Help with a patient who wants to end her life

Published

I have had limited occational contact with a 50 yo patient who has been brought to the facility with ALS or Lou Gerhigs disease. She is ventilaor dependent. She communicates by writing on a board, very slowly and hard to read. My heart goes out to this woman. Her mind is perfect, but she is trapped in this body and is 5 years with this disease. She was brought to this facility because no one else in her area would take a ventilator patient. So she is an hour away from her family, who comes on the weekend. She says she was put on the ventilator without her permission, the family insisted. She has decided to end her life. She told me she'd be gone in two weeks.

I've questioned the two Respiratory Therapists who work with her. One explained that the wheels to begin this process have begun. she and her family will need visits from social workers and hospice. Then she'll be transfered to an ICU closer to her family and sedated with MS and taken off of the ventilator. One says she will be snowed and completely comfortable and have an easy death. The other said it doesn't always come easily, the MS helps some but not entirely.

The patient and I had a limited conversation about this and it left me rattled. I found I had trouble talking with her about her death. She obviously is having trouble with her decision. She said her family says she owes her grandchildren to stay here. I responded that I was so sorry she has this terrible disease and was so rattled I don't know what else I said. She cried and I hugged her. I had to leave, I'd already spent so much time, communication from her is very slow.

I don't know that religious counsel has been in, or if she even wants it. I worry that this lady isn't recieving the emotional attention she needs (from myself or anyone else). I would think that hospice would be coming every day to start this process but I've not seen anyone visit her yet.

I feel guilty that I've had her as my patient 4-5 times but spent my time with her concentrating on tubefeeds, meds, ventilator, treatments, and haven't taken the time to be there for her emotionally.

I'll see her again later this week, dont' know if I'll be assigned to her, but wondered if you could help me with a few thoughts on how to do a better job this time? It might be my last time to see her. How do I say goodbye?

Up Vote Up Vote ×
Specializes in Case Management.

Are you not a patient advocate? Respiratory therapy says they have started the process. I cannot understand why you and your facility are not working on this. Nursing should be contacting the attending to make sure her wishes are considered, and granted. A social worker and/or case manager can work on making sure the ball is rolling in the right direction. You need to talk to her and let her know you are working on obtaining the treatment she wishes for and if she wishes to die, that should be her perogative. :nurse:

Up Vote Up Vote ×

I'm so sorry for her that her family is guilting her out, but I completely understand at the same time. It's hard enough to let your parent go but when that parent is trying to die --- that's unfathomable. All you can do is listen to her and acknowledge that her feelings are real.

Up Vote Up Vote ×

Hi gr8rnpjt, I avoided saying in my original post how I came to be slightly involved here, and did present myself as her primary caregiver but I'm not. I apologize to anyone who reads this. I'm not an employee and it's not within my scope to be coordinating this. I come with students and we were asked 4-5 times if we would like to care for the lady. Sometimes we are asked if we would like to gain experience in certain areas, sometimes we are asked not to take on certain assignments.

I was told that a social worker and hospice 'would have to be contacted', and that it was taking much longer than they thought it would. After that the patient told me 'she would be gone in 2 weeks'. I'm hoping all of this coordinating has been established by the time I see her again. I just will listen to her and offer my time and support, along with my students.

Up Vote Up Vote ×

If you have requested to die because of your illness because you can't do it youself, isent that the same as taking your own life..

Up Vote Up Vote ×

I feel that only the patient can make this decision for herself. I'm saddened that the family is "guilting" her into staying (or trying to guilt her into staying) so that they can visit her for a few hours on the weekend. The rest of the time she is trapped in a body that has failed. I can't even begin to imagine what kind of life that is. In my book it's certainly not quality life (personally). It sounds as if she may seem to feel this way as well.

I'm sure that the "process" will include some psych evals to make sure she's no actually clinically depressed (although with that diagnosis who wouldn't be). I woudl hope that if I were in that situation my family would stand by my decision in the end and be there for me when the time came.

As for "ending her life" I'm not sure that is what she is doing. Without the ventilator (heroic measures) she would not live anyway. I think she has every right to ask to be removed from it.

It certainly is a sad situation.:(

Up Vote Up Vote ×

I think that if anyone should feel guilty it should be the womans family for putting her on the ventilator in the beginning when she didn't want it. I would hate to see my parent suffer because of my selfishness and then turn the tables on them. I hope she has everything in order now and can go in peace and with dignity.

Up Vote Up Vote ×

she was put on the ventilator against her will.. can anyone tell me why this happened..? if she was meant to die, then she would have died.. i'm just saying that if it's not your time to die and you decide to end it before your time, it's the same as killing yourself.. if you kill yourself, then you will not go to a better place..

Up Vote Up Vote ×

why did she agree to ventilatory support?

als pts lose muscular functon but retain their intellectual abilities.

this pt desperately needs hospice involved, asap.

this is so very tragic.

even if you're not staff at this facility, you still have a right to advocate to the social worker.

you can also find the number of the ombudsman, hanging on the wall out front....

stuff like this really burns me.

leslie

Up Vote Up Vote ×

cdk001

How dare you say that! Your personal beliefs are yours but you have no right to inflict them on patients. Perhaps you should review the part about patient autonomy. A patient has a right to refuse treatment. Period.

Up Vote Up Vote ×
Specializes in Maternal - Child Health.
she was put on the ventilator against her will.. can anyone tell me why this happened..? if she was meant to die, then she would have died.. i'm just saying that if it's not your time to die and you decide to end it before your time, it's the same as killing yourself.. if you kill yourself, then you will not go to a better place..

a patient who thoughtfully prepares to withdraw invasive life support that s/he never consented to in the first place is not commiting suicide. please have more compassion for your fellow human beings.

Up Vote Up Vote ×
Specializes in Maternal - Child Health.
why did she agree to ventilatory support?

als pts lose muscular functon but retain their intellectual abilities.

this pt desperately needs hospice involved, asap.

this is so very tragic.

even if you're not staff at this facility, you still have a right to advocate to the social worker.

you can also find the number of the ombudsman, hanging on the wall out front....

stuff like this really burns me.

leslie

Boy, have you ever asked some very important questions.

Where is the ethics committee in this facility?

It sickens me to hear of stories like this. A friend of my mother's who had a long history of cardio-respiratory problems had a living will clearly stating her opposition to mechanical ventilation. She wrote out the document because she didn't believe that her family was strong enough to stand up for her wishes in a medical emergency. Sure enough, she was admitted to the hospital with pneumonia, was sedated, and was declining rapidly. Her physician refused to intubate, citing her living will. The family arranged for a transfer to another facility that would put her on a vent. She suffered for months before her care was transferred to another physician who respected her wishes to be removed from the vent.

Up Vote Up Vote ×
+ Join the Discussion