This is sick

[tmiller027]

I'm watching an OLD episode of Chicago Hope on Discovery Health channel. This episode, a doctor went to court to try and have a morphine drip increased for a patient in a vegitative state up to a fatal dose.

What I found disturbing was one...at one point, the doctor ordered a nurse to adminster it, and she refused. He then proceded to scream and yell at her. Her nurse supervisor told her "Don't you see what you've done? This is done in silence all the time, but now its on the record!"

The doctors said the same thing, how euthanaisa goes on every day in the U.S. with a "wink" between Dr's and families. Has anyone ever heard of this? I'm almost halfway through an ADN program, have worked a year as a CNA and know lots of doctors and nurses and have never heard of this. I just found it highly disturbing. I don't like to see people suffer, but I also don't like to see doctors playing God either.

[cathy2005]

help studing for finals does anyone know website for lpn exam

[caroladybelle, BSN, RN]

I work in LTC with Alzheimers patients. Ive heard of it. Its called "hospice".

No, that is not Hospice.

Hospice is comfort care - nothing more or less...it is most definitely not snowing them to death.

I have seen that Chicago Hope but it has been a while. Is that where Shuut's girlfriend Neurologist is dying??????

First if the Nurse refuses on principle, the MD can intervene...and he can also face the ethics committee that will be convened if the action was actually inappropriate.

Second, the dose of analgesia is a really bad joke...as I recall (but then it has been a while), it was not going to be a dangerous increase. Dying patients frequently rate a much higher dose and higher increase. It was very overly dramatic and an extremely poor representation of treatment. Several nurses that I know laughed about the dosage and viewed it as a bit silly.

Third, Chicago Hope portrays some of the most ridiculous images of nursing that I have seen, to the point that it is laughable.

Fourth, if you read some of the books written in the 1960's, 1970's, "snowing" was done.....as well as "slow codes". But these are neither legal nor ethical, and you will be guilty of crime if you participate, MD order or not. Just because something was done in the past does not mean it should continue.

Fifth, if an MD behaved that way and a DON backed him, quit that job....you so do not want to work there.

We have a serious image problem with use of pain meds, CPR, death & dying protocols, hospice and DNR orders in this Country. Giving adequate pain meds, even if it may inadvertantly hasten death is approprate, but hastening death by drug administration when increased analgesia is not required is not legal nor appropriate. And hospice is to control symptoms, provide supportive care and maintain comfort....it has no license to kill. ER/Chicago Hope show patients being resuscitated from a flat line (frequently using defib) and getting up and walking away or regaining function easily in a majority of cases. But the actual stats for that kind of a recovery are extremely dismal. A DNR does not mean do not treat, but you would never know that from the Public perception.

[tinkerwomp]

Mmmm. Comment withheld. I have questions myself re: Hospice vs. "helping a pt along" that is still regarded a regular floor patient.

[roxannekkb]

So now, what is the difference between given someone a fatal dose of morphine (to dying or vegetative patient) or removing a feeding tube, as in the case of Terri Schiavo? It's not like the patient is going to live if you stop feeding them, so it hardly seems like that is allowing a "natural death." I think it's more humane to give them the morphine, quite honestly, if you want to go that route.

So what is the difference? Is one an "intentional act" and the other a "passive act?" Is letting someone die of starvation not considered euthanasia? It sure is in my book.

[sockov, ADN, ASN, BSN, CNA, LVN]

No

that doesn't happen. But in the ICU, there is heavy dosing with sedation and narcotics. But not to intentionally kill the patient.

That is so Hollywood!

[caroladybelle, BSN, RN]

Mmmm. Comment withheld. I have questions myself re: Hospice vs. "helping a pt along" that is still regarded a regular floor patient.

Hospice is not "helping a patient along" it is merely medicating to maintain comfort. No more and no less. That does not change whether patient is on the floor or in the hospice.

"Helping a patient along" is a criminal act. And administering MORE meds than the patient needs for comfort falls into that category. That does not change whether the patient is on the floor or in the hospice.

These two things are very different, though at times it means walking a fine line. Sometimes the big difference involves intent.

And I have no vague idea why Terry Schiavo is being brought into this thread. This has nothing to do with her case or the OP.

[Jamesdotter]

In the 1960s (now THAT was awhile back), I had a patient dying of cancer whose MD had ordered MS 20 mg with scopalamine q 2 hours, not prn. He was, of course, thoroughly snowed. I don't know the reason for the scop--it may have been something the MD had discussed with the patient. I only worked with that patient that one day, but I assume that that regimen did hasten the patient's death. He definitely needed the MS by the end of the 2 hours, by the way.

[Jamesdotter]

Yesterday's Portland paper had a big story about a man who took a lethal dose of seconal, slept for three days, woke (and asked why he was still alive) and lived another two weeks before dying of his disease. Below is the reference (I hope!)

http://www.oregonlive.com/news/oregonian/index.ssf?/base/news/111002781789770.xml#continue

[scooterRN52]

I agree with fergus51. We administer potentially fatal doses every day, but not to kill someone. If they are at deaths door and in agony, we medicate the heck out of them. Sometimes the window between a fatal dose, and a merciful, pain relieving dose, is very narrow.

We do the same in oncology and hospice, if a patient is in pain or has difficulty breathing and they are terminal and a DNR, we give them MS04, this dialates the pulmonary vessels and helps them breathe easier, helps relax them and helps their pain. You are right, sometimes the window is narrow. Families and the patient are aware of this and want the pain medication. I've been in oncology for at least 10 years and this is done, but not aggressively, everything is tried first,surgery, chemo, radiation etc. before a doctor says, there is nothing else we can do and a disscussion w/ the patient and the family takes place. Then the patient is placed on hospice,

and goes home to die or sometimes they stay in the hospital.

[scooterRN52]

In the 1960s (now THAT was awhile back), I had a patient dying of cancer whose MD had ordered MS 20 mg with scopalamine q 2 hours, not prn. He was, of course, thoroughly snowed. I don't know the reason for the scop--it may have been something the MD had discussed with the patient. I only worked with that patient that one day, but I assume that that regimen did hasten the patient's death. He definitely needed the MS by the end of the 2 hours, by the way.

Scopalamine dries up pulmonary congestion.

[Jamesdotter]

Scopalamine dries up pulmonary congestion.

Oh, of course. I have only ever given the drug as a pre-op--and not recently. At the time I only noted that the patient was apparently amnesic. I can't remember where the patient's disease originated, but in retrospect, I think he probably had either lung cancer or lung mets.

[1angie]

I agree with fergus51. We administer potentially fatal doses every day, but not to kill someone. If they are at deaths door and in agony, we medicate the heck out of them. Sometimes the window between a fatal dose, and a merciful, pain relieving dose, is very narrow.

I started out in Nursing as a CNA some 20 years ago. Watching the elderly, cancer patients,etc. suffering in the nursing home made me question everything frome my purpose in life to what their purpose was in this life. I now know that our purpose in life is not to suffer needlessly as we are a compassionate being. I was pretty young and green, but i was taking care of a gentleman who had one legs amputated at the thigh and gangreen in the other leg. He had other issues to which I can't quite recall. He was dying a horrible painfull death. One day a Doctor came in and i asked if their was anything he could do for this man becouse there was a constant, disturbing groan coming from him and he would constantly turn his head from side to side. I could almost feel his pain. It was horrible. The Doctor said to me, "don't worry,I amgoing to give him some morphine and I keep upping the dose untill he goes to sleep" I wasn't shocked, or disturbed in any way. In fact, I have never told this story. I was so relieved that he was not going to be in that horrible hell for very much longer. So yes, it's done all the time. It is just kept in the "family". Nursing is about helping people,be it going poop, or helping them end their suffering. Play God? No. Then why don't you call removing a breast,to save the life of a 36 year old woman playing God? Maybe God wanted that lady to pass on. It was in his plan and you screwed it up. Come on. We were given intelligence and compassion for a reason. If we have the knowledge and the love of health care, than why should it stop at a persons final agonizing hours. Death is part of life. If it taked a near lethal dose to stop their pain, and that dose is the fatal one, then thank GOD !!!