It's been awhile... How about another ethics question?

Heather333 · Apr 14, 2003

What a sad case. Sounds to me like this poor baby needs to just have comfort measures. This baby will probably not have any quality of life. We can't save them all.

Heather

sanakruz, ADN · Apr 14, 2003

No

Ethically, aggressive treatment seems cruel.

She was miscarrying.

Now the criminal justice system will punish her. adding insult to injury.

I dont have any answers.

Mimi2RN, ASN, RN · Apr 15, 2003

Further tx on the babe is unnecessary and cruel, he should be allowed to go. What kind of quality of life will he have? Am I right in thinking that this child is a ward of court? Was a UDS done? What this mother did is criminal, maybe if she is in jail she won't have any more babies. Chances are she went into labor because of the drugs.

Can the hospital ethics committee get involved, to discuss this case?

Jolie, BSN · Apr 15, 2003

I agree with you, dawngloves. But in my experience, it may be a case of CYA on the physicians' part. A number of years ago, we had a mom come in at about 24 weeks, high on crack, trying to self abort. The baby was septic, had severe RDS (pre-surfactant days), and a laundry list of drugs in his system. He got maximal support for the pathetic 8 hours he lived, and we got slapped with a lawsuit. I wonder if that is the mindset of your physicians. How terribly sad.

prmenrs, RN · Apr 15, 2003

Check and see if there's a corporate motto, something like: "No fetus'll beat us"?

Sorry, had to let that out, very inappropriate.

tough dilemma, very true. I would ask for an Ethics Consult, if you have an Ethics Committee in the hospital. At our hospital, ANY member of the team could ask for one, it did NOT have to be a doc.

Then, sit down, w/ the entire team, including the parent, and lay it out for her. IMHO, knowing VERY little about the case other than what you've said, is that the best option would be to take the baby off the vent, go to a quiet room, and have mom (or RN) hold the baby. Warn her the baby may gasp. You can give some MS if ordered, but you shouldn't [ethically and legally] give them a paralytic agent.

Don't be surprised if that doesn't happen. Sorry.

IttyBittyBabyRN · Apr 15, 2003

Dawngloves, do you work with me?????? This is so typical where I work also. I don't think our hospital must have an ethics committee--I sure know they don't darken the doors of the NICU!!!! I often chant "We're all going to hell!!!!!" to the tune of my choice as my theme song for work. I've suggessted that if we would hand out coupons from Wendy's for "free fries (or even crack, for that matter) if you agree to get your tubes tied while in the hospital" we could do a great service for the world.....

dawngloves, BSN, RN · Apr 15, 2003

Originally posted by prmenrs
Check and see if there's a corporate motto, something like: "No fetus'll beat us"?

:roll I think you're right!!!! I swear, the next time I see this I WILL go to the ethics committee. I'm in a teaching hospital, but PLEASE!!! How about a lesson in letting go?! I'm as "right to life" as the next guy, but there is a limit.

I'd be surpise if this little guy lived the night. I almost pray he slips away. Tired of torturing these kids.

dawngloves, BSN, RN · Apr 15, 2003

Originally posted by IttyBittyBabyRN
I've suggessted that if we would hand out coupons from Wendy's for "free fries (or even crack, for that matter) if you agree to get your tubes tied while in the hospital" we could do a great service for the world.....

I remember in CA the big uproar because a group was offering free tubal ligations and paying you cash! "People" felt it was wrong. :rolleyes:

NicuGal, MSN, RN · Apr 15, 2003

The joy of working in a NICU...and I love...NO FETUS WILL BEAT US! I think I will make Tshirts for our whole staff LOL

Neonatologists have a hard time admitting defeat. That kid would be a nice long term nasty chronic in our unit.

We have an ethics committee, but truth be had, most of the time they aren't much help with the micronates.

Caitlin's Mommy · Jun 13, 2003

Originally posted by dawngloves

I remember in CA the big uproar because a group was offering free tubal ligations and paying you cash! "People" felt it was wrong. :rolleyes:

Then why do alot of people think its ok to give teenagers free condomes? I don't see offering tubal ligation any different.

There should be some kind of a law that a drug addict has to be on some sort of birth control,untill they complete a drug rehab program and stay clean for so many years.And if they don't and get preagnate,then they should be required to have a tubal after they misscarry or give birth. I know this is easier said than done,but I too have seen to many babies being brought to the NNICU ,because of the stupid choices their mother made.

I'm all for the right to life ,and do belive life is precious and a gift from God,but where do we draw the line?This baby has no voice and cannot make the desion to say "Hey just leave me alone and let me die in peace."

I'm just shocked that residents would do this,and not just give the baby comfort measures untill he/she died. "Hey this is a human life we are talking about here,not some ginuie pig{sp?}to experiment on"!

After reading this post I'm not to sure I want to be a NNIC nurse.I've always dreamed of working with sick babies ,but the more I see stories about this kind of thing happening,the more it makes me sick.I'm not sure if I could handle seeing this sort of thing happen day after day.

roxannekkb · Jun 15, 2003

>>After reading this post I'm not to sure I want to be a NNIC nurse.I've always dreamed of working with sick babies ,but the more I see stories about this kind of thing happening,the more it makes me sick.I'm not sure if I could handle seeing this sort of thing happen day after day

There's a very fine line between birth and death in the NICU, and it is one of the grayest areas of medicine. In my experience, more of the ultra-heroics and "no fetus'll beat us" took place in larger teaching hospitals. When I worked in a smaller unit, there were less micronates, less drug babies, and the docs were more aware of when to stop and to allow nature to take its course.

If you're planning to work in a large urban public facility, you're going to see a lot of heartbreaking cases, like the one described. It can get hard. In one unit I worked at, we kept oral morphine and AZT as stock drugs, if that gives you an idea of the clientale passing through.

My advice would be not to give up your dream of working in the NICU, but maybe try out a level II unit first. The babies won't be as small or as sick, so it may be easier to deal with.