Futile Care. Dead is dead.

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One of the most challenging ethical dilemmas for me. I just HATE participating in it. We get so many patients in the ICU setting that prove to us in so many ways that it is JUST TIME TO DIE! But no, for whatever reasons ie: Doc is a super god..saves everyone, doc is too wimpy to call it to a stop, families running the show and docs letting them...and other various reasons, we get to come to work everyday and poke and prod these poor souls. Costs the system alot of money too. I don't go home feeling like a good nurse when having to do this. In fact I feel really bad. I am pretty aggressive about it and corner these docs and families for a "chat" to help bring some reality to play, but sometimes have to get ethics involved to make any headway....docs don't appreciate it either. But geez people...we are maintaining dead or dying people with all the bells and whistles, for weeks on end. Can't we just let people die when they ARE. Treat pain and suffering....not cause more. Never a good day when you get to work and the buzz phrase on the unit is "I see dead people"

:angryfire

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...as doctors can be the worst offenders. I've heard doctors tell families "I could have saved her but she gave up on me'. The God complex at its worst. :(

ditto ditto ditto

one of my biggest pet peeves... :angryfire

i see so much needless suffering because of this God complex.

sometimes i would like to have them as a critical patient for one week.

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When my grandmother was dying, my grandfather only waited long enough for us to get there (about 12 hours.flying cross country) and then we made the decision to pull the plug. We never could have let it go on....we even had other family members on the way and we didn't wait for them. It just wouldn't have been right.

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What a fantastic discussion. I have two stories to share.

My husband's grandfather was in great health, had DM but was well controlled but told his wife that if he were to stroke out or end up on a vent, that he wanted to be let go. Just a few short months later, at age 75, he had a masssive strok and as put on a vent. She called everyone and asked everyone to be there on Sunday as they were going to pull the vent (48 hours from the phone call). We all flew, drove, walked to the hospital and on Sunday morning, we gathered around the bed and held hands and touched his grandfather and the doc pulled the vent and we all said our good-byes. It was the best way to go that I had ever seen. He looked at us and smiled and closed his eyes and stopped breathing. No doubts, no regrets. It was an amazing experience.

Second story, my own grandpa began having strokes and everything else about 7 years ago. My grandma (who is a retired RN) will NOT let him go. He has been in and out of hospitals, homes and such. He is now home with her (complete vegetative state, feeding tube, etc). Yet she tells me to not let this happen to her. Hello? If you don't want it for you, why do you want it for him? I don't get it. It kills me to see him there. I KNOW he would not want it this way. Yet, when his RR is 5, she's calling 911. I just don't understand.

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No we need to educate the public and in particular the relatives so that ICU is not seen as the drama queen's dream - think on all the soap operas. Days of our Lives and Muma Mia has just been admitted to ICU - there she is still in immaculate make-up and hair styling lying oh so tragically on the bed while the family gather round and express regret for every harsh word they have ever said.

Sadly for many people this view of ICU is the only one they have encountered so "life at any cost" becomes an easy ideology. It is too easy to deny that the person you love is going through hell when they do not see it. I am not sure about America but here we usually make sure the patient looks their best before letting the family in. We try not to do things to the patient that will upset the family while they are there. Perhaps this is wrong. Somehow we must break through the stereotypes implanted by the media to bring truth and acceptance.

actually here in america, there are sev'l hospitals that allow the family to be present during codes, intubations and the like. some staff are opposed to it, but it does clearly show the reality of what heroic measures entail.

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What a fantastic discussion. I have two stories to share.

My husband's grandfather was in great health, had DM but was well controlled but told his wife that if he were to stroke out or end up on a vent, that he wanted to be let go. Just a few short months later, at age 75, he had a masssive strok and as put on a vent. She called everyone and asked everyone to be there on Sunday as they were going to pull the vent (48 hours from the phone call). We all flew, drove, walked to the hospital and on Sunday morning, we gathered around the bed and held hands and touched his grandfather and the doc pulled the vent and we all said our good-byes. It was the best way to go that I had ever seen. He looked at us and smiled and closed his eyes and stopped breathing. No doubts, no regrets. It was an amazing experience.

Second story, my own grandpa began having strokes and everything else about 7 years ago. My grandma (who is a retired RN) will NOT let him go. He has been in and out of hospitals, homes and such. He is now home with her (complete vegetative state, feeding tube, etc). Yet she tells me to not let this happen to her. Hello? If you don't want it for you, why do you want it for him? I don't get it. It kills me to see him there. I KNOW he would not want it this way. Yet, when his RR is 5, she's calling 911. I just don't understand.

I truly believe that the reason some people call the emergency services is because they don't want their family member dying in front of their eyes or that they don't want to be alone in the presence of death (and let's be honest, death is not always the gentle "slipping away" portrayed on TV - often it's messy and noisy). I'm not sure that they fully realise the implications of initiating emergency care, but I certainly understand their immediate desire to have someone else (anybody else) deal with the situation at hand.

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The only solution to all this that I have been able to come up with is to educate people that are not all that sick. We have a standard of asking almost everyone that comes through our facility if they have written their wishes down.( I am in the ED now) I know that many nurses ask and do not spend any time talking about it. Not me. If I think it is in way relevant to the pt- if they are older and/or have a bunch of children- I tell them that is very imprtant to think about what they would or would not want done and then TALK to their families- give them permission to say "no" to further treatments and tests. I tell them that it is too hard to decide not to do everything when your parent is very ill and that is enough to cope with at that time. I sya that we will do whatever they want - but we need to know it is what they want and I tell them talking about it is still more important than documenting it- the people can pay a lawyer,,, I have seen too many children come flying back from out of state saying "I just talked to him/her and he/she sounded fine- so do everything." and just be ding-danged if we do not 'save' them sometimes only to have them come back in a couple of months and finally die of the same thing, and we were doing 'everything' again. Because of this phenomenon I teach.

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I was an ICU nurse for 15 years and have moved on to a happier playground, but in my old wise years I have decided that, although it is frustrating for us to watch and participate in, there are so many reasons we know nothing about which results in families' behavior and refusal to let go. We must provide dignity to both patient and family as best we can, know when to ask for another assignment, and EDUCATE EDUCATE EDUCATE the public at home, in our neighborhoods, in our churches about living wills, healtcare surrogate designees and the reality of death. My brother was 19 when he "died", but he was pronounced 9 1/2 years later. He never thought of death or comas or anything like that. But I guaran-damn tee you now, that everyone I come in contact with, including my own children understand that life is fragile and that things happen which can cause it to end early. And we speak openly in our family about what we want and don't want, and have signed the necessary papers. We must be very vocal about these issues to everyone, and when you can't stand the heat, then move on to another kitchen, knowing that you've done your best to make changes for the one that follow you.

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Specializes in Education, Acute, Med/Surg, Tele, etc.
I was an ICU nurse for 15 years and have moved on to a happier playground, but in my old wise years I have decided that, although it is frustrating for us to watch and participate in, there are so many reasons we know nothing about which results in families' behavior and refusal to let go. We must provide dignity to both patient and family as best we can, know when to ask for another assignment, and EDUCATE EDUCATE EDUCATE the public at home, in our neighborhoods, in our churches about living wills, healtcare surrogate designees and the reality of death. My brother was 19 when he "died", but he was pronounced 9 1/2 years later. He never thought of death or comas or anything like that. But I guaran-damn tee you now, that everyone I come in contact with, including my own children understand that life is fragile and that things happen which can cause it to end early. And we speak openly in our family about what we want and don't want, and have signed the necessary papers. We must be very vocal about these issues to everyone, and when you can't stand the heat, then move on to another kitchen, knowing that you've done your best to make changes for the one that follow you.

OH wow...your brother..very sorry..and I understand!

Educate totally!!!!!! We too are very open in this house, and our children know our wishes and have supported us 100%! My hubby and my values are a little different, he goes for the whole hydration thing..and after seeing what even hydration does I say NO! But he will do it to me if I can't speak...but my kids agree with me because they know it is my wish!

Dvldoc and I (my hubby) have POLST's (heck with those advanced directives in my state..POLSTS are better...those are Physician Orders for Life Sustaining Treatment...short, simple and paramedic friendly (nice for folks that panic and call 9-11 when they shouldn't have)....Not all states have these yet.

I try as hard as I can to educate family..in fact, it seems I don't fear telling folks how it really is...not bias...just..here is what is going on...this is what your doctor means...if you wish for options here is where you go...stuff like that. Thing is..I am honest and even if I don't have the time..I make it! (gets me in trouble but oh well!).

But you take it each situation at a time...do your best..but educate as much as possible...that is the greatest part of our jobs!!!!!! Maybe not the most fun at times..but certainly a highlight~!

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Specializes in ICU.
I truly believe that the reason some people call the emergency services is because they don't want their family member dying in front of their eyes or that they don't want to be alone in the presence of death (and let's be honest, death is not always the gentle "slipping away" portrayed on TV - often it's messy and noisy). I'm not sure that they fully realise the implications of initiating emergency care, but I certainly understand their immediate desire to have someone else (anybody else) deal with the situation at hand.

Bottom line is that it is easier to do something than to do nothing. That goes for medical staff as well. An interesting study would be to see if the "calling of a code" was less prevalent in those religions/societies where a priest/minister/shaman was called to administer last rites/ death ceremony.

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I've read through all the posts and have not seen the words "Ethics Committee." When doctors play God and keep corpses alive to stroke their own egos, and when families cannot/will not accept the truth, that's where the ethics committee comes in handy.

We even have a STATE ethics committee to step in and intervene if any hopsital ethics committee is ineffective.

I think we as nurses have a responsibility to involve ourselves, if possible, in the ethics committees of our respective hospitals.

I used to just hate it when we did full codes on 98 year olds in the operating room because, according to management, "Once they hit the OR, any DNR order that existed becomes ineffective. We have to do everything in our power to resucitate them."

Yeah--meaning, we have to do everything in our power to avoid having them die on the OR table--too much paperwork; too many headaches. Let 'em die in ICU and let THEM deal with family. or, worse, let 'em deal with family who is outraged that their DNR father or grandfather came back intubated and on multiple pressors.

Management's response to nurses objections to being expected to ignore pre-op DNR order? "Well, if he was DNR, why did he come to the operating room in the first place?" Usually the reason is pain from a problem that can be treated surgically--i.e., fractured humerus secondary to metastatic bone cancer--but, other times, you wonder why, indeed, they came to the operating room.

Ethics committee. They work wonders.

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I've read through all the posts and have not seen the words "Ethics Committee." When doctors play God and keep corpses alive to stroke their own egos, and when families cannot/will not accept the truth, that's where the ethics committee comes in handy.

We even have a STATE ethics committee to step in and intervene if any hopsital ethics committee is ineffective.

I think we as nurses have a responsibility to involve ourselves, if possible, in the ethics committees of our respective hospitals.

I used to just hate it when we did full codes on 98 year olds in the operating room because, according to management, "Once they hit the OR, any DNR order that existed becomes ineffective. We have to do everything in our power to resucitate them."

Yeah--meaning, we have to do everything in our power to avoid having them die on the OR table--too much paperwork; too many headaches. Let 'em die in ICU and let THEM deal with family. or, worse, let 'em deal with family who is outraged that their DNR father or grandfather came back intubated and on multiple pressors.

Management's response to nurses objections to being expected to ignore pre-op DNR order? "Well, if he was DNR, why did he come to the operating room in the first place?" Usually the reason is pain from a problem that can be treated surgically--i.e., fractured humerus secondary to metastatic bone cancer--but, other times, you wonder why, indeed, they came to the operating room.

Ethics committee. They work wonders.

Absolutely!.

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:o In the old days at nursing homes if someone was in pain and their body was full of cancer they would be a no code. Now it seems at the LTC's some persons in pain from cancer and other incurable diseases have "Full codes" orders.

Is it just at my LTC that this is happening or are other LTC's experiencing this same problem? It seems like cruel and unusual punishment to me.

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