ethical situation

[boid_86]

He was in his early sixties. He had been in a traffic accident and had come to us for rehabilitation. He had a nasogastric tube in. They wanted him to have a PEG (percutaneous epigastric tube). He realised that he would never be able to swallow anything again. This was because he had a stroke after his accident and was very limited in his self-care abilities. He also wasn't able to speak very well at all, but with a lot of effort he could write what he wanted, he was just able to do this. He had a much younger wife.. He said--or actually he wrote (because he couldn't really speak)--that he didn't want any intervention of any kind. No PEG, and no resuscitation or any other treatment if he had another stroke. But she (his wife) desperately wanted him to have every treatment possible. He (the patient) was begging the doctors and begging us not to have anything done. But the doctor wouldn't put a no-CPR order in his medical record. Wouldn't agree to it because the wife didn't want it. It was a horrendous situation. He (the patient) would write little notes to us saying things like "please no tube" and hold them out to us and put them in our pockets. Even though he had a stroke he appeared to be as mentally alert as you or I. The doctors said his quality of life wouldn't be too bad. He would go to a nursing home and be looked after and fed through the PEG. He would possibly be able to live for years like that, if he didn't have another stroke or something. He would write to his wife that he loved her but he didn't want to live like this. He would get really angry that he wasn't being listened to, and try to express himself verbally but couldn't, and she would sit with him and cry and say she couldn't let him go. It was such a stressful situation for everyone, the nurses were all so upset about it, but what could we do?"

[ceridwyn]

I feel for all of you nurses faced with this situation. It must be very hard, when you get to know people in rehabilition far more than you do in acute situations, so that you can just flick the surface and not be involved as much.

-some points to consider, though I am no expert,

-not sure if they can insert peg without client consent

-don't think they can remove naso gastric without court order

Is not a social worker involved here? They can make life so much easier for the client his wife and the staff.

Give them time to adjust..how long has it been, knowing the acute hospitals these days it might be only a week or so.

Insist on social worker involvement, they can contact others, like a solicitor, provide /organise conselling for his wife and get support for the staff.

[carolmaccas66, BSN, RN]

'His quality of life won't be too bad, what with sitting on his bum in a nursing home, being fed through a (probably) dirty tube, developing pressure ulcers, becoming obese, being bored to death and being talked to like he's an idiot'. The doctor that said this knows nothing about human life or caring for patients, though he/she was probably trying to be solitcitious and caring.

The patient will have a crap quality of life, and he knows it. I've nursed them in these places - I've seen their pleading eyes, saying kill me, before I have to spend another day in this hell hole. It's no way to live your life.

He has had a CVA. If he can still communicate, he can still state his wishes to the SW and other staff involved in his care. His wife can't just refuse care or the doctor - it is not their call. The SW should contact a solicitor, or contact the hospital solicitor/ethics committee. You cannot, under the law, force care onto anyone without THEIR rational consent, and he appears ratoinal from what you say. You cannot force anything onto a patient who has dementia even, even if it's a medication the need. People have rights under the humane court of law.

He can communicate rationally. He can refuse care and if I was his nurse, I would be telling him this. Forcing care onto someone is considered battery and you can be prosecuted for it. I'm surprised the doctor refused the patient's request for no life saving measures.

As his nurse, I urge you to be a strong advocate and tell everyone they cannot refuse or force care onto this patient. He knows what he does & doesn't want. It's hard being an advocate, but I've seen other nurses do it.

I feel very stronlgy re this, as I was told I would HAVE to force a lady partsl pessary into a demented woman one night, who was kicking, screaming & biting everyone. She did not want it and I absolutely stood my ground & refused to give it to her. She has rights like everybody else, and forcing a medication/procedure onto someone smacks of Nazism, in my opinion. We SOOO don't want to go there again!

[carolmaccas66, BSN, RN]

I feel for all of you nurses faced with this situation. It must be very hard, when you get to know people in rehabilition far more than you do in acute situations, so that you can just flick the surface and not be involved as much.

-some points to consider, though I am no expert,

-not sure if they can insert peg without client consent

-don't think they can remove naso gastric without court order

Is not a social worker involved here? They can make life so much easier for the client his wife and the staff.

Give them time to adjust..how long has it been, knowing the acute hospitals these days it might be only a week or so.

Insist on social worker involvement, they can contact others, like a solicitor, provide /organise conselling for his wife and get support for the staff.

Excellent answer Ceridwyn. The wife needs a lot of support by the sounds of it.

Carol