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.
Specializes in Oncology/Hematology, Infusion, clinical.
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.
All I can say about this post is that I wholeheartedly disagree.
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?
Yeah, because dying of aspiration pneumonia is so comfortable. Thank you for your ignorant, useless contribution to a 2 year old thread.
No, it isn't killing someone. It is allowing nature to take it's course, which we should do a hell of a lot more often IMO. Further, you should have been allowed to remove it. How, praytell, could you possibly have harmed him? That nurse was an idiot.
oops, just noticed this thread was bumped after 2 years. please disregard, lol.
Specializes in Med Office, Home Health, School Nurse.
My husband and I were in a similar situation when our 11 week old son was placed on life support in 2008. He was hooked up to every machine known to man for 5 days. After the first couple of days, we knew that he wasn't going to recover, the doctors had told us he was 99.6% brain dead and would never recover. They told us we would have to eventually pull his life support and let his body die in its own way. His organs had already began to shut down and his body was dying anyways. As a nurse, I knew that the support had to be pulled, that we were just prolonging meaningless suffering, even though he couldn't feel anything or respond at all. As a mother, I would have taken my baby home just like he was, hooked up and all and taken care of him forever. I didn't want to unhook him because I didn't want him to die, but I couldn't leave him in the state he was in. He had fought the fight he was meant to fight and he couldn't hold on any longer. That was the toughest decision I've ever made in my life and the worst 5 days of my life that I could ever imagine. It was even worse for me because the nurse in me was battling the mother in me and vice versa.
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.
Well then explain a few instead of just saying I am wrong.
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.
Thank you for pointing that out, I missed it initially since it wasn't part of the information given in the original post... should have kept reading.
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."
I am glad you bring up this point. Because I think a lot of people consider it to be that way. I am in no way suggesting that brain damage wasn't the real underlying medical issue. Terri was unable to feed herself and the people who were feeding her before stopped and that is why she died. The medical examiner said "Shiavo died from dehydration." Thus, dehydration = cause of death.
Providing food and water in a situation like this is basic care like turning patients and providing warmth. I am not saying its always wrong for a patient to die from dehydration, but if someone dies in the manner Terri Shiavo did... I am saying I think that is wrong.
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.
I hope you do realize that I am not suggesting "we must keep people alive at all costs." It seems I am being painted with that brush. I think it is wrong to keep people alive "at all costs."
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.
Agreed
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.
No one wants to have to endure what Terri Shiavo and their family had to endure, but I don't think it is acceptable to remove the feeding tube in that situation.
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.
annister
94 Posts
All I can say about this post is that I wholeheartedly disagree.