Allowed to die

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Specializes in Med/Surg/Respiratory/orthopaedic.

hello, i'm writing from new zealand. it's really interesting reading your posts - usually i write in the hospice section but i thought i'd 'come over' to talk to you geriatric experts.

last week i looked after an elderly lady who'd been admitted during the night with urinary sepsis. she was from a rest home and quite dependant for her adls; she had some dementia. the decision (by the husband, son and doctors - i wasn't there so i don't know who had the most 'sway' in the discussion) was for no antibiotics, no fluids, no feeding. she was 'cast' in bed, being turned two hourly - it seemed the relatives expected her to die.

do you have this scenario often in your work?

i'm not 100% sure that what we were doing was morally acceptable: it seems 'murky' ethically to me.

jeanette:stone

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A little "murky" in my opinion also. Hospice allows feeding,fluid,and antibiotics where I worked, had assumed that was all places. These signify comfort measures to me and seems like should be automatically given.:o

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Specializes in Med/Surg/Respiratory/orthopaedic.
a little "murky" in my opinion also. hospice allows feeding,fluid,and antibiotics where i worked, had assumed that was all places. these signify comfort measures to me and seems like should be automatically given.:o

actually, i work on a medical ward - so it's not hospice focused (i read the hospice section of allnurses.com because that's my interest.)

[color=#556b2f]i've seen people decide to stop taking iv fluids when they are able to make their own decisions - they don't live for many days after that.

[color=#556b2f]

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Specializes in Med/Surg/Respiratory/orthopaedic.
a little "murky" in my opinion also. hospice allows feeding,fluid,and antibiotics where i worked, had assumed that was all places. these signify comfort measures to me and seems like should be automatically given.:o

one hospice expert - ira byock - writes that there is not much suffering involved in dying while not eating or drinking.

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Hey NZealandHospice

This doesn't seem to out of line to me....

We in the US have Pts brought from LTC (I 'spose equivalent to your 'rest home') to the 'acute care' hospital so that they can be more closely monitored but not treated. Many of them are 'comfort measures only' and do not receive treatment other than compassionate nursing and pain medications.

Papaw John

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Specializes in Med-Surg.

Maybe the decision wasn't made by the husband and the son, but hopefully by the patient long ago prior to her dementia. In the US we have living wills, etc. Nothing wrong in my opinion to letting nature take it's course. What would antibiodics and fluids do for her? Prolong her life so she can continue to lie in bed and be truned q2h and be dependent. Probably not the life she wanted and the family are just granting her wishes. I think they are making a very loving and compassionate decision on her behalf.

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Specializes in Gerontology, Med surg, Home Health.
Hey NZealandHospice

This doesn't seem to out of line to me....

We in the US have Pts brought from LTC (I 'spose equivalent to your 'rest home') to the 'acute care' hospital so that they can be more closely monitored but not treated. Many of them are 'comfort measures only' and do not receive treatment other than compassionate nursing and pain medications.

Papaw John

If we have someone who is "comfort measures only" we wouldn't send them to the hospital! They would be kept comfortable at the SNF where they and their families know the staff and we know them. What is the point of closely monitoring someone if you're not going to treat them? We can do everything the hospital does except put someone on a ventilator or in a telemetry bed so why send them to be with strangers?

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

this is a very common senerio in my experience with working in hospice. alot of times doing the everyday things causes more pain and discomfort than not doing them at all. on my unit under comfort measures if it hurts we dont do it, that includes turning , the patient attempting to swallow or any meds that have to be given rectally.of course comfort measure are only usually used on the patients expected to pass fairly quickly. alot of times families have all this planned and talked out prior to being on hospice. maybe it is the patient that choose this way to go. remember hospice is pallative not curative. (please forgive spelling errors)

hello, i'm writing from new zealand. it's really interesting reading your posts - usually i write in the hospice section but i thought i'd 'come over' to talk to you geriatric experts.

last week i looked after an elderly lady who'd been admitted during the night with urinary sepsis. she was from a rest home and quite dependant for her adls; she had some dementia. the decision (by the husband, son and doctors - i wasn't there so i don't know who had the most 'sway' in the discussion) was for no antibiotics, no fluids, no feeding. she was 'cast' in bed, being turned two hourly - it seemed the relatives expected her to die.

do you have this scenario often in your work?

i'm not 100% sure that what we were doing was morally acceptable: it seems 'murky' ethically to me.

jeanette:stone

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

Patients that are dying and are on hospice do not need to be in a acute care hospital where they are disturbed by call lights, feeding and IV pumps beeping ,plus all the hussle and bussle of a acute floor. Hospice should be calm with low dimming lights and soft music... a very soothing atmosphere

Hey NZealandHospice

This doesn't seem to out of line to me....

We in the US have Pts brought from LTC (I 'spose equivalent to your 'rest home') to the 'acute care' hospital so that they can be more closely monitored but not treated. Many of them are 'comfort measures only' and do not receive treatment other than compassionate nursing and pain medications.

Papaw John

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Specializes in Med/Surg/Respiratory/orthopaedic.
patients that are dying and are on hospice do not need to be in a acute care hospital where they are disturbed by call lights, feeding and iv pumps beeping ,plus all the hussle and bussle of a acute floor. hospice should be calm with low dimming lights and soft music... a very soothing atmosphere

hi and thanks for your comments. the pt was admitted with sepsis. they decided to not treat and yeah, it wouldv'e been good to send her back 'home' straight away. sigh.

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Specializes in Gerontology, Med surg, Home Health.
Patients that are dying and are on hospice do not need to be in a acute care hospital where they are disturbed by call lights, feeding and IV pumps beeping ,plus all the hussle and bussle of a acute floor. Hospice should be calm with low dimming lights and soft music... a very soothing atmosphere

Hmmmm....call lights, feeding and IV pumps beeping...hussle and bussle....sounds like my sub acute floor and my long term floor too for that matter. We are considering changing a few of the rooms on one end of the hall to hospice rooms....away from the nurses' station.

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Specializes in Medical.

Hi nettie,

I also work in acute care, and see this quite often. Ideally patients like this would stay in or return to their residential living to die. However, for a variety of reasons this rarely happens once they'd been admitted to hospital.

I'm not sure, reading your post, which aspect you found troubling: was it that she died in hospital, or that she did not have fluids, nutrition or antibiotics?

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