Quote from JBirdAngel
I am not a nurse, and i cant say that i agree with being comfortable but dying sooner is better, than not being comfortable and living longer, someone can think that smoking makes them comfortable, and they will die sooner, this is ane example where this would not be correct to do.
It's a bit more complicated than that, from a nursing perspective. Particularly, opiates to relieve pain may tend to suppress respiration, but it's still desireable to relieve the pain. Actually, it's usually possible to balance these effects, since sedation occurs before respiratory suppression. But, at the end, respiratory suppression can relieve respiratory distress and the anxiety that accompanies it, so you give the patient enough pain meds to be comfortable, even if they don't live quite as long.
But, to go with the smoking analogy a moment, would you forbid someone to smoke who was dying of malignant melanoma? Or, for that matter, lung cancer? As healthcare workers, most of our energy is geared toward preserving life, but priorities change when death is imminent. When we speak of interventions that may shorten life, we're talking hours, or even minutes. It's true in a sense that all of us are moving toward death, and some of us do things that aren't good for us, but the situation is different for someone in the actual dying process. "No pain, no gain" may make sense for someone with years ahead of them, but it seems needlessly cruel with minutes left.
In my recent experiences, the matter has been complicated in that my patients have been unable to speak for themselves, so I have to use my nursing judgement to determine whether they are comfortable. My problem is that I'm not entirely confident of that judgement, yet. So I'm more concerned, here, with the relative comfort of the actively dying patient.
Just to clarify, I have no doubt at all about the doctor in question caring. I don't know whether he was the one who suggested removing the trach or simply agreed with the one who did, but I've worked with these guys enough to trust their motives. For that matter I have lots of confidence in their judgement--but that doesn't relieve me from using my judgement.