refusal"" of Nutrition and Hydration:
    Walking the Ever-Finer Line
    American Journal Hospice & Palliative Care, pp. 8-13, March/April 1995.
    Ira R. Byock, M.D.

    --------------------------------------------------------------------------------

    "In the midst of an increasingly heated debate over physician-assisted suicide (PAS) another option available to patients who are determined to end their lives is receiving serious attention -- the conscious refusal of nutrition and hydration. Patient refusal of nutrition and hydration (PRNH) is hardly new, indeed, virtually all hospice clinicians remember people who came to a point in their illness when they could be described as having "lost their will to live" and who recognized that continued eating and drinking was having an undesired, life-prolonging effect. In the hospice context, death that follows the decision to refrain from food or drink is not usually considered a suicide, however, by choosing to do so these patients were conscious that their death would likely be hastened." -----------------------------------------------------


    I copied the above paragraph to point out a difference when discussing the lady with Alzheimer's who is comatose and unable to make a decision and the link that was cited above . . . .the crucial part is the "patient refusal" part. The patient has the right to refuse water and food, therefore is cognizant of the consequences. Here is the tricky part for alot of us . . .can we make that decision for someone else? I posted a link to another perspective. This is tough for me too . . .I wouldn't want to live in some of the conditions I've seen since becoming a nurse but what about ethics?

    http://www.thecbc.org/exp/Papers/rsr...vegetables.asp

    My hat is off to Hospice Nurses . . .. you are all classy people who give alot to your patients and their families. My grandmother died of pancreatic cancer, it was not pretty, and the hospice nurses were a Godsend. Thank you.

    steph
    Last edit by Spidey's mom on Apr 25, '03
  8. by   aimeee
    Originally posted by stevielynn
    I copied the above paragraph to point out a difference when discussing the lady with Alzheimer's who is comatose and unable to make a decision and the link that was cited above . . . .the crucial part is the "patient refusal" part. The patient has the right to refuse water and food, therefore is cognizant of the consequences. Here is the tricky part for alot of us . . .can we make that decision for someone else? I posted a link to another perspective. This is tough for me too . . .I wouldn't want to live in some of the conditions I've seen since becoming a nurse but what about ethics?
    You are quite right that the situations are not equivalent and I did not mean to imply that they were. It was the best source that I could quickly find though for providing support to the concept that withdrawal of food and hydration does not add to the suffering of the patient, which was one of love4neos' concerns.

    As a hospice nurse it is my job to support the decisions of the medical POA as to what they feel is right for their loved one. If we act in good faith with love in our hearts, I feel we cannot go far wrong. Families do not usually arrive at this point without a great deal of thought and prayer.

    The whole issue certainly underscores why it is so important for people to address their advance directives in as specific a manner as possible. It is a terribly difficult position for most family to be forced to make such decisions without clear evidence of the patient's wishes.

    Steph, I am sorry that you lost your grandmother to pancreatic cancer, but it is good that you found her hospice helpful.
  9. by   Lucy RN
    This topic brings up a very tough subject but we can see how important it is for everyone to have advanced directives and a Health Care Proxy that allows someone that you designate make health care decisions for you. In this day we have so many ways to prolong lives, even if the quality of the life is terrible......it really can be very sad.
    I certainly want to make sure my wishes are carried out if I become unable to speak for myself.......

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