I am a nursing student and at my patient the other day at clinical was comatose, after a stroke and has been in the same condition for several weeks now. The nurse told me he was being place on hospice and the doctor ordered removal of his NG tube and d/c's most of his meds. I was going to remove the NG tube, but the nurse became uncomfortable because I hadn't done it before, so she did it herself. So while I realized basically what was going on, I clarified with my instructor . . . he now has no feeding tube, and he has no IV fluids going in . . . obviously they are going to let him die. I was talking to my mom on the phone later on and mentioned the situation, and she said, "I'm so glad you didn't kill that man", meaning I didn't remove the NG tube myself as I was going to.
IDK, I really hadn't thought about it that *I* would be killing him by doing that . . . first, the family made the decision, then the doctor gave the order . . . but I guess I can see her point.
Just curious how other nurses feel and deal with situations like that.
I don't see "pulling the plug" by any means a way of killing someone, but I think of it as setting them free to go as nature and God intended. It's okay to be sad when you witness or assist with someone being removed from life support, as it is a grief stricken process for the families (and sometimes staff) involved. But for that pt, who will never resume being who they used to be, you have given them the way to no longer have to suffer, to no longer be bed bound and unable to enjoy life. Death is not always a bad thing, sometimes it is the best thing you can do for your pt.
this thread permits me to say my peace at this time as recently as this week i have been on the other side of the fence so to speak. My husband went into the hospital on the 12th of february, ended up being intubated early in the morning of the fifteenth he went into respiratory failure and spent the most horrible last three weeks of his life. He was intubated and extubated a total of three times, was on a vent off the vent, then back on the vent finally an order was written do not intubate he was placed on a bipap for the last five days he was off the vent had an ng tube, foley catheter, rectal tube, and central and arterial lines everywhere i saw him for the last time alive on sunday for the one hour of visitation between 5 to 6 pm i witnessed him being intubated for the first time ( In 25 years as a nurse i had never experienced that) i still have nightmares about it thursday he was made a dnr and they pulled the bipap and ng tube and started the morphine eventually ativan was also given he passed away peacefully this morning about 830 am. I was the idiot who wanted to keep him alive because i was so selfish to let him have his dignity. I should be ashamed of myself for being that way. Until i saw for myself how much he really was suffering god placed a heavy burden on my heart it was released this morning when the love of my life passed on so peacefully. do i feel pulling the ng tube and the vent off killed him no it allowed him to die with dignity and gave him peace forever. tigger
Tigger, love makes us do strange things....don't beat yourself up over it. You did what you had to do, and in the end you made a difficult decision based on love. No one could ever ask anyone to do more than make a heart decision. You did good. Hugs to you, dear.
I apologize for responding to this post more than 2 years after the question was asked. Maybe no one will read this anyway.
I am not surprised by the number of people who feel that the removal of feeding tubes is not "killing someone." Obviously the direct result of removing a feeding tube is not immediate death. Removal of medical interventions is often seen as allowing an individual to die and that is a compassionate and beautiful sentiment. Here is the issue we are talking about though... the removal of a feeding tube is NOT what people are making it out to be in the initial post. Removing a feeding tube in this case is NOT necessarily allowing the disease to take its course and allowing the person to die. It may actually end up being the DIRECT or contributing cause of the patient's death. That is what would make it wrong.
To wade through the ethical issue you have to ask yourself what the purpose of the feeding tube and the IV fluids is? To provide nutrition and hydration to the patient. If the patient can still assimilate his tube feedings by removing them you are unnecessarily starving the patient and the only purpose of removing the tube is hastening their death. That runs contrary to the purpose of nursing and what is in the best interest of the patient
Allowing the patient to die would be removing the medical interventions that are being used to counteract the direct cause of the illness. Medications, mechanical ventilation, CPR (in the event it is needed) are some examples of what can be foregone to allow the patient to avoid the unnecessary prolongation of death.
If a patient can assimilate their feedings it is cruel to deprive them and allow starvation to hasten their death.
The is why the Terri Schaivo case was such a big deal. There was no underlying disease that killed her, she starved to death.
ALL this being said. Feeding tubes are often removed because they are no longer providing any benefit (nutrition) to patients and they are actually the direct cause of additional suffering to a patient beyond what is reasonable. This is when removing the tube is ethically 'right.'
So to the original poster: Your mom was most likely overzealous in her response. However, it is very possible that what your nurse saved you from doing that day was saving an action your performed from being the direct cause of that patient's death. You may never know if that was the case but does that make it right? Maybe the underlying disease was the cause of that patient's death, but did the nurse's action cause the patient to suffer unnecessarily during their last days on earth? These are the questions you have to ask when removing feeding tubes.
^^ they say no question is a stupid question... are you a nurse? are you even in nursing school?
if you are, then you should be well aware that using an ng tube is what can cause pain and suffering for a dying person, not removal.
the dying process is not overly complicated, but you have to understand the progression of events to be facts.
bowel function and motility essentially cease, hunger and the need for food is absent. the body is dying, and organ systems begin systematically shutting down.
terri shiavo case made me immediately write a living will. i would not want to live like that just so my family can see me half grin at blinking lights from toys they shine in front of my face. i do not want a feeding tube, and that is my choice. i also do not want to be kept alive in a vegetative state-everyone around me knows of this.
we are not terri's husband. i do know that my husband knows of my wishes, so it is not a stretch to assume he knew of her wishes, imho.
Post #29 is factually incorrect on so many levels I don't even know where to start ...
I can only hope that my suspicion that the poster is not a nurse or other clinician is correct ... and therefore this person will never be taking care of me or my family.
I used to think that pulling an NG tube was the most barbaric thing that could be done to someone that was dying...mainly because of the dehydation factor.
Typically, pain medications or a drug-induced coma is introduced until the body ceases to function.
I personally, would refuse to participate in the pullling of one unless an order was written for such.
Specializes in private duty/home health, med/surg.
From the OP:
And he wasn't tolerating the feedings well, his abdomen was very distended and firm. I'm sure that had I been fully thinking about the situation, I still agree with removing the NG tube. And I told my husband I would want the same thing done if it were me.
Obviously this patient could NOT "assimilate the feedings." This patient's body was shutting down, and the feeds were most likely going to end up causing more problems.
Also, Terri Schiavo's autopsy confirmed that her brain had severe, irreversible damage -- I consider that a pretty significant "underlying disease" that ultimately caused her death, NOT the removal of a tube that was artifically prolonging her "life."
So many misconceptions from medical people who SHOULD know better...so take the time to learn, those of you who feel that we must keep people alive at all costs and we are killing them if we withdraw nutrition and hydration.
If someone is dying and their bodies are showing signs of not using food, the LAST thing they need is to be filled up with fluid and artificial nutrition so that they can choke on the fluid filling their lungs and wallow in their own diarrhea. If your patient is as thin as a match stick, has fluids and nutrition, and is constantly having stomach pain and diarrhea (I just had one like that) the KINDEST and most HUMANE thing to do is to discontinue fluids and feedings. The physiology of dying is such that dehydration and lack of intake actually cause a natural cascade of endorphins in the brain that help ease the dying process. It is horrible to watch someone die when we fail to withdraw what only causes more pain and misery. After a certain point it becomes torture.
Terri Schiavo is obviously a different case. It would have been good if she had made her wishes widely known. But what quality of life did she have? She had no higher brain function and was alive in the strict minimal definition of the word. But how many of us would want to be alive like that? I sure as heck wouldn't. But if someone wanted to be, then it should be done.
What was even more sad in the Terri Schiavo case is that she went for years in a PVS after they realized that nothing that they were going to do was going to make her better, then her parents claimed all these "treatments" were going to help her after her husband wanted to withdraw life support.
I always disagreed with the way that the media portrayed her husband. He had a right to get on with his life when it became obvious that she was not going to get any better, however, if he claims were true (and I don't want to get into a debate about this here)..that the reason he did not divorce her was to be sure that Terri had a dignified end of life that her parents would never give her and the only way he could guarantee it was to stay married to her..I cannot disagree with that measure...and would have done the SAME thing.
RNMom2010
454 Posts
I don't see "pulling the plug" by any means a way of killing someone, but I think of it as setting them free to go as nature and God intended. It's okay to be sad when you witness or assist with someone being removed from life support, as it is a grief stricken process for the families (and sometimes staff) involved. But for that pt, who will never resume being who they used to be, you have given them the way to no longer have to suffer, to no longer be bed bound and unable to enjoy life. Death is not always a bad thing, sometimes it is the best thing you can do for your pt.