Quote from sbic56
I like what you had to say here, but can't it still be said that this explanation is a rationalization for giving the MS for comfort when in fact you are causing death? I remember a personal situation with a family memeber where I wish the nurse would have thought the way you do. (Wouldn't give the MS just because resps were below 10 :angryfire )
BTW, I believe euthanasia certainly would play a part in hospice if the patient truly desires it.
i've had pts w/resp below 10 and still gave the mso4 because of prolonged and agonizing pain. the fact remains is that it's the disease process that kills the patient and yes
, morphine will hasten death. and it can cause death in a pt w/a hip replacement because that pt is not terminal. but in a terminal pt, late-stage that is suffering, it is the pathophysiology that will take over once that pain has dissapated.
a few years ago, i had a long talk with a member of the legal dept from the mass. nurses association. she is the one that said "as long as it is your intent to relieve suffering then there is no liability for the nurse".
a few yrs back also, i had a pt return from the hospital as cmo. so she was one of my hospice pts. the nm on the gen'l floor (will never know why) verified and changed meds (w/md's approval) from a duragesic patch and mso4 to es tylenol!!!!! :angryfire this pt. had a mastectomy and was dx'd with mets to the bone. she had always been a stoic, independent woman who always said "everything's fine". so in the hospital the summary had indicated her pain was well managed. the nm at our facility evidentally told her primary that she WASN'T in pain thus the reason for dc'ing the patch and the roxanol.
i scurried to this pt's room and she cried to me "louise (mod dementia) i hurt, i hurt!" i promised her i'd take care of her asap. i called her md within 1 minute, had him paged and informed him of the pain. he said the nm had told him she wasn't in pain (mets to the bones.) so after i told him of what this pt said to me, he prescribed a very commendable order for scheduled and prns. i gave it to her a/o (q2-3h) and it was the last dose of mso4 she finally reported relief and died within the hour.
now i had given her pretty hefty amts as the md was quite generous and unafraid to prescribe what he did and i took full advantage. even when her resps were 6-8 i was still giving it-no parameters. but it took all that mso4 and oxyfast to get her pain under control. so yes, i could say i hastened her death but she was pain free and her last words (as she cried w/her dtr present) "thank you louise, thank you, thank you, i love you".
her dtr had asked me if she was getting too much. i asked her dtr if she thought her mum was still in pain and she agreed yes.
so i gave the dtr a choice; that we can get mum comfortable but will die quicker or have her in pain and linger/suffer. of course the dtr didn't want to see her mum in pain.
so i did not administer the quantities that i did to kill her but to relieve her pain; nothing more, nothing less. and once all of the roxanol and oxyfast finally took its' effect, her body and the subsequent stressors from the pain, could finally relax and she died from her metastatic ca.
euthanasia's goal is to actively assist in helping someone die.
that is never the mission or the goal in hospice. hope i didn't confuse you.