Ethical dilema - cancer pain

[mlew]

Recently I was at clinical and was assigned a 50 something patient with cancer. She had increased weakness and didn't speak much at all. Her facial expressions and vital signs showed she was in obvious pain. She had pain medication ordered for every hour PRN. What really frustrated me was that everyone looked to her son and asked his permission when to give her pain medication, when she could have something to drink etc. It was frustrating to me to see this patient in pain and the son not wanting us to give her pain medication because he didn't want her to be "out of it" all the time. When is it appropriate to go above the families wishes and care for the patient? No where in her record did it state that the son was the power of attorney or in charge of her medical care. Has anyone else been in this situation? What was done regarding the situation? What would you do in this situation?

[mlew]

Thanks - I hadn't thought of that. That is something I will make sure to think about in the future.

[mlew]

Thank you for the information. I know that the son and family was educated on several occassions by myself and other nurses regarding the need to stay on top of his mother's pain. I discussed with the doctor and he thought the family was in a state of denial. I think that social work and family education was still needed to assist this family with their concerns. Thanks!