How do you feel about the right to die?

[sassynurse78]

I was just curious as to what other LTC nurses thought about the right to die? I am very supportive of someones rights to die with dignity. However I am quite uncomfortable with a current situation at work. We have a pt. who has a g-tube. Has had for two years now. The pt. is alert, can communicate with facial expressions, and yes or no answers, is usually smiling and waves and winks at the staff. Also holds staff's hands when staff is careing for the pt. The family has decided to pull the g-tube and let the pt. die. The pt. has no living will, and the family is insisting that the pt. "would not want to live this way" I do not know if anyone has asked the pt if he/she wants to pull the tube. The family is very supportive and visits daily for the last two years. But I do know that the dr. order has been obtained to remove the tube. I know there are many ways to look at this subject. I had a Dr. tell me once that after the first 48 hours the person does not feel hunger pains anymore. I just don't know how I feel about this. What are your thoughts?

[PPHawk]

I'm all for the right to die with dignity and no pain. But if all the things we've seen on TV and in our daily work haven't convinced health care workers to set up living wills, advance directives and anything else we can come up with to get our desires known, I don't know what will work on the general public. With all the MPOA's out there, they're the ones who make the decisions, they have all the rights. Even when they're taking mom to hospice inpatient and tell us not to tell her.

My mother refused to even discuss a living will because she believed it meant that she wanted to die. Hospice has a big message out there that they'll give you dignified death with no pain...what do they think we're doing? I've never worked with a doctor or nurse who allowed a patient to suffer.

I think there's a lot of misinformation out there.

[ginger58, ASN, RN]

I am all for having automatic DNR for anyone over 80 years old, and the patient has to specifically request otherwise. What are their chances of surviving a code, let alone going home, like 0.05% ?

OMG! Today I have not only been horrified by nurses thinking that taking pain meds makes you an addict but now an automatic DNR!

The chance of surviving a code in any person is about 6% and I think that 30% of those that make it are dead in a year.

[talaxandra]

I agree wholeheartedly with canoehead - show me a patient over 80 who has the cerebral and cardiac circulation to survive a cardiorespiratory arrest intact and I'll reconsider. Until then...

I've had to resus too many 80+ patients at 2AM, felt their frail ribs crack under the pressure of cardiac compressions, managed to get them half way back, only to have a consultant decide that ICU would be inappropriate. It feels like I'm grabbing onto them on their way to heaven, putting them through agony, for nothing. And the only thing that's changed in their condition is the arrest.

Survival stats haven't changed in 30 years. Around 50% of patient survive an arrest. Around 50% of those patients rearrest within 24 hours. One study showed 16.6% of patient surviving to discharge, and that was with pre-screening inappropriate patients out (Arch Intern Med -- Abstract: Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target, November 14, 1994, Ballew et al. 154 (21): 2426). Overall survival is around 5% (Medical College of Wisconsin - Researchers find ways to improve CPR survival) - and that's not "neurologically-intact survival". In one metastudy, "long term survival" was three months post discharge (Entrez PubMed)!

Meta-analysis reveals that the most significant negative predictors of survival from CPR are renal failure, cancer, and age more than 60 years, while AMI is a significant positive predictor. The PAM [pre-arrest morbidity] index is a useful method of stratifying probability of survival from CPR, especially for those patients with high PAM scores, who have essentially no chance of survival. Entrez PubMed

At one hospital studied (where age was not found to be a significant factor), 52% of patients survived resuscitation, 22% made it out of ICU, 11% were discharged, and

4 percent of the patients (n = 10) were alive at the end of follow-up (mean, 22 months). None of the patients discharged alive had a significant new neurologic deficit, and all but one returned to their preadmission environment. The post-CPR hospital charges for each of the surviving patients was estimated at $63,000. Survival after in-hospital cardiopulmonary arrest of noncritically ill patients. A prospective study -- Berger and Kelley 106 (3): 872 -- Chest

[banditrn]

If they've made it well and healthy to their 80's or 90's, when something goes wrong, like a resusitation, it generally doesn't have a good outcome. Even if you DO get them back, you'll probably have broken ribs, they'll end up on a vent in ICU, where they will most likely end up with pneumonia related to the broken ribs.

Their last week or two will be miserable, and then they die - I've seen it happen time after time!!

There are a multitude of reasons why their families don't want to let them go - genuine love, guilt, etc. But the greatest heros in my book are the family members that say 'I don't want any more of this stuff done to my mother - or father - or whoever.'

[Jo Dirt]

I've heard opponents of right to die say that it will easily become a duty to die.

I still say let me have it. I don't want to burden anyone.

[talaxandra]

There's a really interesting ethics text called "Is there a duty to die?" that addresses why, is some situations, that would be the more ethical thing - heartbreaking story about the middle-aged daughter of an elderly woman.

[montinurse, BSN]

How about someone who is in their early 40's, breaths on their own, gtube for ALL nutrition and meds, mentality of a less than 3 month old and a parent who insists on pt being a full code? I am so afraid of this person coding on my shift. We having starting fighting routine pneumonia and recent ilius.. This person has never had any quality of life, IMO. Just laying in bed or being pushed in a chair. Their only communication is occasional crying out when wet or discomfort. It's sad.

[montinurse, BSN]

Bump!