Do you think removing an NG tube is "killing someone"?

allnurses Guide · Mar 6, 2009

Ummm... no. Basically, you just gently pull the thing out. That's it.

Are you referring to, killing someone because you have just removed their only means for receiving

nutrition?

No, you would not be "killing that man" by removing his NG tube. There has been a decision made

by doctor, family, etc, that this is what would be best for this patient.

bmyluv831 · Mar 6, 2009

Hello, I have been in this situation but not in the hospital setting, MY very own grandfather had a stroke and was getting better when he was ready for discharge he had a second massive stroke. He was sent back to the hospital and a few days later the doctors presented a critical question/ decision which my grandmother & my parents had to make. Do you want us to put a feeding tube in your loved one? My parents came to me (being the nurse in family) I gave them my opinion on the situation. Grandpa would NOT want to lie in a bed in a vegitative state only being kept alive by aftificial feeding. WHERE IS THE QUALITY OF LIFE?? Thats where we as nurses have to respect the decision of the family ... Any time you have a hard decision to make put yourself in the shoes of the patient or the family member Do not be judgemental, as a nurse it's best to be caring, understanding and always non judgemental. We did put Grandpa on Hospice and about a week of comfort care and lots of family visiting him sitting by his side and giving him all the Love we have for him .. to him .. Grandpa passed on ... The decision was hard but Grandpa respects us for making it Im sure of that ...

Hope my reply to your question helps you in futher situations ... Just remember you can only be the best you can be ... Love, Caring and Understanding goes a long way ...:redbeathe

NeosynephRN · Mar 6, 2009

I have been part of "pulling the plug" more times than I can count. Usually it is not just the pulling of the NGT, but the vent and drips. You can look at it in two ways...you are killing the patient, we have a nurse that feels this way, it affects the way she cares for some patients and deals with families that are going through the hardest decision they have ever had to make! OR you can see it as being a patient advocate, now what kind of life would this guy have?? Would HE have wanted to "live" like this? Are you helping him or is it just "torture" what modern medicine is putting this person through to keep him "alive". I feel that at times I do my best and hardest work with terminal withdrawl patients, being with the families and helping them to understand and holding them up at their lowest moment. It is not an easy thing to do....but many times it is the only right thing to do.

heron, ASN, RN · Mar 6, 2009

The damage from the stroke is killing the patient, not the removal of the ng tube.

Artificial nutrition is basically forcing this person's body to stay alive when it is trying to die ... you have to ask yourself what is gained by prolonging life here and whether it's worth the very real risks of tube feedings.

Death comes to all living things ... we have no choice about that. We sometimes get to choose whether that death will be peaceful/dignified/comfortable or torturous. Seems like that's what this family has done.

morte, LPN, LVN · Mar 6, 2009

The damage from the stroke is killing the patient, not the removal of the ng tube.
Artificial nutrition is basically forcing this person's body to stay alive when it is trying to die ... you have to ask yourself what is gained by prolonging life here and whether it's worth the very real risks of tube feedings.
Death comes to all living things ... we have no choice about that. We sometimes get to choose whether that death will be peaceful/dignified/comfortable or torturous. Seems like that's what this family has done.

you (herron) beat me to it, the disease process is the cause of death.....the NG feeding was polonging the dying, not living. perhaps you (OP) could have a discussion with your mom, about what she wants done, in case it comes to that.....

Cindy-san · Mar 6, 2009

I'd think you were "killing him" if you took a pillow and smothered him.

There's a big difference between "killing someone" and not interfering in a natural death.

All these things, vents, tubes & whatnot are all things we do to stop people from dying when their body is incapable of basic processes of life (like eating, breathing).

Some people don't want these artificial things to stay alive in a bed, unable to move, covered in sores, no control over their excretion, awaiting the next bout of infection which might be the final one, plenty of them not even cognizant of their suroundings, the only response being a grimace of pain when you turn them. It's an ugly picture, but it's reality for many pt's I've had, who've suffered horribly before they died.

In short, no, that's not "killing someone."

Jolie, BSN · Mar 6, 2009

Thanks, heron, for your thoughtful explanation.

I wanted to respond, but couldn't put my thoughts into coherent words.

To the OP, I'm sorry that your mother's words have caused you such heartache. I'm sure she didn't mean to, but people without medical experience sometimes say things that aren't intended to be hurtful to us, but they don't know how to express themselves better. One positive of this experience is that you've had an opportunity to examine your thoughts on the issue of removing life support.

Tait, MSN, RN · Mar 6, 2009

Thanks, heron, for your thoughtful explanation.
I wanted to respond, but couldn't put my thoughts into coherent words.
To the OP, I'm sorry that your mother's words have caused you such heartache. I'm sure she didn't mean to, but people without medical experience sometimes say things that aren't intended to be hurtful to us, but they don't know how to express themselves better. One positive of this experience is that you've had an opportunity to examine your thoughts on the issue of removing life support.

Agreed.

Ruthiegal · Mar 6, 2009

I feel you are NOT killing someone. You are following either their wishes per Living Will or the family wishes after they realize their loved one is gone from them with no hope of recovery. Letting someone die a natural death with dignity is not "killing" them. For me it is more compassionate than letting them live with no quality.

I worked LTC and could tell horror stories of families that wanted tube feedings etc, because they wanted to keep Mom/Dad *alive* even when there was no hope or regaining any cognitive functions. I took care of a young woman in an anoxic coma, who had no brain wave function, but her family believed she would get a miracle and wake up. She lived for 25 years in that anoxic coma. After seeing her decline every day while I worked with her, I decided that I would never want to exist that way. Existence is one thing living is something else. The two are not the same. Life without quality, or awareness, is really not Living. So when you help remove the tubes, you are really being caring and compassionate.

Just my thoughts on the subject.

RD

Dalzac, LPN, LVN, RN · Mar 6, 2009

In 2007 my mother and my sisters had to make the same call about my dad. I hated it but it was the right call. We did the exact same thing for the exact condition small stroke getting better and then a massive second stroke.

My dad lived life to the fullest he loved everyone He was always laughing and loved to meet new people And the one thing we knew about Dad was he would never ever want to be kept alive in a coma and he would have wanted us to DC the NG and everything else quicker than we did. All of us even felt guilty just keeping him on for one day.

As a nurse we have to be aware that sometimes these plans may not sit well with us. And at somepoint we can't do anything else except pallitive care for the patient. And that is when our focus becomes helping the family. If there was no hope for the patient, always be honest with the family. If they ask questions, tell them the answers. Don't give them your opinion. Just truth. And always always be kind.

talaxandra · Mar 6, 2009

A lot of ethical issues in health care can - like removing an NG tube - present like routine tasks, and it's not until someone draws attention to the potential ethical dimensions of the act that we even realise there's more to it. For a lot of nurses, particularly those without much experience, the discovery that they didn't just remove an NG tube (hang a flask of analgesia etc) but participated in a chain of events that possibly hastened a patient's death can be distressing.

Some people (particularly philosophers) talk about the difference between acts of commission (stopping NG feeds) and omission (not beginning feeds in the first place). In either case the real act here is stopping NG feeds and medications, rather than pulling the tube - removing the tube after the decision is made increases the patient's comfort but isn't the act that allows the patient to die. As other members have posted previously, the root cause of death is the patient's underlying disease.

It is this, rather than the fact that the decision was made by the medical team and the family, that is the most important thing to take away from this experience. If you're still feeling uncomfortable, bear in mind that, had supplemental feeding and medications continued, your patient would almost certainly have died in the not-too-distant future, from aspiration pneumonia, a further stroke, or possibly sepsis from a pressure wound - all outcomes more unpleasant and drawn out that terminal dehydration.

Nurses like me, with many years working with patients like these, often find these 'flogging' deaths, where the patient's life is prolonged at any cost, considerably distressing, cruel adn frustrating.