confused...legal to not feed patients?

[IHeartPeds87]

Okay so I am confused. A family friend has a parent in the hospital. The patient is in a coma and was on a ventilator. They pulled the ventilator out and the patient was able to breathe on his/her own.

I was under the impression that the "DNR" status means that if the patient arrests/codes, heroic measures won't be taken and they won't put him back on a ventilator even if he needs it....hence the "Do not resiscuate"

What I don't understand? There is no stomach tube and he's not getting any food or water! Won't this kill him anyway? Is that even legal? Or is there something about the situation that I don't understand?

This is a very, very old person who has lived his/her life. I am not anti the person dying but I am trying to understand, from a legal standpoint...isn't this killing him?

[proudnurseRN]

In my short period of nursing I have realized that our ultimate goal is to keep people alive and keep them comfortable. However, there comes a time when these two goals are not compatible with each other... they can either stay alive or be comfortable. Now, if it were me, my hope would be that if I wasn't terminal I would be kept alive. However, if I was terminal, if I was going to die in a day, week, month no matter what measures are used, I would want to be kept comfortable.

As others have mentioned "starvation" isn't cruel. I have read several articles regarding this. Mostly though, I think people forget that no matter what, death is a battle we will all lose. Medical technology may extend life, but death will always win. As nurses, family members, and people of a society it's our duty to really think about when medical technology goes to far, because the end result is the same. We will all die, and there is apoint where medical intervention actually becomes cruel.

[loriangel14, RN]

After you spend some time working with patients whose suffering is being needlessly extended by g-tubes (and there are a LOT of them), you will know exactly how you feel about this topic.

This is very ironic that I am reading this today. I just worked a midnight shift. We have a pt that has feeding tube. She had a subdural haematoma last year. Her family still believes that she will miraculously recover. She is bedridden, unless we get her up with the mechanical lift. She is in pain. She cannot swallow. Her limbs are starting to contract.She is limited in her ability to communicate.She constantly pulls her feeding tube out and they keep reinserting it.She asked me for pain medication at 0400 and I had to tell her she couldn't have any for another hour. I offered to reposition her and she looked straight at me and said " Repositioning doesn't help. I am tired of this. I want to die". I cried.I know this woman would never tell her famiy how she feels. Her husband refuses to listen when we explain that he cannot feed his wife solid food and that she will develop aspiration pneumonia. At this point it looks like this would be her only ecscape.

I have already put it in writing for my family for my family that I do not ever want this for myself.

[JulieCVICURN, BSN, RN]

There's plenty of palliative research that will tell you that to stop feeding and hydrating a terminal patient at the end of life is a kindness. It allows the body to shut down naturally and stop fighting the process. It's not only legal, it's an act of mercy. As an ICU nurse, I watch feeding tubes and IV's and procedures forced on people whose families can't bear to let nature take it's course. Most of us (on my unit) shake our heads at the selfish cruelty inflicted on these patients who simply want to be allowed to pass on. We try to advocate for the patient, but the will of the people left behind often supercedes what the patient wants.

[Simba&NalasMom, LPN]

I just didn't know that was legal and I don't really understand how it is. there is a difference between "not saving a person" (DNR) and speeding up the process of death. By not feeding someone, aren't you essentially killing them?

On a related note, what does this indicate for organ donation? Won't the organs become unviable if this occurs?

As long as this patient, before he went into the coma, signed and filed paperwork in accordance with state law, stating that any artificial feeding is to be withheld in the event of this type of condition, it is perfectly legal. It's not seen so much as "speeding up the process" as it is "withholding treatment." So no, it is not really essentially killing him. I understand where your confusion comes from; I felt the same way when I was a student.

If you have not seen it already, there's a really good video called "Whose Death is it, Anyway?" I believe it was made by HBO. It's a documentary that covers this type of subject; you may find it helpful (then again, you may find yourself with even more questions, LOL...it really is a complex sort of subject).

[Simba&NalasMom, LPN]

There's plenty of palliative research that will tell you that to stop feeding and hydrating a terminal patient at the end of life is a kindness. It allows the body to shut down naturally and stop fighting the process. It's not only legal, it's an act of mercy. As an ICU nurse, I watch feeding tubes and IV's and procedures forced on people whose families can't bear to let nature take it's course. Most of us (on my unit) shake our heads at the selfish cruelty inflicted on these patients who simply want to be allowed to pass on. We try to advocate for the patient, but the will of the people left behind often supercedes what the patient wants.

I thank God frequently that my entire family feels the same way you do. If/when the time comes that any of us are in that kind of situation, we will go with a minimum of suffering and with dignity.

[I_LOVE_TRAUMA, RN]

This patient also could be receiving TPN right now, because they may not be a canidate for gastric/duodenal feedings d/t disease process, I'm just saying...

If as you said the patient is "very old" then it is their time to go, why prolong it...what good will come out of it?

[One1, BSN, RN]

There was an article in AJN September 2009 titled "Stopping Eating and Drinking" about this. It was a wonderful article, and very much an eyeopener to the physiologic process of the loss of desire to eat or drink in a dying person. The one point that stuck out in my mind was that dehydration can cause a calmness of sorts and its actually quite comfortable for the person. If you have or know of somewhere to get access to this article I highly suggest it.

The article is downloadable for free from the AJN website:

http://journals.lww.com/ajnonline/pages/results.aspx?k=Stopping%20eating%20and%20drinking&Scope=AllIssues&txtKeywords=Stopping%20eating%20and%20drinking

I am writing a paper on right-to-die/ Euthanasia/ Physician-assisted suicide right now and found this thread very interesting. Thanks for the tip on the article!

[Mike A. Fungin RN]

There's really not enough information about the patient's condition to make a call one way or the other. What do you mean by "coma." That's not really a term we use in a hospital setting, as it's nonspecific.

[caroladybelle, BSN, RN]

so is this what the whole terri shavo case was about? or was that about taking her off the ventilator?

The Terri Shiavo case was about who has the right to decide if a pt has not given written or taped advance care directive. The husband stated that she had verbally expressed her wishes regarding living after serioud impairment and he was abiding by them, and her family disagreed. And in her case, she still had some potential longterm physical functioning - in many cases, the pt does not.

[NurseLoveJoy88, ASN, RN]

As a new nurse I experienced this exact situation today. One of my residents returned from the hospital and is now on hospice. Currently she doesn't tolerate anything po except SL meds. I feel that I as her nurse is giving her the best quality of life as she proceeds through the dying process. Her organs are shutting down,and if she ate she may aspirate. There a no feeding tubes because the family and doc agrees at this stage its not necessary. And no she not starving to death, she's comfortable and having a peaceful dying process. This is how I feel and there is nothing illegal about not risking harm to feed a resident or following the POA request of no feeding tubes.

[rosthenurse, LVN]

Ok, think about it like this, the body can live for a while without any support. If the family or pt chooses no feeding tube and the patient can't swallow and also is a DNR there are no options left really. Doing hospice made me realize this. Sometimes the pt having nothing is better than complicating under lying problems.