Death With Dignity?

bunky, BSN, RN · Jul 11, 2000

You see Earle I don't think that the family is getting informed consent. To inform them that a G-tube will save their life isn't what I called informed. To tell them that inserting a feeding tube will just prolong this death would be more like it! It's like allowing them to grasp at straws that are nothing more than illusions of life. If they came to the doctor and said "What can be done to save them"? I think a competent and human doctor would tell them that we should make them comfotable and let nature take it's course. Not give them false hopes for THEIR sake, but from the patients point of view.

And Blue, I think it hits on what you're saying too! If the MD viewed these patients as people, and he/she put it into the context "if this was MY mother" we'd see a huge change in treatment decisions. It's as though many physcians leave their humanity at the entrance to the hospital at a big coat check rack.

Do you guys ever wonder if financial gains comes into play for some of the doctors? Yes, it's a cheap shot, but sometimes it seems like the only thing I can come up with as a motivation for some of what I see. There, I said it!

Keep me posted Earle.

JillR · Jul 15, 2000

There was a doctor that I disagreed with about telling the family the truth about their mothers impending death. The doc said to me that he didn't want to take all hope away. I told him that by not telling them the whole truth he was preventing them from going from hoping that the patient lives to hoping that their loved one dies with dignity. My point is that, in my opinion, there are all kinds of hope, and by not allowing the family to face the facts, I felt that he was keeping then from what they needed to do the most, begin the grieving process. Just my thought for the day.

bunky, BSN, RN · Jul 17, 2000

I agree 100% Jill. If you knew that a family member was dying, wouldn't you use those last days differently?!

fergus51 · Jul 17, 2000

I am a student nurse and recently had clinical in a geriatric facility. One of my residents had terrible pain related to a CVA he had years ago. He has had severe chronic pain since then and has developped contractures sa well. He says his pain meds don't work and I talked to my instuctor about it. What I would like to know is if any of you could tell me if your patients get "layered" pain meds. Mt instructor said they layer different types and strengths of medicatioins and often get a better result. Have any of you had experience with this? Has it improved things for any of your patients?

happydog · Jul 17, 2000

I agree whole heartedly-sometimes medicine gets in the way of the natural order of things. Sometimes i think we treat our companion animals better than our fellow humans. I had a doctor order for me to d/c a patients 02 (sating at 93% on a 15 L non-rebreather mask) after we started the MS drip. I wouldn't do it, and it went to the ethics committee. O2 is a comfort measure in my opinion, and he was going to die soon, anyway. Why push him through the door? I believe that the MS would suppress his respirations soon enough, why force the poor man to gasp for air? The MD ended up taking the O2 off in the morning, and the man died 14 minutes later, turing blue with each last moment. I sat with him until he died. It very much disturbed me. I think there needs to be more protocol for the dignity of dying, as well as maintaining comfort measurs, and it is such a touchy subject, few want to touch it.

happydog · Jul 17, 2000

I too, had a frustrating case; a man in his late 70's has metastatic prostate ca with mets to the bone, lung and brain. He has severe ascites and wet, lung sounds, and coughing up blood, along with poor output. His son wants EVERYTHING done to save him; chemo, blood tranfusions, you name it he wants it tried. He is one hospice care, per his wife, which has the family torn apart. He has three different MD's on the case, all reccommending different treatment, and giving false hope to the son. (Do i hear a cash register cha-chinging?) In a conference with interdisciplinary care team, the son refused to allow his father to have morphine, or even asublingual roxanol. He said " I don't want him all doped up on narcs, and if he has pain, he will have to deal with it. Life is about pain , anyway. I wanted to throttle him! Life may be full of pain, but who says death has to be? For the dying, anyway. Families need to deal with their own issues of death, and not force their loved ones to suffer because they can't cope. EDUCATION is the key, and patient advocacy most important. Family dynamics can certainly be difficult. Denial is such a powerful thing... Well- that is my vent for the day, thanks. Any ideas on how to help families come 'round and admit that a loved one is not getting better?

Originally posted by JillR:
There was a doctor that I disagreed with about telling the family the truth about their mothers impending death. The doc said to me that he didn't want to take all hope away. I told him that by not telling them the whole truth he was preventing them from going from hoping that the patient lives to hoping that their loved one dies with dignity. My point is that, in my opinion, there are all kinds of hope, and by not allowing the family to face the facts, I felt that he was keeping then from what they needed to do the most, begin the grieving process. Just my thought for the day.

Phoenix · Jul 17, 2000

I am a first year nursing student from Australia, and although i have only been doing formal study about nursing for 6 months now I would just like to voice my opinion. Although I do agress with allowing a patient to die with dignity, i can not understand the families of patients that are die not letting them go in peace or with any dignity.

I can understand that they may be trying to cling to the last straws of the patiens life, but why not give then a peaceful sendoff. Rather they have them pumped full of drugs, tubes placed in every place possible and demoralized when there is nothing that is going to save them.

This both angers and saddens me. When will people stop trying to prevent death, and start to consider quality of life?

darla80 · Jul 23, 2000

Originally posted by bunky:
What happened to this concept? I am NOT advocating euthanasia. I am however advocating that we take a close look at what we are currently participating in when we keep chronically ill, multi problem, end stage patients in a hospital without any hope of improving their quality of life many times doing more to add to the suffering of their death than to the quality of their life. Is anyone else out their seeing this? What have we accomplished when we admit an elderly person whose life consists of lying in a bed, unable to speak or respond to anything but painful stimuli with more than a blink? Unable to eat, or drink or sustain themselves in any way except breathing. Their quality of life is not one that any of us would wish to live. If you asked the family, I feel certain that they'd agree that they themselves would not like to be in this condition either. What are we accomplishing when we care for these patients beyond comfort care? I have to stress that I myself could not EVER administer a medication that would end a life. I couldn't live with myself. But what I am speaking of is not even about witholding basic life sustaining treatment such as IV fluids. It is the pervasive practice of sending these people for invasive procedures even surgeries, inserting tubes in every orifice, and subjecting them to blood test after blood test as though we are looking at curing them when we know it is not possible to do so. More importantly what do you feel is the motivation for this prolongation of a death? Is it all the family? If so, do you think it is an uniformed choice made by the family or a display of too much trust in medicine? Is it the physician? Where do we as nurses fit in this familiar picture?

I am very interested in what everyone else has to say on this subject, and if any one else has a problem with seeing this like I do.

darla80 · Jul 23, 2000

Originally posted by bunky:
What happened to this concept? I am NOT advocating euthanasia. I am however advocating that we take a close look at what we are currently participating in when we keep chronically ill, multi problem, end stage patients in a hospital without any hope of improving their quality of life many times doing more to add to the suffering of their death than to the quality of their life. Is anyone else out their seeing this? What have we accomplished when we admit an elderly person whose life consists of lying in a bed, unable to speak or respond to anything but painful stimuli with more than a blink? Unable to eat, or drink or sustain themselves in any way except breathing. Their quality of life is not one that any of us would wish to live. If you asked the family, I feel certain that they'd agree that they themselves would not like to be in this condition either. What are we accomplishing when we care for these patients beyond comfort care? I have to stress that I myself could not EVER administer a medication that would end a life. I couldn't live with myself. But what I am speaking of is not even about witholding basic life sustaining treatment such as IV fluids. It is the pervasive practice of sending these people for invasive procedures even surgeries, inserting tubes in every orifice, and subjecting them to blood test after blood test as though we are looking at curing them when we know it is not possible to do so. More importantly what do you feel is the motivation for this prolongation of a death? Is it all the family? If so, do you think it is an uniformed choice made by the family or a display of too much trust in medicine? Is it the physician? Where do we as nurses fit in this familiar picture?

I am very interested in what everyone else has to say on this subject, and if any one else has a problem with seeing this like I do.

I have read all the posts with great interest.

I do agree that education and Patient advocacy are key!!

Do you think the general lack of respect that our society has for the value of life has anything to do with this?? It is all very contradicitory. Our society will sanction the death of unborn babaies yet not allow the sickest people to die!??

However I think much of this problem with undignified death comes from the families inability to come to terms with their loved one dying. What role models do we have for "good death?" I hope we as nurses and as compassionate human beings can somehow make a difference in our societies perception and acceptance of death.

I do want to say that I work for an Internal medicine physician who strives to help families come to terms with death before death becomes reality in the acute care setting. However we are often met with much denial and even anger that the doctor is willing to let thier mother/spouse/brother/ sister die!!!We struggle with this and he tries and I try but people do not want to accept death as a part of life.

So I do want to say please support the docs who are trying to help families cope with death but remember the denial and the pain are palpable for these family members. We have all seen those sad people that are kept "alive" for the selfish family members who can not understand death let alone comprehend the act of giving their loved one a death with dignity. I pray that when it is my time and if I am in the hospital setting that I will have nurses like you who have posted and that death with dignity will be an option!

bunky, BSN, RN · Jul 24, 2000

This may sound morbid Darla, but I have already pumped it into my own families head that if something is ever to happen that my wishes are to be allowed to go as painlessly as possible.

darla80 · Jul 26, 2000

Originally posted by bunky:
This may sound morbid Darla, but I have already pumped it into my own families head that if something is ever to happen that my wishes are to be allowed to go as painlessly as possible.

Not morbid at all Bunky!! Is there any way we can educate the public about this? Or is this death concept simply to dificult to grasp??

I think books/movies like "Tuesdays with Morrie" helped but then again only a certain shall we say more sensitive group of people actually watch/read those types of things.

I enjoy your posts .. Take care!!

askater · Jul 27, 2000

This subject I've dealt with, in nursing. Now I will be dealing with this, in my family. My grandmothers got a diagnosis of terminal cancer. I think the hardest part, is knowing what road is ahead. I'm praying her death will be peaceful and the pain will be well-controlled.

I agree with much of what's been said.

p.s. When the time comes and I want to die with dignity.