Pain Medicine for a dying patient ...

  1. with unstable vital signs. The patient is very near death and is a DNR.

    A scenero such as a patient that is actively dying, vitals signs are poor, bp low, heart rate low, respirs low. The patient is moaning. The family says give him something, and you have doctors orders. You know the pain medicine may slow the respirations down too low and you're nervous it may even stop the respirations, but you know the patient is in some kind of distress, perhaps pain (say in a terminal cancer patient who prior to this has been in a lot of pain for months). You may even call the doctor to clarify orders, who says give it now. Do you give the pain medicine?

    This is not a question about euthanasia, it's about pain and comfort measures. Is it going too far?
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    About Tweety, BSN

    Joined: Oct '02; Posts: 59,986; Likes: 14,814


  3. by   ratchit
    Unless they've withdrawn it, the ANA has a position paper stating that providing comfort measures including meds for dying patients is NOT euthanasia, even if that treatment or med hastens the death of the patient. The difference is the intent- are you planning on promoting comfort, with death being a known risk, or are you planning on killing them?

    I am not OK with actively killing someone. I am absolutely OK with giving morphine, ativan, or whatever to promote a dying patient's comfort, no matter what happens next.

    I see it as one of the most honorable things I can do as a nurse- provide comfort at the end. Their cancer killed them, we just make them comfortable. If the patient is competent to do so, ask them what they want.

    (Except for that serial killer in KY of course- he deserves to be tarred, feathered, drawn and quartered.)

    A mentor of mine somewhere along the way told me that pain is not an acceptable way to sustain a blood pressure. That voice in the back of my head has made this situation easier for me several times.
  4. by   Katnip
    The same thing was taught in my bio-med ethics class. There is always a *final dose.* The intent of that dose defines whether it's pain relief, euthanasia, or murder.
  5. by   dphrn
    With the scenero stated, I would provide the pain medicine without hesitation.
  6. by   fab4fan
    Absolutely, give the med.
  7. by   Noney
    Give it.

    And if I'm eve the patient in the above situation:

    Give it 5 minutes ago.

  8. by   ScarlettRN
    During the first year out of nursing school,I took care of a patient who had tried to die a couple times and ended up in ICU before the family finally decided to let him be a DNR. He had lung cancer, and the family had a hard time accepting that he was terminal at first. He was transferred out to me from ICU and was actively dying at that point. I went to give him an MS push to calm him...he was just wild trying to get air, but wasn't conscious. What a learning experience that was!
    But I gave him the MS and he died while I was standing at the bedside. Just like that. It took me a while to mature as a nurse to understand that I had not actually killed the man. I think a lot of nurses worry about that when they are giving huge doses of MS to terminal patients.
  9. by   Dave ARNP
    I think that the simple fact that you're questioning whether to give the pain medication in this situation shows that your intent is to do what is best for this patient. It also shows the execllent skills you posses as a nurse.

    As to answer your question, in this situation I would in no doubt administer the medication. I would in no doubt ORDER the medication.

  10. by   Tweety
    Thanks for the input. I would give the medicine, and have before and will again. I'm encouraged to know there are others like minded people, and I hope I get a nurses like you guys when my time comes.
  11. by   NursePaula
    The hospice that I worked for had a saying, "They finally got comfortable enough so they COULD die". If a pt is actively dying and in obvious pain I think it should be a crime not to give pain meds at that time...also if they have been taking it for a while a dose at this point is not going to suppress their respirations further...
  12. by   Hellllllo Nurse
    I worked aa an inpt acute hospice nurse for four years.

    We routinely had pts w/ resp rate of 4-6 getting 20-100mg MS04 per hr who lived for days and weeks that way. I do not think I have ever seen MS hasten death, although it would have been a blessing in some cases.
  13. by   TiffyRN
    A good oncologist once counseled my good friend (also an RN) about this very thing, giving IV morphine to a dying patient who was in pain. She was very torn about doing it thinking she would "cause" this patient's death. He told he "the morphine isn't what's killing her, Cancer is killing her. You are relieving her pain". She gave the morphine with tears in her eyes and witnessed this woman as her pain was relieved and then she passed away peacefully within the hour. My friend came away sad that his poor patient had to suffer at all but comforted that she was able to help the patient. By sharing this experience with me we were both able to learn something.
  14. by   sbic56
    Originally posted by cyberkat
    The same thing was taught in my bio-med ethics class. There is always a *final dose.* The intent of that dose defines whether it's pain relief, euthanasia, or murder.
    Well said!

    Tweety, when my mom was dying, she presented just as you describe your patient. I asked the nurse to give her some more MS and she wouldn't because her resps were something like 8. My sister and I were incensed, of course. I told her to draw it up and I'd give the damn thing myself. We ended up going over her head and the MS was given.