Ethical Death Issue

  1. Hi,
    I need to get an opinion. My fiance' and I are having a "difference of opinion" as you could say. Today, for the first time, I had a patient pass away. She had ESRD, COPD, the whole nine. Her family was still trying to make her better. She had this test, that test, Vanco here, Morphine there. I was, to be honest, scared to go in her room at first. I had a coworker come with me while I changed her position Q4 hrs. She had a stage 4 decubeon her coccyx. Face it folks, this woman was suffering. I was curious as to the signs of impending demise so I went online and looked it up. She had every one of these signs starting with the confusion, loss of speech, loss of ambulation, eventually becoming non-responsive. I also had read that some people just keep "hanging in there" so to speak. The day before yesterday she had her "miraculous recovery type" good day and then went backwards. I had her on 5L o2 with a rebreather mask. She was o2 sat 94%. Everytime I changed her position her sat would drop down to the 80's. The CNA had taken vitals and forgot to tell me that she had a temp of 101.3. I put icebags under her arms and gave her a Tylenol suppository and that's when she crashed. But, before this all happened I had sat with her a few times and rubbed her arm and told her that she didn't have to hang on anymore, that it was alright and she could go. My fiance' thinks that this is unethical or possibly illegal. Please help me with your opinion. I have more to tell but I'm running out of room.
    Last edit by dinkysam on Oct 3, '06
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  2. 11 Comments

  3. by   grinnurse
    I would have done exactly what you did and as a matter of fact have done that several times to my patients that I have known (by clinical signs and symptoms) are in the end stage of life. I have also even prayed when I went home at night for God to take the patient home. I don't know if this is illegal activity or not to me it's simply humane when the family is in the state of mind that it is!!
  4. by   doodlemom
    I've done hospice work for many years and I can tell you that this is not either unethical or illegal. It is something that we do all of the time and encourage our families to do so, as well - and encourage them to let the patient know that they (the family) will be ok when they are gone. This is called compassion. You might make a good hospice nurse - have you thought about it?
  5. by   jo272wv
    eventhough I have not been in this situation as of yet, I would not have a problem telling a pt it is ok to go. My sister told this to my mother when she was end stage and two hours later she died a peaceful death which eased my heart.
  6. by   Marie_LPN, RN
    Maybe if he had been there, he would have had a better idea on what you were going through (not suggesting that he tags along though lol).
  7. by   indigo girl
    You did everything right and more. You sound like a very competent and compassionate professional to me. I would be honored to work with someone like you.
  8. by   VivaLasViejas
    Sometimes that's all a dying person needs---"permission" to stop fighting and slip away in peace.

    What you did is nothing different from what I've done countless times in my career, or what anyone with an ounce of compassion would do under the circumstances. That's part of being a good nurse, and it's the kindest thing we can do when our patients are suffering intolerably and their time is approaching.

    If someday I am near death, and hanging on because I think I have to for someone else's sake, I hope someone like you will take the time to sit with me, stroke my arm, and let me know it's OK for me to leave.
  9. by   Daytonite
    i don't think there is anything unethical or illegal with what you did. where your fianc is coming up with what you did being illegal is really off the wall. me, i'd seriously reconsider marrying this dude. that, or else, get a durable power of attorney in place naming someone else as my healthcare power of attorney. if you ever find yourself in the same position as your patient, this dude, who may be your husband by then, is going to have the healthcare team pulling out all the stops to keep your body going. is that what you want? i think this incident has given you some important information about the character of your fianc that you weren't aware of before.
  10. by   gitterbug
    A nurse is supposed to do no harm to the patient and to attempt to make the patient "better" with the care given. This poor lady was suffering, she was given comfort measures and, in the end, the most comforting measure was to allow her to pass over gently. YOU did nothing wrong. YOU were doing the most ethical, caring, loving thing by taking the time to tell this poor lady it was O.K. to lay her burden down. DO NOT feel guilt, YOU are a good nurse.
  11. by   veronica butterfly
    Quote from dinkysam
    Hi,
    I need to get an opinion. My fiance' and I are having a "difference of opinion" as you could say. Today, for the first time, I had a patient pass away. She had ESRD, COPD, the whole nine. Her family was still trying to make her better. She had this test, that test, Vanco here, Morphine there. I was, to be honest, scared to go in her room at first. I had a coworker come with me while I changed her position Q4 hrs. She had a stage 4 decubeon her coccyx. Face it folks, this woman was suffering. I was curious as to the signs of impending demise so I went online and looked it up. She had every one of these signs starting with the confusion, loss of speech, loss of ambulation, eventually becoming non-responsive. I also had read that some people just keep "hanging in there" so to speak. The day before yesterday she had her "miraculous recovery type" good day and then went backwards. I had her on 5L o2 with a rebreather mask. She was o2 sat 94%. Everytime I changed her position her sat would drop down to the 80's. The CNA had taken vitals and forgot to tell me that she had a temp of 101.3. I put icebags under her arms and gave her a Tylenol suppository and that's when she crashed. But, before this all happened I had sat with her a few times and rubbed her arm and told her that she didn't have to hang on anymore, that it was alright and she could go. My fiance' thinks that this is unethical or possibly illegal. Please help me with your opinion. I have more to tell but I'm running out of room.

    I'm just seeing this thread 3 months after it's posted. Sorry to be blunt, what does your fiance do for a living? does he understand ANYTHING about nursing? You are perfect, you are blessed, you are a kind, compassionate nurse. For your first death, you did everything PERFECTLY. This is what it's all about. We all die, and hopefully a good death after a good life. Keep doing what you're doing. I'd pick you to be MY nurse in a heartbeat!
  12. by   RNSuzq1
    I also just saw this post and think the original poster was incredibly compassionate and did the right thing. Several years ago, before I became a Nurse - I was on the other side of things. My siblings and I had just lost our Dad, our Mom became gravely ill, so we were the grieving family that wanted everything possible done to help our Mom so we wouldn't lose her too. At the time, we couldn't see the agony she was in, all we saw was the possibility of a future without her.

    Unfortunately for all of us, the Nurses that cared for Mom were overworked, stressed out, treated her like a machine they had to keep running, instead of a human being. Not only didn't they have compassion for her, but they also had none for my siblings and I - I've never felt so helpless in my life. All the Nurses would tell us was - very bluntly - who knows, your Mom might live, she might die. If one of them would have just taken a few minutes to sit down with us to tell us how grave the situation was, a kind word, holding a hand (anything), we could have prepared ourselves to let go, and been able to tell Mom it was ok to go and be with our Dad. Her entire life was devoted to us right up to the end, looking back it's so very sad to think of how much agony she was in, but trying to stick it out because she knew the pain her passing would cause all of us kids.

    I was so scared to talk to her about death, she was the brave one that brought it up. She said she wasn't scared to die, just afraid of what came afterwards. I've only been a Nurse for 6 months, but because of my Mom, I realized that dying patients want to talk about death or at least the possibility of it - it's something they have to talk through with somebody and sometimes don't want any feedback, just someone to listen to their thoughts and fears, hold their hand, etc.

    I've heard quite a few Nurses complaining about "the families" of dying patients wanting extreme measures performed to keep them around longer. We were taught that the "family" is also under our care - so why not treat them with some dignity and help them prepare for the loss of their loved one instead of complaining about them. I can't tell you how much it would have meant to all of us if my Mom had a Nurse as caring as the original poster. Just my 2 cents, for what it's worth.
  13. by   dinkysam
    Again,
    To all of you wonderfully, kind, caring, nurses out there, I cannot thank you enough for all of your kind words and loving support. I am soo excited to be in such a wonderful field and look forward to each and every day that I have such a wonderful opportunity to touch those lives who need it. Thank you and God Bless all of you, His special Angels! :angel2:
    Last edit by dinkysam on Dec 20, '06

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