END-OF-LIFE Ethical Dilemmas

Nurses Relations

Published

  1. What is your opinion on this?

    • 10
      Help someone on the way out?
    • 6
      Let God do his thing?
    • 2
      Is it going to far for a nurse?
    • 1
      Only if its my family

19 members have participated

We have all been there...a patient on a morphine drip just laying there waiting for their heart to stop...a family taking shifts, one leaves another stays so their loved one don't die alone....or the patient who is laying there, with no one there to wait with them for the end....

How many times have you been asked to "increase the morphine" on a care and comfort patient? Only to have to go on to explain that we can titrate it if we find the patient to be in any discomfort. I usually go onto explain, if the patient is moaning, grunting or such I can titrate the drip....within minutes the family is at the desk stating, "my mom/dad/loved one is moaning in pain can you increase the drip?".

You know, i know....but what to do? How to handle this situation? I can personally say, WHY EXTEND THE SUFFERING? WHY MAKE THESE FAMILY MEMBERS SIT AND WAIT FOR WHAT IS ULTIMATELY GOING TO HAPPEN ANYWAYS? I sometimes think to myself, this patient will never get up and walk, talk do anything ever again-- should I help them on their way to the "other side"? I have that ability to increase the morphine drip...but am I playing God? Am I committing the act of murder?? This is a very tough place to be in.

Personally, my dad was dying of metastatic colon cancer..he was diagnosed in June 2013, dies in December 2013. He asked me one thing, that I had the ability to do, don't let him suffer....and I DIDN'T. Was I playing God, Kavorkian? I tend not to think so. I was helping a loved one die peacefully, a loved one that had suffered for the last 6 months and was going to die whether or not I gave him an extra dose of dilaudid or ativan...a loved one that was there to take care of my scraped knee, to hold my hand when I had stitches put in my head...to give me away on my wedding day and dance the father-daughter dance....WAS HE ASKING TOO MUCH OF ME?? Are these family members asking too much of me??

Please tell me what you think.

Specializes in Critical Care.
You can't give any more morphine than a doctor orders you to give. A range is a wonderful thing. Along with some ativan, some atropine....Continue to get orders for what you think and the family thinks eases a patient who may be in discomfort. What you can't do it give "extra doses". They need to be accounted for. You have to have witnessed wastes.

The family is so in tune with a loved one that perhaps they are noticing discomfort that sometimes as nurses we can't. Some people who are dying are far too weak to grunt and/or grimace and moan.

The goal is peaceful.

I got the impression 'extra dose' referred to giving more medication than was needed, not more than what was limited by the range, which can be two very different dosages on comfort care orders.

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Here is an article I'd suggest you read if your view is that increasing opioids "hastens death":

International Association for Hospice & Palliative Care - IAHPC

Excellent article. For those of you who haven't yet hit the link, here's the abstract:

The principle of double effect is used to justify the administration of medication to relieve pain even though it may lead to the unintended, although foreseen, consequence of hastening death by causing respiratory depression. Although a review of the medical literature reveals that the risk of respiratory depression from opioid analgesic is more myth than fact and that there is little evidence that the use of medication to control pain hastens death, the belief in the double effect of pain medication remains widespread. Applying the principle of double effect to end-of-life issues perpetuates this myth and results in the undertreatment of physical suffering at the end of life.

The concept of double effect of opioids also has been used in support of legalization of physician-assisted suicide and euthanasia.

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What I meant was that if morphine 1mg q 1 hour as needed for pain/discomfort....and you give 1 mg every hour for 8 hours (just an example), that will HASTEN death, I don't care who says what, and give Ativan as ordered also, will hasten death. If a family member wants to get on with funeral arrangements and such, they can call you in every hour to give meds stating that their loved one is in pain....and who am I to argue, but I know in the back of my mind what is going on.

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What I meant was that if morphine 1mg q 1 hour as needed for pain/discomfort....and you give 1 mg every hour for 8 hours (just an example), that will HASTEN death, I don't care who says what, and give Ativan as ordered also, will hasten death.

Well, if you don't care who says what, even if the research literature and experienced professionals disagree with you, then, well, why ask, and why go into an evidence-based profession at all? I hear they're hiring at Faux News. And there are still people there who believe in death panels, to boot. :)

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OP if you don't feel comfortable providing care to a dying patient or find it too difficult to deal with persistent family members who are looking out for their loved one perhaps you should not care for that patient. It's really that simple. I would not want you to care for my dying relative.

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Specializes in NICU, PICU, Transport, L&D, Hospice.
What I meant was that if morphine 1mg q 1 hour as needed for pain/discomfort....and you give 1 mg every hour for 8 hours (just an example), that will HASTEN death, I don't care who says what, and give Ativan as ordered also, will hasten death. If a family member wants to get on with funeral arrangements and such, they can call you in every hour to give meds stating that their loved one is in pain....and who am I to argue, but I know in the back of my mind what is going on.

I agree with GrnTea, you have no need for peer reviewed research or the opinions of others when you have made up your mind and are convinced that your opinion is correct.

I am sorry, frankly, that you are practicing hospice nursing and feel a bit uncomfortable that you practice any evidence based profession given your dislike and disregard of facts.

For the benefit of those of us who do practice evidenced based nursing I would offer a reminder that when we are aggressively using opiates to alleviate pain we shouldn't forget about the nonpharmacologic measures that have been mentioned. Engaging the family in helping to reposition, applying cool cloths to the warm forehead or neck, good gentle and frequent mouth care, hand holding, soothing conversation or music...all of those may help to improve a persons comfort levels in the last hours. At the same time that engagement helps the family to feel like they are participating, making a difference, and not helpless.

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