Ethical dillema

[twister431]

I have a class project due and would like to get some feedback, espcially those in hospice care. Here it is.

The doctor has an order in for increased dosages of morphine for a terminally ill patient, her resp are 4 to 8 per minute. I think that increasing the dosage anymore would kill her and the order should be clarified by the doctor. I also believe by increasing the dosage would be unethical because it would be Practioner asisted suicide. Am I on the right line of thinking or no.

[mskate]

hrm... why did he increase the dose? did she appear to be "air hungry"?

[twister431]

this is a class project and gives no information other then her stated intentions by health care directive, but does that make it right.

[ghillbert, MSN, NP]

Does she have pain? That is the primary reason for giving morphine - if she was in pain, I'd give it regardless. It is NOT "assisted suicide" if you treat her pain and a side effect is respiratory depression in a hospice patient.. IMHO, of course.

[Batman24]

It could be given in higher doses for pain relief to keep the patient comfortable. I would find it unethical not to give additional morphine to a dying patient in pain.

[heron, ASN, RN]

OP, I'm with the other posters. The info given is insufficient to make an ethical choice, because we don't know why the dosage was increased.

Hospice operates in these situations under the principle of unintended consequences: a measure is ethical even if it shortens the patients life if the underlying intent is to relieve suffering. Patients can still experience pain or air hunger even with a slow respiratory rate. You cannot make an ethical decision here unless you have information on what's going on with the patient at the time of the dosage increase.

[twister431]

After recieving her last dose of medication she has lost consciousness and is unable to communicate. They give no information on non verbals like squirming around or grimacing.

[heron, ASN, RN]

After recieving her last dose of medication she has lost consciousness and is unable to communicate. They give no information on non verbals like squirming around or grimacing.

Then you can't make an ethical judgement here.

BTW, I don't follow the assisted suicide thing ... do you know whether the patient has had suicidal ideation in the past or has she asked for terminal sedation? Assisted suicide and euthanasia are different things.

[leslie :-D]

as others have indicated, we address/treat any signs of pain/distress, regardless of resps.

but if pt seemed comfortable and relaxed, yes, it would be unethical to administer more morphine in absence of any suffering.

leslie

[truern]

I've given morphine knowing each dose could be the last, but if the patient is terminal and in pain it's unethical and inhumane NOT to.

JMHO.

[twister431]

Thank you all this information is very helpful

[ghillbert, MSN, NP]

If this is an ethics assignment, I'd say you just have to address the issues. Balancing the needs of the patient to have their pain relieved with the need of the nurse not to overdose her. There is often shades of grey in ethics, and you don't need a "right" or "wrong" answer to do the assignment. It's okay to say "given the information, it's not possible to decide.. these are the things I would assess prior to giving the medication..." As assignment is usually intended to make you think about the issue.