Do Dr's get to play God

[nebrgirl]

There was a reccent discussion on here about that sometimes we have to remind ourselves that "No Code" does not mean "do not treat"....and I agree, and I know that when a person, or their POA elect for hospice care you are choosing to discontinue interventions that might extend life. Oh I should probably say this question is coming from a student. And that I don't know the whole story, so what I'm really seeking is just clarification for my understanding. But in clinicals I had overheard that a Dr. had decided not to treat this patient's high potassium level, because "it would be the best thing for him" to just pass. Now again I don't know the details of what conversations the Dr. had with the patient or the patient's family, and the patient was elderly with a number of medical conditions....but do Dr's just get to decide this kind of thing? sorry if this is kind of rambling an unclear. I'm just trying to understand.

[TheCommuter, BSN, RN]

Patients who are alert, oriented, and lucid should be the ones making the decisions about their care. If the patient is demented and has no advance directives, it is usually the POA who decides.

There are cases where the demented older patient has no living relatives or POA. In my state, the patient's attending physician can sign a DNR order and validate it by having another physician sign it. If the demented patient can no longer make informed decisions and has no family or POA to decide for him/her, then the attending physician can make the decision to not treat an outrageously critical serum potassium level.

[BrnEyedGirl, BSN, MSN, RN, APRN]

Nebrgirl would it make you feel better if you knew the pt was dying of metastatic renal ca (lung mets), was end stage CHF, and had already refused dialysis? Would you feel better if you new that they had "treated" the high K many times before and they know it is just going to go back up again? Would it it be easier to understand if you knew that the high K isn't painful, and that the hospice team and family are doing their best to keep him comfortable? These are just things everyone should think about when they use the term "playing God", sometimes I believe it's best not to step in and change what God is already taking care of.

Best of Luck in your studies! I hope you love nursing as much as I do!

[nebrgirl]

Thanks RN Cardiac....I don't know what the particulars are for this patient, I understand what your saying I had POA when it was time for my sister to go into hospice, and when the nurse asked if we wanted her to have a what was her "last" shot of pain medication....I guess what my lack of comfort was in this situation was that it seemed to be the Dr's decsion rather than his discussing it with the family....now who knows maybe he discussed it with the patient....I guess I feel bad about the fact the patient died without the family being there, when in fact the dr. seemed to know that death may be immenient (yes, the family lived close by..)

[BrnEyedGirl, BSN, MSN, RN, APRN]

Nebrgirl I do understand your feelings about a pt dying alone. I so hate it when family isn't around and if at all possible I stay with the dying pt. That said,..here's something else to contemplate,..I have often seen family stay at bedside for weeks on end. They often ask the nurses "how much longer?". I have seen one family member call everyone at 0200 because "Dad's about to go". Sometimes this happens multiple times and "Dad" is still hanging on days or weeks later. This is so very hard on family. Family that has jobs, kids, spouses, homes to care for etc. (It sounds as if you have first hand knowledge of this,.so sorry)

I have no scientific data to support this,.it's strictly personal experience over the years. I swear some people will not die while family is present! Others wait until great niece from LA arrives, or until after granddaughters wedding etc. I have also seen pts who wait until their wife says it's okay or until someone tells them they are going to take care of wife, kids, etc. I know this may sound silly to you, but I'm not so sure that we don't have more control over our death process than some may think.

I also believe that my responsibility as a nurse includes helping people die as well as helping people heal. Dying is part of the life process. The medical community can't keep everyone alive forever and we shouldn't try. It is my job as a nurse to do everything in my power to make the dying process as comfortable as I can. Sometimes that means giving meds and emptying Foley's, other times it means holding hands and listening to family's fears and memories. Every situation is different and every family has different beliefs/fears/concerns about the dying process. I am honored to be a part of persons last moments on this earth. I hope that I am able to ease pain/fear/hurt for all involved, in at least some small way.

[CHATSDALE]

****THIS IS PART OF HIS JOB**** sometimes when we are involved in health care we are in positions that we would never want to be in..it is not easy to call someone in the middle of the night and tell them that a loved one has passed - when they ask you if you would make the decision for DNR if it was your family member

decisions like these [mds writing a dnr] are not made without a lot of thought and consideration

[nebrgirl]

Thank's Rn-Cardiac, I too believe that people make some type of choice about when and where they die.