Mercy Killing

[CandyGyrl1985]

ok - this topic is probably hot - but i wanted some real opinions from seasoned nurses. my father died a year ago - from prostate cancer. here is the scenario - he entered the hospital for a blood transfusion... the doctor missed diagnosed his sepsis and began treatment a day to late. the sepsis put my father into a mild delirium, with a fever of 104. his pulse was through the roof - constantly triggering an alarm and of coorifice his bp was very low.

he was moved to icu - (we were told because they had a bed shortage in the imc - but as it turned out he was the most critical patient on the floor.)

the doc ordered my dad to be in trendlenburg. he also said that they were not going to push any kind of meds- accept for tylenol for fever, the iv bag to help raise the bp and the broad antibiotics. no pain meds or anything else, since his body was in over drive trying to battle the infections. the doctor told my mom he could either push drugs - but he would definitely die or they could have him ride it out for 24 hours and if no progression consider the enevitable. my mom chose the 24 hour route.

here is where the situation got nasty. all day the icu nurse took excellent care of my dad. kept him in the correct position, and was pretty honest with us. the night nurse came on - and everything changed. she took my dad out of the position he was in and when my mother questioned her- she bullied my mom. she said something along the lines of - who is the nurse here? do you think you know more than me? and if you have a problem you can get another nurse. my mom felt terrible- like she had crossed the line and began to second guess her feelings about the nurses decision and at that point became very intimated by her. the nurse also complained that the doctor was being inhumane by not giving my dad meds - and that she didnt believe patients should suffer- and as the nurse, she had the right to push pain meds if she chose so. (is this correct?)

the nurse told me that my dad was going to pull through. she told me to go home and get a good nights rest. (after my dad died - she admitted that she lied, bc she knew he would die and felt that i should get some sleep since after he died i would be stressed.)

that night - she came into the room. my mom pretended to be asleep, to avoid talking to her. she had her head lowered as she walked by, but raised it once she was next to my dad. she pulled a vial and needle out of her pocket and shot my dads iv up with a drug. she then held my dads shoulders down. my mom says that no monitors went off on my dad - which was odd since they went off all day long. (maybe the nurse turned them off- but that part was not witnessed so i do not know for sure.) after she held my dad down for about 45 seconds - my mom became concerned and lifted her head up. the nurse quickly straightened up and casually said "he's dead, he had a seizure while you were sleeping." but my mom was not sleeping - and even if she had been shouldnt she have woke her up if something was wrong?

my mom could not believe it - he was just alive moments before. the nurse left the room at that point. i arrived at the hospital exactly 5 minutes later- since i lived across the street. after the initial, panic, shock and grief passed... my mom told me what happened. she then pointed to the bed side table where the empty vial sat. it was adavan.

i asked the nurse if she gave him an meds that night since i had left- and she said only tylenol. my mom definitely saw her administer an iv drug from the vial that was resting on the table. she is 100% certain!

my questions

is it possible in this day and age - to do a mercy killing and get away with it?

does that sound like this is what might have happened?

if not - why do you think she administered the drug- maybe an error? and then she was afraid to admit the mistake?

we never pursued legal action since my dad would not have wanted that. (he didnt believe in suing people or revenge and he didnt want an autospy, etc) so now, i live with knowing that the nurse might have killed my dad - either intentionally or accidentally.

as a nursing student - i know mistakes happen. i guess the purpose of this post - is to see what others would think of this situation. clearly my dad was critical and even if she didnt do anything wrong- his death was a release from his suffering. but i hate not knowing for certain. i just wish i knew for sure what she did either way. not necessarily to do anything about it - but just so i can come to terms with it.

please be kind in your posts- just writing about what happened breaks my heart.... i dont want to be perceived as trying to start any kind of conflict, i just am searching for answers.... that i fear i will never know for certain.....

~candace~

[nkara, CNA]

What a horrible experience for you and your family. I sure hope this doesn't happen to anyone else. I personally would investigage the incident. I'm not in a position to give legal advice however. I know in my families case the doctors and nurses taking care of my brother when he had a stroke were very uncaring and once we pulled every rank in the book by bringing down my Aunt who has been a nurse and nursing instructor for over 30 years they finally ordered the test's needed to help him.

I hope you find peace with the knowledge that he is no longer in pain. I know it isn't much but my thoughts and prayers go out to you and your family.

[hypocaffeinemia, BSN, RN]

Two things:

The questions you ask delve into the legal realm and cannot (nor should not) be addressed here.

Secondly, ativan (lorazepam), not "adavan", typically comes in 2mg vials-- typically not even enough to take away respiratory drive. Chances are the reason you saw it out was because it was given for the seizure your father experienced as it is one of the drugs of choice for treating acute seizures. Once again though, any of this is speculative and you're making very serious accusations without any way for any of us to give your closure either way here.

As an ICU nurse I can just tell you that sepsis patients occasionally seize and the first thing I reach for is ativan. If your father was intubated (which I certainly hope he was considering how sick you describe him), ativan would be the last drug I would suspect for a "mercy killing" as it doesn't have much cardiac effect and an airway would already be secured.

[talaxandra]

Hi Candace. I'm sorry for your loss.

I can't answer any specific questions you have, both because I'm unqualified and because of the ToS. However, I do feel comfortable saying that lorazepam (Ativan) is an unusual drug to use to bring about death. Life threatening respiratory depression (which I assume would be the method of death) is an unusual side effect and would warrant a really large dose. In Australia and the UK it's also a scheduled medication, meaning that it has to be signed out in a log, not only leaving a record but also raising questions if it wasn't prescribed. It's usual use in the context you've described is for seizure management.

While 'mercy killings' do occur, the situation you describe is atypical. Health care providers who kill terminally ill patients usually do so because they believe the person is suffering and will not recover. In many cases the practitioner has cared for the patient over a period of time and feels a bond with and responsibility for the patient. In twenty years of nursing there's been one patient where I wanted to give a non-therapeutic dose of medication. I've never seen or heard of it actually happening in anything like the kind of case you describe.

It certainly sounds as though you have a number of unanswered questions and concerns about your father's treatment, from your perception that there was delay in diagnosing and treating his sepsis to your belief that he was killed by a nurse. I note your statement that you're not interested in litigation. There are other avenues of answering questions. Perhaps contacting the hospital and asking to discuss his case with a hospital representative would help. Bear in mind, though, that there is no way you can ever know for sure - it's not possible to prove a negative (ie that she didn't kill him) and unlikely she would confess (if she did). However, if I were going to bring about a patient's death I would use a number of other methods before a dose of benzodiazepine occured to me.

I hope something one of us says will help.

[saintplatypus]

I doubt it was a mercy killing. As has been said, your father must have had an order from the MD for the ativan or the nurse would not be able to give it. And all narcotic medications such as ativan must be signed out and accounted for by the nurse, as all narcotics are counted at the beginning and end of each shift by the offgoing and oncoming nurses. A record with signatures of both nurses is kept to verify the count is accurate. It is unlikely that the nurse chose to give it without an order for this reason.

Also ativan is often given for labored resperations as well as seizures. It also is used as an antianxiety medication. It is used in hospice routinely. If the nurse stated your father had been seizuring, then most likely he had been. The fact your mother did not witness this is probably because she hadn't been looking. Seizures are quiet, rarely is there any vocalization, although it can occur. And seizures do happen sometimes with fevers as high as 104, so for him to have a seizure, even without a history of seizures, is very possible.

Your mother was in a very stressful state and was tired, she may not have been as acutely aware of what was going on as she believes she was. And stress can make you see, or think you see, things differently or inaccurately than what really took place. Perhaps your mother did see the nurse holding his shoulders down, but it could be the nurse was readjusting his pillow or performing oral care. You said your mom had her head down until after he had passed so she may have only believed she saw it, or maybe even dreamed it because she had dozed off unaware of having done so.

I really think nothing was done wrong in this scenerio. But what you described has happened, as many nurses have been convicted of murder. If you have any questions or concerns you should call the hospital and arrange to discuss this with them. I doubt you will be able to have any closure unless you do so.

Good Luck and sorry for your loss.

[traumaRUs, MSN, APRN]

I am so sorry for your loss.

The above posters are correct in that we can't offer opinions into either medical or legal advice. Its obvious you have some unanswered questions. There is nothing wrong with presenting your questions in writing to the attending physician and the hospital.

I wish you the best and hope you get the answers you seek.