Hard Choice for a Comfortable Death: Sedation
- 5Dec 27, '09 by alan headbloomHard Choice for a Comfortable Death: Sedation
By Anemona Hartocollis; New York Times; December 26, 2009
In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.
In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.
- 0Dec 27, '09 by Sadhi1A hard pill to swallow, knowing that the medication the I adm may speed up the death of my patient is hard to deal with. But, what is better... having the patient so confused and agitated to point where he may injury himself or others, or medicate the patient using safe parameters. Seems like we lose either way.
- 8Dec 28, '09 by mamamerleeMany thanks to the person who posted this. When my dad was still awake and alert, his body was already slowing down. His kidneys had stopped functioning, he was refusing to eat or drink, refused a feeding tube. Although he clearly stated that he did not want to die, we made it clear to him that if he didn't have any intake, he would soon die. He repeated that he didn't want to die, but also didn't want to eat. All he wanted was pain relief, for his diabetic neuropathy. His only complaint was how bad his feet hurt. That evening he was started on a morphine drip, the next day he was totally sedated, the following morning he died. Did the morphine hasten his death? I don't know - - his body was actively shutting down prior to the drip.
We never questioned the plan, my mother was only sorry that we weren't there when he passed.
- 29I went through this earlier this year with my father. I know everyone is different and I'm not judging anyone, but I have a v. hard time understanding people who would rather have their loved one alert, awake, and in terrible pain rather than resting peacefully and comfortably prior to death (even if that means that they don't last quite as long ...) I was grateful that the hospice staff were able to make my father comfortable (which he had not been at the assisted living facility prior to being moved to the hospice facility when death was imminent).
- 11Dec 28, '09 by txspadequeenRN, BSN, RNmorphine and ativan are two of the most widely used drugs in hospice care..they work wonderfully together and provide a lot of comfort for dying patients in pain...i stopped reading this article at the end of page one....i see this as another article to stir up the media just like the mrsa scare....i wish if someone was going to write about a sensitive subject such as this they actually knew something about it....."slow euthanasia"... are you kidding me ????
- 4Quote from txspadequeenrni did read the article all the way through, and i thought it was pretty balanced and fair. honestly, over the course of the article it mostly made you (me, anyway) question just why anyone would rather have their loved one suffer, when s/he could be comfortable with sedation (seems pretty selfish to me, but that's just me) ...morphine and ativan are two of the most widely used drugs in hospice care..they work wonderfully together and provide a lot of comfort for dying patients in pain...i stopped reading this article at the end of page one....i see this as another article to stir up the media just like the mrsa scare....i wish if someone was going to write about a sensitive subject such as this they actually knew something about it....."slow euthanasia"... are you kidding me ????
- 0Dec 28, '09 by goodneighborCertain end of life patients, such as patients with dementia, become so agitated that they suffer because of confusion, such as the example of the pt who climbs out of bed and cannot control himself or be settled down by redirection. The pt usually forgets how to eat or drink. Cognitively, he can no longer perform the act of even drinking water. The main point is that they no longer can safely or intelligently make their own decisions or actions to prolong their very life. The root cause of stress for the family is that THEY have to make decisions for this person. It's assuming the mantle of responsibility. It is no longer trying to figure out what "Dad would want", it's "what do I do for him?". You cannot expect the pt to express his wishes, you can try but...
It is not so much about palliative or terminal sedation, but "when does the patient lose autonomy?" It is similar to a situation where a patient is severely mentally ill and the family must commit the pt to medical care (depressed, delusional, hallucinating). An agitated pt must sometimes be sedated for safety and that is considered more humane than restraints generally. A screaming writhing trauma pt must be sedated, given morphine to be treated, and medical personell do this with no hesitation. I am just trying to say that it seems that the big issue is the loss of autonomy for the patient-that is the line we are all afraid to cross.
- 0Dec 28, '09 by stephenfnielsenI took care of a end-stage COPD pt a few days ago in the ICU, had a DNR- DNI order and was on BiPAP which was sustaining very minimal breaths (tidal volumes<150, ~10/min) that she was initiating. O2 sats in the 85-90% range and dropping. Titratable Morphine and Precedex drip for comfort/sedation.
Family said that they wanted her to pass peacefully, but didn't want to take the mask off until the next day when they could be with her when she died.
She looked in pain and uncomfortable, but I hesitated drug titration based on the family's wishes to be present at death- thinking that respirations would cease with an increase in dose.
What would you do in this situation? Do you milk the pt along for one more day in pain for the family, or do you medicate for comfort (and possibly death) for the pt?