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

stta11 · Apr 2, 2011

What this article fails to mention is that Terri was placed on heavy doses of pain medication for comfort.

Correct... Pain medication makes this situation less 'barbaric' as you mentioned earlier. I guess to bring this whole issue back to the original point is that removing Terri's feeding tube and removing the feeding tube of anyone in a like situation is indeed "killing" someone. The only way you could rationalize otherwise is if you think people in a PVS are dead.

Dehydration is what killed Terri. She was unable to provide nourishment for herself, she was not brain dead, her feedings were providing benefit that outweighed any existing burden and that nourishment was taken away and it killed her.

That being said I do see how people will disagree and I do appreciate the idea that you would not remove a feeding tube in this situation without an order for proper sedation and relief. I am sure families and patients would be very grateful as well. If I was Terri's nurse after the feeding tube was removed it would be a priority for me as well. But, while that reduces the 'barbaric' nature of the act it doesn't change what is ultimately happening.

BluegrassRN · Apr 2, 2011

Yikes... I don't remember bringing up a situation in which a patient was dying from aspiration pneumonia.

Well, when someone in a weakened state can't digest the formula being shoved down their gullet, vomiting and aspiration follow.

stta11 · Apr 2, 2011

Well, when someone in a weakened state can't digest the formula being shoved down their gullet, vomiting and aspiration follow.

Well that would fall under the category of a legitimate reason to consider removal of a feeding tube. Why would you assume I would think otherwise?

steelydanfan · Apr 3, 2011

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.

Actually, I think that the OP's mother expressed a sentiment that a majority of people feel; which is simply a total ignorance/refusal of death. Americans, somehow; cannot deal with or face the fact of death.

Until this cultural denial is addressed, (And I think Obama's medical insurance plan made a BIG attempt), we are faced with LOTS of ICU beds filled with 90 ear olds in ESRD undergoing futile proceedures. It's no longer about saving lives, it is about no one wanting to stop futile care until Grandaughter Jennie feels "okay" about it.

BluegrassRN · Apr 3, 2011

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.
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.

Because you wrote this, and you felt so strongly about it that your revived a death thread to state it.

madwife2002, BSN, RN · Apr 3, 2011

Please stay on topic and discuss your opinions in a professional and dignified manner

Remember personal attacks are not permitted

BluegrassRN · Apr 3, 2011

Please stay on topic and discuss your opinions in a professional and dignified manner
Remember personal attacks are not permitted

I'm not sure if this was directed at me, but since the poster asked me a specific question, I answered it very specifically. I'm sorry if that was out of line or against the UA. I wasn't attacking, just being very specific (and I'll admit, in my first post a little sarcastic).

madwife2002, BSN, RN · Apr 3, 2011

No dont worry it wasn't directed at any one poster :-)

BluegrassRN · Apr 3, 2011

Okeydokey, I appreciate the feedback! Sometimes it's difficult to tell when you're online...

Horseshoe, BSN, RN · Apr 3, 2011

I usually read through all responses before replying, but don't have time this morning. Sorry if I'm being repetitive.

Tell your Mom that an NG tube is not appropriate for long term placement. The tube would have had to be removed soon even if all efforts to prolong this man's life were going to be made. The tube can cause damage to the nasal passages and esophagus if left in too long. Pulling the NGT had nothing to do with causing his death; the deciding factor in a literal sense is not the pulling of the tube, but the decision to not replace it with a more permanent solution.

PMFB-RN, RN · Apr 3, 2011

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.

*** First of all as you get more experience you will learn what about your job should not be shared with non-medical family and friends.

Second there is a VAST difference between allowing nature to take it's course and killing someone. In my unit withdrawing life support measures like IV, ET, NG, pressors and allowing the patient to die is done all the time. We do it once or twice a week. I assisted our medical director with writing our withdrawl protocal.

You guys absolutly did NOT kill that patient.

stta11 · Apr 3, 2011

Because you wrote this, and you felt so strongly about it that your revived a death thread to state it.

I feel like you aren't seeing something i wrote in my original post. "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.'"

I feel like that adequately covers your example of aspiration pneumonia...

I should retract some of that initial statement, and feel I kind of already have, because I have admitted there was a critical piece of information that the poster left out of the original post that I missed later on in the thread. It seems like the patient in this example was not tolerating his feedings. Besides that I don't think me saying that removing feeding tubes is 'not necessarily always an okay thing to do' is something that suggests I feel all people with feeding tubes need to suffer through things like aspiration and its resulting consequences.