ethical problem... need opinions

[txspadequeenRN]

I have a situation at my job that I do not feel comfortable with and I would like to get some opinions. I have a patient and he has a G tube and we were giving him feeding 5 times a day. He gets up in the W/C daily and rolls himself around, seldom starts conversations but will talk to you when you speak to him. About 10 months ago he went unresponsive and when I spoke to his family about either sending him out or getting labs at the facility and seeing what happens their response was "Oh what ever he needs lets do it". Then he started coming around and everything from there was ok . He was back to being himself. His family seemed so caring and concerned. Now Im going to fast forward to present time and 3 weeks ago I come to work and his feedings have been cut to 2 times daily and they are giving him pleasure feedings. Now this to a geriatric nurse seems like a progress in the right direction except.... His family requested he be put on hospice and allowed to die naturally. He has had NO change , no decline. They have made the commit to the staff.."We want him to choke and die". They say he has no quality of life and death is the best thing for him. I am very uncomfortable with this situation and find it unethical. This man still gets up and can hold a short uncomplicated conversation with someone. Their reasoning also could be financial but I feel bad for this man. They never come to see him but have always been gung ho for "getting whatever he needs". I just want some other insight here. I feel for this patient but also wonder where I stand in the ethical/ legal part of this.

[achot chavi]

Thank you for all your replies. I have been let go from my job after 5 years for no reason and my point here is I will not be able to update ya'll on this case. I look everyday for a obit for this man and hope someone had the sense to listen to me and get some help for this man.

I'm really sorry about your job situation and I'm sure that you'll find a better one more suited for your talents and strengths, beleive it or not it usually works out that way- keep us posted.

a peice of advice- move on, there is nothing that you can do for this precious soul anymore, you are no longer his nurse. Don't check the obits everyday- it won't help him or you, When I left a job ( for good reasons) it was very hard to emotionally just stop caring for my patients- it isn't a spout you can turn on and off at will. If you want to continue with your career- just make a clean break, let the family and facility deal with it and turn your attentions to your future.

Lucky are the patients who are destined to have such a caring and empathetic nurse!! Lucky is your child for having you as a mother!

[twotrees2]

What a pickle, I really feel for you and thank g-d there are pt advocates like you out there. I've been in similar situations but they've never turned out the way I'd have liked. We had one Alzheimers Patient who stopped eating (He forgot how to swallow and any foood put in his mouth just dribbled out). The family (and POA) refused a N-G tube or a G tube. We had no choice but to try feeding him and get in fluids through an IV\or subcutaneous drip). He died a couple of months later on the eve of his grandsons wedding. 2 days before he died the frantic family realizing what they did- asked if a n-g or g tube could be put in but it was too late. He trully suffered and it broke all of our hearts. We got Zero support from ADM. The SW tried to be helpful but claimed her hands were tied.

If there is any way to educate this family I guess you have to try or ask the SW to get involved. Try to do it with the support of your supervisor.

Bottom Line is...See the Serenity Prayer!!!!

i think its a personal call - my living will is very specific - i have alzheimer's and know no one and cant eat i do NOT want a tube to keep me alive - keep me comfortable do not feed me to keep me alive. i do not wish to live like that - i work with alzheimer's residents primarily - its so sad - they aren't there and do not know anyone or have any quality of life - my whole family has the same views and we have made sure it is written down so that it is followed. it isn't our call to want to keep them alive even though we get as attached to them as family ( at least i know i do ) we have to learn to let go which is the hardest thing. noting sadder than someone laying around living only by a tube feeding and then usually the family even rarely makes a token visit - other than to say "keep them alive - for what?? so we have enough residents to keep our jobs? id rather loose my job cause the residents die with dignity and in comfort and there are not enough residnets there for me to work than have them kept alive for them to have no quality of life. just my opinion here.

[dream'n, BSN, RN]

Years ago, I had a resident once in a sort of similiar situation. She had swallowing issues and even though extra care was taken, she would get aspiration pneumonia several times a year. Well the Dr., administrator, head nurse, and family all had a pow-wow. The next thing you know, they make the patient NPO! NPO until death! Awful, awful, awful! As long as I live, I will never forget it.

[medsurgnurse, RN]

Thank you for all your replies. I have been let go from my job after 5 years for no reason and my point here is I will not be able to update ya'll on this case. I look everyday for a obit for this man and hope someone had the sense to listen to me and get some help for this man.

I am sorry to hear about the loss of your job. Why do we keep hearing over and over about good competent nurses with a brain and a heart being let go? At least your conscious is clear, you did try to help the patient.

[bethin]

Sorry to hear you lost your job. Sounds like you really cared about your patients. It seems like whenever we speak our opinions we get backlash.