dying with dignity

KaroSnowQueen, RN · Jan 13, 2003

I agree. I am not in favor of euthanasia, BUT I think as health care professionals, people, especially the elderly, their families, as well as those with chronic illnesses need a strong, strong, strong educational drive about end of life changes, living wills, advance directives and making their wishes known.

I personally have told my family I have two parameters about deciding my health issues if I am not able. "Will I be able to read a book on my own power??" and "Will I be able to drink a Coke?"

Now I'm sorry if someone thinks this is superficial, but other than interacting with my family, drinking a Coke and reading a book are my greatest happinesses in life and if I can't do those,without someone else basically doing it for me, I probably won't be able to interact in any meaningful way with my family. So I say if the answer is no to those two things, then pull my plug!!!!

And so far as your patient refusing meds, food, withdrawing from life. In my experience refusing food in those who aren't deeply depressed, is a clear sign of the beginning of the end. Ask any LTC nurse and she/he can tell you so. And the government and uninformed families force food on these patients to the point of feeding tubes forcing food into bodies that want to go, but have to work and process the food. To me that is cruel and unnatural.

Americans overall, have a great fear and distrust of death, and we go to unnatural lengths to delay it. Including full code orders on patients with terminal, clearly terminal diseases. I am with you. I see these orders and I think WTF is going on in these people's heads??????

I will stop now as I could rant for sixteen pages on this subject, it makes so angry.

kids · Jan 13, 2003

Originally posted by burntnurse
...i've recently had a patient who refused meds and freguently food, she's withdrawn and clearly just wants to die.
BUT her family keeps signing "full code" orders. wtf is up with that? someone is clearly dropping the ball.
if a patient choses to not seek further treatment and die shouldn't that be their right?...

Is this lady in ANY WAY compitent to make her wishes know...even by responding to yes & no questions by any means? If she is then WHY TF is anybody...family or not being given the option to sign any code status paper work on her? Even a DPOA or POA/medical does NOT have the right to go against a patients expressed AND documented wishes...and the DPOA-POA/med can ONLY fulfill the acts/deeds that the patient can not.

I have seen some pretty severly demented patients be interviewable...they may not know what year it is or where they are BUT many do understand the meaning of CPR/DNR when it is explained to them in very simple terms.

Sounds to me like Social Services and the Doc need to quit pandering to the family and sit down and actually interveiw the patient.

cargal · Jan 13, 2003

This is why I went into Hospice.

Little One2 · Jan 13, 2003

It is hard for family to deal with their loved ones dying. Families need to be better informed.

As long as the patient is competent to make decisions, the patient's wishes should be followed. Especially if there is a will.

There is a lot of politics involved. It is a complex issue.

burntnurse · Jan 13, 2003

thanks for your input everyone. i know its a complicated subject. but the problem is #1 the doc's don't seem to have the jewels to go against the families or even speak frankly with them. #2 social workers seem to bring their own religious and moral beliefs to work with them, at least in this case. #3 hospice is very very underused in nursing homes in this part of the world and #4 call me crazy but i think the homes like things the way they are because it keeps their beds filled. who cares about the feelings or welfare of the patients.

i do feel that there needs to be more education. i've already submitted a class proposal to "the learning connection" a local adult education orgainization. i want people to know the difference between sudden death and dying; just what "extreme measures" entails; and, most importantly, that they need to put their wishes in writing and pound them into the heads of their families. any ideas or info on these subjects welcome.

mageean · Jan 13, 2003

I believe more use should be made of the Advanced directive (Living will) where people can make their own INFORMED choices in this matter and also consider decisions re resusitation. Open, honest discussions with the Elderly and their family with Health Care Professionals is the only way to deal with it.

Tookie · Jan 14, 2003

I agree - If people can make their thoughts known with a living will and what they want in advance to ALL of their relatives then maybe - just maybe theres a chance to die with dignity and choice.

it is no wonder that many people fearful of their possible outcomes choose to take their lives often in a way that is not an obvoius suicide - ie car accidents etc.

As nurses we are advocates - we must be their not only to support their wishes what ever they may be if we know them but to also recognise that sometimes medications such as antidepressant are an option - and may in fact be a useful tool if not tried before.

We recently had a lady who has a chronic lifelong arthritic condition condition she has isolated herself and has been quite manipulative of her family -(unmarried) due to her limitied mobility has had a series of large wounds requiring care - result of a number of her medical conditions - it had been very difficult to control her pain etc.

Her wounds are improving - but so to is her pain management and her humour - she isnt talking about death any longer or ringing the family to 'wait' on her - The reasons

Firstly good wound management and yes pain mangement but also she has now been on an antidepressant for over a month- her anaelgeasia is being reduced, Previously she has gone through the cycles of the wounds whereby they improve and then break down after a number of months - but the main change overall is her mood she is happier - more content.

Burnt nurse - I understand a fully appreciate what you are saying.

in our role we must advoacte what is the best for our resident / clinet/ patient - but we also need to ensure that we try options this may be to introduce a drug or in fact to cease all drugs.

I hope this has mad sense. - its getting late now - must go to bed.

Tookie

cargal · Jan 18, 2003

burntnurse stated:

but i think the homes like things the way they are because it keeps their beds filled. who cares about the feelings or welfare of the patients.

I agree. I just recently heard of a nurse who received a three day suspension day suspension for mentioning Hospice as an option to a patient or their family. It has been my experience that residents/patients that are worn out and do not wish any further treatment are relieved to talk about end of life issues. We have even seen improvement in health and well being after being on hospice. Perhaps the emphasis on quality of life and the start of the dialogue about issues that were previouly skirted enhances the last months or years.

Our society hides from death and tries to delay it at any cost. Does someone know the percentage of medicare or healtcare money spent on the last months of life?

RockiNbarbi · Jan 29, 2003

Death is the natural enemy of the healing science....

That said, this topic puts everyone in a difficult situation. I have viewed several situations on a medical floor where the families have overridden the patient and demanded whatever was necessary to keep them around. People have to seriously and clearly state their advance wishes while they can, in order to prevent this from happening to them.

sandyth · Sep 13, 2003

I dont know how the rest of you feel about the elderly dying, but I have actually sat in their room with them and held their handbecause the family was no where to be found, and I dont think anyone should die alone. Theres too many people in this world for people to die all alone.