Starving a patient..... - page 2
LTC resident. Peg tube feed. Totally NPO. Has been for years. Is now going through some rough times with hip. Not broken, but has had a replacement put in a few years back, started having pain a... Read More
May 23, '03quote:
Originally posted by Julielpn
So in other words, even if you have a "living will" or something else that says you don't want to be kept alive (or DO want to be kept alive), it's worth spit if your POA feels differently?
Just wanting to repeat this again as it's a VERY important point. Living wills are fine IF you have someone who is willing to assure your wishes are followed if you should become unable to speak for yourself. But they are not a legal document and if your POA (or even a heretofore uninvolved family member) objects to it once you're unable to make your own competent decisions, it's typically discarded.
May 23, '03That's such crap!
Here all this time I thought it was an actual document that could be upheld.
What's the use then? If no one is going to abide by the persons wishes.....
May 23, '03Gosh I think I would keep bringing up hospice. do you have a provider you usually work with on this? Maybe a family meeting with a hospice provider, the DON, yourself and the POA and client if she is able should meet and discuss options. The home really should do that because otherwise they are not investigating all options for health care. Very sad.
When my mom was acutely ill, her poa was my older sister. My mom told all of us no vents or extention of life if she was so ill. My sister had the poa, so did the hospital but everyone ignored it. Since I was not the poa my words meant squat. She died a horrible gruesome death from the flesh eating bacterial infection. Went into DIC after two gruesome surgeries. Her horrible death will be on my mind forever.
It made me mad that my moms wishes were ignored. After my sister, brother and I were convinced her death was being drug out and against her wishes, my sister asked me to take over and ask for the measures to be stopped, off the vent and such. I had to ask for an emergency meeting with the ethics committee at the hospital because the doc refused to do it even with her POA and living will in their hands. The doc made a resident d/c the measures and life support. She died in less than 20 minutes.
Goes to show those papers do not mean squat.
Is your resident A&O?
Jun 4, '03Can someone clarify the differnce then between a living will and durable power of atty. for healthcare?
I know they are differnt and our facilty requires we assess if a patient has either one.
Jun 4, '03Is the patient on IVFs? Necrotic wounds are always left open, because they usually require more mechanical debridement, plus you want to get the infectious debris out of the wound- not close up over it. It sounds like sepsis may have already set in- what do the blood cultures say? I guess the Gent wasn't effective, and that's why they D/C'd it? Did they try Vanc? Does the patient still have active bowel sounds? If not, tube feedings aren't going to nourish the patient, they'll just keep building up, and eventually go into the lungs. If that's the case, then TFs wouldn't be a comfort measure, especially if breathing is compromised. Anybody ever NT suctioned TFs out of somebody's lungs after arguing with a Dr that the PT had no bowel sounds? Is the patient alert at this time? If so, did the Dr talk to her and hear her wishes? Sorry, I know I have too many questions, but there are usually explanations for these kinds of orders. I would hate to think that the dr and family just gave up for no reason.
Jun 4, '03POA is for someone to have control over finanaces, etc. HCPOA is the document that gives a person the RIGHT to make medical decisions on your behalf. Many times we have family members that say they have "POA" and when the bring it in for us to copy it is only to control the persons finances. There really is a huge difference. Especially when you get into family dynamics. THE HCPOA gives the medical team the chance to take "orders" from the one person only. THE POA it is still the "family decision". (which you all know the uninvolved family member always shows up and gives us the worst time)
Jun 4, '03Had a pt recently who had a beautifully written living will...she addressed her family as "knowing you love me and losing me will be difficult for you" but included her intentions to die peacefully, rejecting all life support, just wanting to have adequate pain management and her family at her side...and for ONCE, the doctor and family gave her the respect she wanted and deserved.
Her death was peaceful and graceful. I wish I had made a copy of the living will (blanking out her name, witnesses)...reading it brought tears to my eyes...
Death is a natural process...and when I witness the greed and ignorance of family members and MD's...I could just whack them...
I have seen living wills ignored, cancelled...and I have seen humans suffer at the hands of doctors who refuse to believe that we all die and then perform horrible, painful procedures on beings that deserve an end to their suffering...We nurses have had it crammed down our throats that we have to asses and re-assess pain relief...but for some reason, MD's seem oblivious to the needs of the patient facing the end of their lives...
I am a supporter of hospice and the services they deliver...beautiful, gifted people...I am thankful for all of you who have chosen this area of work...
I am also waiting for some family somewhere to pursue litigation against MD's who believe they are omnipotent...I plan to appoint a HCOA who has enough common sense to understand my wishes and desires for a pain free, peaceful journey to the other side...
If the resident is alert and able to verbalize his/her desires for a natural death, I am in complete agreement of compliance for his/her wishes. Sometimes we humans are afraid to let go because we don't want to hurt our families...but no one needs to suffer at the hands of anyone else...
Jun 6, '03When my FIL was acutely ill (he had suffered a massive stroke and was totally flaccid on one side of his body and was becoming comatose), my husband was quick to make him a DNR. We knew that he would not want to live this way. He had been blessed by relatively good health all of his life and had been independent up until that point. Even with the DNR order in place, the doctor still was doing "heroic" stuff like placing him on renal dose dopamine, IV fluids, etc. By this time my FIL was completely unresponsive. I finally bluntly insisted that all "heroics" be stopped and he died a very peaceful death only a few hours later.
Oct 3, '03Since res is having trouble recouping from all this, family has decided (with dr's ok) to dc all meds (except morphine) and all nutrition (Jevity bolus 6xd).
Day shift nurse calls dr to tell him that we all feel very uncomfortable doing this and would he please reconsider. >>>>.It sounds like many of your staff ( and many of my co-workers and medical staff) need to work on end of life issues...It's unfortunate that the staff's feelings were viewed as more impportant then the families wishes...The doctor or your DON could have taken time to re-assure the staff regarding the problems that occur with continuing the feedings when someone is actively dying.......................When I hear someone say -is "starving" the resident a form of abuse?" I just cringe......People need to be informed about the process of dying.If nursing staff are not educated how can we educate oyr patients and their loved ones?..I firmly believe that as the body slows down one does not feel hunger as a healthy person does...I am sure this poor person in the thread is long gone-I hope that their loved ones got some support....
Oct 4, '03Actually, the person in this thread has pulled back and is alive and kicking!
Pt is doing very well, still has some pain issues and some intermittent confusion, but is very well indeed.
I do agree that we need to be educated in the process and how the body reacts to upcoming death...but I hadn't been a nurse very long when that was written, and I wanted to know... I was curious.
Thank you all for your differing viewpoints and opinions.
Oct 4, '03Actually, it depends on the state you work in. I was always under the impression that family could override living wills. In my state, they cannot. The hospital MUST abide by the living will as long as they have a copy of it. Only a competent patient can change it.
Oct 14, '03Concerning hospice....and yes I agree, this patient should absolutely be hospice. Let me ask though...my facility told us we are never to approach family regarding hospice care. Why is that?