Ethical issue? Treating a 101 year old patient

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Specializes in Education and oncology.

I've been an oncology nurse a long time- over 34 years. For the first time I'm posting on Allnurses because of my moral distress and lack of consensus. I have booked a woman who is 101 years old for Keytruda next week for aggressive head and neck cancer. Her oncologist thinks it's appropriate that she wants treatment and is over the moon that he gets the credit for this new treatment. I believe it's wrong on so many levels that I don't know where to begin.

First- is she able to give consent? Yes. Is she frail and with a very poor prognosis? Yes. Would she benefit from palliative care and hospice care? Absolutely. Do we care about cost and providing appropriate end of life care? Er, not so much. SO when your co-pays and deductives and cost of routine health care go up- I do not want to hear about it. This is an incredibly costly treatment for one who will likely experience very little benefit.

I'm simply sickened and had long discussion with medical/nursing friends over Thanksgiving dinner and got very different viewpoints. Do I value life? Of course! The surgeon weighed in with his "do whatever it takes." This patient is approaching 102 years old and I'm sad and distressed. Thoughts?

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Specializes in Clinical Research, Outpt Women's Health.

If she is mentally competent it should be her choice. If not, just stop.

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Specializes in Education and oncology.

Would love to. As Charge Nurse I can't just stop. Have to plow on and treat. I'm not sure the patient truly understands but her family doesn't want to give up. Really?

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Specializes in ER.

Good God, have mercy on us all.

This is only a very blatant, extreme, and brazenly horrific example of the macabre side of medicine.

Modern medicine seems to have lost its soul.

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Specializes in ER, Pediatric Transplant, PICU.

I totally understand your ethical dilemma. It feels wrong, and is one of those ethical areas thats not warm and fuzzy and doesn't feel good as a nurse to see. I will say this though - you need to have an internal change on opinion or this patient will be very difficult to take care of for you. I say this because you are essentially powerless - the patient wants it and the physician has signed off on it. Is it ethical and right? Maybe not. Does it feel pointless? Sure. But legally, you have nothing to stand on. Its frustrating, yes, but I can tell you from experience that you have to find some kind of peace in this situation or it will nag at you. Perhaps look at it from a perspective of, she's getting to fight till the end and thats what she wants.

Also, this is coming from a peds nurse, so I can tell you that age doesn't matter. Its the same dilemma with an 8 year old that has a huge, invading tumor that you feel is suffering. Its hard, but sometimes finding some sort of perspective that gives you peace is the better approach.

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Specializes in NICU.

You can't arbitrarily decide when a mentally competent woman shouldn't get healthcare. This viewpoint is exactly what scared people about Obama's so-called "death panels." Is it important that we give the patient all the information and do our best to see that she understands the side effects and lack of quality of life that she may get from this? Absolutely. But we can't just decide arbitrarily that because she's 101 that she can't receive care. Her values may be different than ours.

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Specializes in Nephrology, Cardiology, ER, ICU.

Very difficult to stomach in the face of what we know will be the inevitable outcome. I'm sorry.

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The situation you are facing is one I have faced more times than I would like. We talk about waste in the healthcare system, but refuse to start in the most obvious places. I've aided in spending hundreds of thousands of dollars stabilizing 70-80-90 something year old's with terminal diseases (insured and uninsured). Years ago, I cared for a 93 year who had a pacemaker put in, who ended up coding twice in surgery, then being placed in ICU for 2 weeks then dying. Yet I still have to grin through discussions about should we or should we not turn away a pregnant immigrant having concerns because her prenatal healthcare only covers a certain number of visits. I have to keep quiet and turn a blind eye and sometimes pretend I didn't hear a lot of things. There are so many gray areas in healthcare and it can sometimes leave you speechless.

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Specializes in Hematology/Oncology.
babyNP. said:
You can't arbitrarily decide when a mentally competent woman shouldn't get healthcare. This viewpoint is exactly what scared people about Obama's so-called "death panels." Is it important that we give the patient all the information and do our best to see that she understands the side effects and lack of quality of life that she may get from this? Absolutely. But we can't just decide arbitrarily that because she's 101 that she can't receive care. Her values may be different than ours.

Exactly... there is one flip side.

There comes the financial ethical dilemma of who is paying for this. I think Keytruda goes for 6-8k a pop. Although I'm not completely sure

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I am faced with ethical dilemmas at work almost every day. I feel your pain.

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