How do you feel about the right to die?

itsme · Jul 17, 2003

That is odd without a living will- but the doc must have talked to the patient, at least I hope so, about the order. What gets me is the full codes on some of these poor bedridden folks that are about 90# dripping wet with no quality of life. Once you do CPR and break those brittle old ribs, you NEVER forget the sound and it actually haunts you. I am a believer in death with dignity and to be pain free. I guess some people think that if grandma is a full code CPR will make her all better. Even with family teaching it amazes me how many are full code, thank goodness more and more folks are getting living wills and advance directives!

ChainedChaosRN · Jul 17, 2003

Hard situation. I guess my first question I'd ask is if the patient is competent, and deemed competent by a physician. If yes, advance directives should be in place prior to the tube being pulled. If she IS competent it is not the families decision, especially if they do not have guardianship.

If she is not competent, without advance directives for no tube feeding, which she obviously didn't have in place hence the tube feed. Then I would feel the court should be petitioned to put in place an immediate guardianship.

Who knows if the family present that made the decision is the only family? Who knows if there is money to be made by her death?

If the facility has legal counsel available, I would suggest they contact them immediately. Steps need to be taken immediately to sort this mess out to make sure this isn't a medically sanctioned murder.

LTCNursemidwest · Jul 17, 2003

I agree - First it has to be determine in the pt is able to comprehend and understand what question you are asking of her if she does then it's her call. if not then with out advance directives its up to the courts.

justjenn · Aug 2, 2003

Do you have an update on what has happened to-date. I am really interested to see what has happened.

Thanks

justjenn

**canoehead, BSN, RN** · Aug 2, 2003

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% ?

KaroSnowQueen, RN · Aug 2, 2003

Yes the PATIENT has a right to die. Does the family of an alert, awake patient with no immediately threatening ailment have the right to DECIDE for them to die? No I don't think so.

I am all in favor of living wills, etc. but I would think twice about participating in this. Somebody somewhere is not in the right.

Long Term Care Columnist / Guide · Aug 2, 2003

I agree with KaroSnowQueen. I faced a situation when I was a care manager in LTC a couple of years ago in which a resident's daughter and son-in-law, who hadn't even visited her in months, suddenly decided she was "in terrible pain" and got her MD to order morphine (10-20mg IV every 4 hours around the clock). They also convinced the doc that she was dying, and he ordered us to stop giving her food and fluids.

Now, having suffered from Alzheimer's for many years, the resident wasn't in a position to make these decisions. But for her so-called family to come in and basically force us to drug her and starve her to death was still wrong, IMHO. I have no problem with allowing people to die naturally, in God's time rather than ours, but I do have an issue with being asked to commit murder, which is what I (along with my nursing staff and the facility administrator) believed this family was doing. So I called both Senior Services and the MD, told them that we were NOT going to give morphine in those doses to a pt who weighed maybe 90# wringing wet, and who had been assessed by several different staff members and found not to be in pain. I also told them we could not deny food and fluids to someone not actively in the process of dying. (This doctor hadn't even seen the resident for months---I've never understood how he, in good conscience, could have given orders like these without having first assessed her.)

The family, of course, was furious. I told them that they would have to take her home---we, as nurses, could not and WOULD not be the instruments of this woman's demise. They said they couldn't deal with her at home, then called in another doctor who took one look at her and said "She has no quality of life, it's time to let Nature take its course" before ordering us to give her the morphine (every SIX hours). He did tell us we could offer food and fluids, though, and ordered PRN oxygen for "comfort".

Senior Services told us they couldn't do anything to help us at this point, so we basically were stuck. That was when the family began taking turns staying with the resident to make sure we gave the morphine on schedule, and to discourage the aides from "forcing her to eat". In the two weeks it took her to die, she developed pressure sores on her coccyx and both trochanters, and her lips became cracked and then ulcerated from dehydration. (To say the least, the morphine came in handy as one system and then another began to fail.)

Again, I am against prolonging life artificially, especially in cases where the pt is suffering from some intractably painful or degrading condition. I hate it when families go to the other extreme and demand full-code status for a 98-year-old who's full of cancer and in the final stages of dementia. However, I do NOT condone actively hastening death in any case, regardless of the so-called justifications for it (e.g., "no quality of life").

And that's all I have to say about *that*.

allnurses Guide · Aug 2, 2003

MJ . . that is horrible. And criminal. I completely agree with you in this regard.

And removing someone's feeding tube who is as the original poster described is also wrong.

steph

Marie_LPN, RN, LPN, RN · Aug 2, 2003

My instructor had a family member who lived 2 years on a feeding tube. This woman kept asking to die over and over she was so miserable and in so much pain.

That is not living, that is suffering. I have an agreement with my family that i am not living my final years out like that.

jenac · Aug 3, 2003

Ok guys- I get that we all have very deep feelings about this. But-is there a legal issue here? I mean-if the family has made this decision, and the Dr. has given the order, are we LEGALLY liable here? Withholding nutrition and fluids is essentially murder (as is stated over and over here). Even with a debilitating disease, or h/o one, if the resident is currently medically stable, how can we legally do this? How does the State look at this? Can anyone address the legal ramifications for me?

Marie_LPN, RN, LPN, RN · Aug 3, 2003

Advanced directives are supposed to clear this kind of thing up, but they did research at my facility and over 55% were not "Specific" enough on what and what not to do for the pt.