i am struggling and even starting to lose sleep over the following. a couple of weeks ago, one of my pts. had a cva and lost her ability to swallow. she was receiving ivf until her niece decided to opt for a fdg. tube or comfort measures. even though this pt. has minimal dementia, she herself had always been making her own decisions. whenever we asked her if she wanted a fdg. tube, it was an impassioned "NO". ivf's have been dc'd. she sits there, eyes open, so alert, just waiting to die. most times she has her hand over her face. there's a prn order for mso4; her vs are stable including respirations. she's afebrile amazingly, as her face is looking skeletal and dehydration has not set in yet. i've consulted with her doctor about a possible ativan order or something, something to make her sleep. the doc states that there is no physical distress, as i do agree. i'm concerned about any mental/emotional distress; i don't know what she's thinking, just sitting there all day and noc, eyes open, non-verbal. but i did tell the doctor that we should assume the worst and give her something for her emotional pain. i've thought about giving her mso4 as often as possible but decided against it because it's probably unethical, as this would be a form of conscious sedation, would it not? my stomach just goes in knots every time i look at her. i am accustomed to helping pts. die, as this is my specialty at an inpt. hospice. but for the 1st time, i feel so very helpless. any input would be most appreciated.