Ethical Death or Not?

augigi, CNS · Oct 3, 2006

I agree with all of the above. It's painful to watch a patient hanging on painfully because the family don't want to let go. I definitely feel people decide to let go. Having said that, if it wasn't her time, nothing you said would make any difference; she wouldn't have died. All you did was offer comfort and peace. Don't ever apologise for or regret that. Until your fiance tries to walk in those shoes, he doesn't get to comment.

goats'r'us, ASN, RN · Oct 3, 2006

i can understand why your fiance might feel it was unethical. i don't agree, but i can see his point of view.

Perhaps what he finds unethical is that you gave the lady permission to stop fighting when her family wanted her to keep on. in this way, you 'allowed' her to die when it was against the family's wishes.

i don't think you did anything unethical. even if your words did make the difference for this woman, all you did was enable your patient, which is exactly what you've been trained to do.

in the end, it was either a co-incidence that she passed that day, or it was her decision to do so.

i think you did really well.

oh, and i noticed before that you were worrying that the suppository you gave hastened her passing, and that it was the wrong thing to do, so let me reassure you that you did the right thing there too. the woman had a fever, and you followed protocol in your actions. if you hadn't, then when she passed, someone could have looked at her chart and asked why you did not treat her, and could have even suggested that by not treating her fever, you contributed to her death.

again, you did well, and i don't think you did anything unethical. right to life/death with dignity stuff if very gritty and full of grey areas. there are many different opinions in this area, and people usually have a lot of conviction behind their views. clearly you and your man have slightly differing views, but hopefully you can see each others sides on the issue and understand where you both stand.

nerdtonurse?, BSN, RN · Oct 3, 2006

To the OP, let me share something that happened to my sister, the MD....

She was in residency, and there was a guy who was very, very sick, yet was absolutely against being made a DNR. Guy had stage 4 this, stage 4 that, heart issues, lung issues, basically, he should have already died, but just...wouldn't. Every new resident that came to the floor was sent in to try to talk to this guy, and convince him that he would still get pain meds, etc., but nothing human beings could do would make him well again. Guy still wanted heroic measures.

My sister goes in to talk to him. We tend to be a pretty direct bunch in my family, so she just asked him, "okay, why are you afraid of dying?" The guy opened up, and started telling her that he'd cheated on his wife, stolen money from his church where he was a deacon, cheated business partners, etc., just a flood of remorse and sin. She offered to get his pastor, to which he said NO, so my sister asked if she could get him a priest. He talked to the priest for 2 hours, agreed to go DNR, and died at peace the next day.

Not for the OP's situation, (and I think you did the right thing), but maybe for others they aren't just waiting for a "you can go" but for absolution of some real or perceived sin? I hopefully will start nursing school in January, and I will always remember that guy when I'm confronted with my first terminal patient. Not only tell the person it's okay to go, but make sure they think it's okay to go....

pkapple · Oct 3, 2006

My Dad died in July. My sister, who is a LTC LPN, is still wrought with guilt. She tended to go a little beserk when either of our parents was sick, you know the one, the family member who is ranting and going to admin every other day. Anyway, Dad was a DNR, he was having a lot of difficulty managing secretions and was semi-responsive. Deb raised holy hijinks and demanded the nurse suction him right now. Long story short, she now feels it is her fault he died, no amount of nursing knowledge can console her. Thankfully she does not feel the nurse who sx'd Dad killed him, you see it's all her fault.

Anyways, please always remember if you offer as much comfort and compassion as possible to your patients and/or families, you are a good nurse and a good person.

PANurseRN1 · Oct 3, 2006

Thank you to all who replied. I am not sure as to why he feels the way he does either. From a christian viewpoint I know that there wasn't anything I could have or should have done different. But, I can't help wondering if that suppository ( isn't the orifice connected to the vagus nerve, possibly her heart?) might have exacerbated things.

The suppository didn't kill her; her multiple disease processes killed her. Telling someone it's OK to let go is not illegal or unethical. Some pts. need to hear that. You were alleviating suffering.

allnurses Guide · Oct 3, 2006

As with the last poster I have recently experienced a difficult berevement - my grandfather had a massive CVA and after 2 weeks he finally died this week. The day he died I held his hand and told him that when he was ready it was OK to go, that my grandmother was waiting for him and we knew he was going to a better place. He died shortly after.

What you did was comforting and very caring, not unethical but responding to your patients needs. It is difficult sometimes for those who are not in a position to experience such a relationship with those who are dying to understand the nature of what as nurses we do, this maybe why your boyfriend has difficulty in accepting your actions.

Antikigirl, ASN, RN · Oct 3, 2006

You did awesome in my book! I have worked with many people at their end of life, and one of the true occurances in almost any case...they need the re-assurance that they CAN move on...that their job here is done, and it is time for rest.

I have even seen crowds of people in a room and dying pts holding on, but once the room clears, and if there is even one person there and they go to the bathroom or what not...in those few minutes...they die. No one wants to die in front of loved ones or people caring for them.

A good area of communication with your fiance would be the issue of quantity vs quality of life! It would be good to know that before marriage! Remember, he could be choosing your medical desicions if you are unable to speak and can override some areas of an advanced directive or POLST. My hubby shares my views, and with a few minor arguements (mainly about hydration), we agree to the others wishes totally!

You comforted someone on their next journey, and let them know it was okay to go there...KUDOS to you. I would certainly hate it if no one did that for me when it is my time! Just do nothing and let me die...or do wayyyyyyyyyyyy to much to give me little time and suffering! EEEEEKKKKK that is scary to me!

LOL, I am of the mindset for MYSELF when it is my time...use the wonderful drugs to knock me out, keep me cool, and let me make the transition, and feel free to hold my hand or stroke my hair a bit!

radoncrn · Oct 3, 2006

I also think that you did what a reasonable and prudent nurse would do. We are NURSES...we need to be advocates for our patients at all stages in their life. Not giving the suppository would have made this patient more uncomfortable and would have been wrong, IMO.

We spend so much time and resources preparing for the "perfect birth". We arrive at the hospital (or clinic or home) with the birth plan in our hands with the thought that it like a contract or something. As nurses we do all we can to advocate for our birthing mothers and families. We need to see that death is just the other end of the spectrum. We need to advocate for our patients so that they die the way they want to (This is not an endorsement for active euthanasia).

Tweety, BSN, RN · Oct 3, 2006

Good job in my opinion. From a nurse/patient perspective.

I see what your fiance is saying because the family obviously was more agressive and not willing to let her go without putting up a fight.

What would the family say if they happened to over hear you? They might get angry, they might think you wanted their mom to die, they might think you were way out of place, they might think that she gave up and died because of what you said. People are crazy. I think this is what your finance is saying, not that he necessarily would agree with them.

weirdRN, RN · Oct 3, 2006

I have only been in LTC Nursing a short time, but in four months I have been with a dozen people who have died.

My personal mission is to ensure that the residents that I serve are reasonably happy and as pain free/comfortable as I can legally/ethically/morally make them.

Families often have a different view, and in this day and age of CYA medicine, Docs do what ever the families want. Docs seldom ask the question: When is Enough, Enough? How much more pain and suffering will you put your loved one through before you realize that Mom or Dad or aunt or Uncle will never be healthy and at home again.

It is hard to be there with all of your knowledge and all of your skills and do NOTHING, but sometimes, Nothing is exactly what should be done.

Aradien · Oct 3, 2006

But, before this all happened I had sat with her a few times and rubbed her arm and told her that she didn't have to hang on anymore, that it was alright and she could go. My fiance' thinks that this is unethical or possibly illegal. Please help me with your opinion. I have more to tell but I'm running out of room.

When I was a nursing student the first time (1993) I had a patient with ESRD and he also went fast. I went in at 7:00 am and his rectal temp was 95. So I had a feeling but was hoping he wouldn't die until I left. I sat with him and held his hand and told him it was okay to go. That his family would miss him but that he had fought the good fight and now he could rest. He died later in my shift. The instructor told me that hearing is usually the last sense to go and that sometimes, a person needs permission to die. I don't believe that I caused his death. I think I just reminded him that it was okay to let go.

I believe you did the right thing.