Just let me go!

Published

Specializes in SICU.

the other day, a group of us ex-nursing students were discussing end of life issues. after being in clinical and seeing the sickest of the sick in our icu observations, i made a decision that should anything go south, i want my family to let me go for the following reason:

-if my quality of life after the event should be worse and i am kept alive by machines,with no hope of getting better, i do not want that for myself or my family.

i know that some people make dnr decisions and then rescind them when death looms in the shadows..

my question is, as a nurse in your day to day activities, do you believe some of your patients changed the way you looked at dnr, cc, full code status?

(for example the 92yr old lol emaciated and stage 4 ca, decubs up to the bone, who kept saying she wanted to go and join her long deceased husband, yet her family insisted that everything be done-full code status. a bunch of broken ribs later, she died a traumatic unnecessary death)

*** what decisions have you made personally about your code status that were influenced by what you see on a day to day basis as a nurse.

Up Vote Up Vote ×

What you describe is called "futile care". There are (in my experience) abnormal family dynamics when this sort of thing happens. Usually, it is one family member driving the poor decisions and it's commonly a matter of guilt and unresolved interpersonal issues.

I've seen enough that I made things clear to my family. I also trust my family enough to know they aren't going to "kack" me for my fortune (joke.)

But I know it happens and we can't rush families through it. You have to be honest, keep them informed, have a team approach, be compassionate but not (EVER) give false hope or buy into magical thinking.

Honestly, what you described is pretty rare in my experience.

Up Vote Up Vote ×
Specializes in Psychiatry.

Regardless of what we feel is right, we must respect our patient's autonomy.

I am a hospice RN and have seen my share pts ofwho are "full codes", while they are on hospice services. Most of them have been/are in their 30's or 40's. Some olders. It just depends. Most of these terminally ill pts will change their minds (code status to DNR) as the disease progresses. Some do not, so we must respect their decision.

We can never judge (and I'm not saying you are, OP), until we have walked a mile in the other person's shoes.

Interesting topic.

Best,

Diane

Up Vote Up Vote ×
Specializes in Trauma Surgical ICU.

I work in a trauma ICU, so I do see alot. What I have seen at times is tough and because of the really bad ones; I want DNR tattooed on my chest in the event of an accident that might make me dependent of a vent,trach, peg etc to continue living.. I have seen pts with an ICP of over 280 a full code, AAA's that walk out the hospital while others have major issues.. You just never know. It is very hard for the families to let go and at times follow their loved ones wishes, but the hardest is when the decision is left to the family because no advanced directive was made and the families are left with the "what if" questions for years no matter if they "pulled the plug" or continued treatment. It is not always cut and dry.

Don't get me wrong, we do have alot of success stories with our pts but you just never know if this accident or injury will leave you bedridden for the rest of your life and that is not something I want to take a chance on. I don't want to be a burden to my family with all it's emotions..

Up Vote Up Vote ×
Specializes in Mental Health, Medical Research, Periop.
Regardless of what we feel is right, we must respect our patient's autonomy.

I am a hospice RN and have seen my share pts ofwho are "full codes", while they are on hospice services. Most of them have been/are in their 30's or 40's. Some olders. It just depends. Most of these terminally ill pts will change their minds (code status to DNR) as the disease progresses. Some do not, so we must respect their decision.

We can never judge (and I'm not saying you are, OP), until we have walked a mile in the other person's shoes.

Interesting topic.

Best,

Diane

Yes I agree with Diane. I've had a patient in her 90s, full code, and when she coded you could feel her fragile ribs breaking beneath your hands. Although, we may not choose it for ourselves, I do understand how family members feel when their loved one is about to die. It's very hard to let go. Many families have hope that their family member will always pull through. They really don't understand the medical portion of it, only that they can't bear to lose someone they love and care about. Unless the patient already has a DNR in place, we have to respect to POA decision, even if we disagree. Some incidents are sudden and unexpected and the person may not have a living will and the family makes a very difficult decision. Like Diane said, all we can do is respect the patient/POAs choice (which sometimes can be difficult for us healthcare people).

Up Vote Up Vote ×

If the patient wants one thing and that is DNR and they have directives and a living will, why is the family given any considerstion, that is not right. My Dad had everything in place in case he was going south and my sisters walked all over what he wanted done as if it didn't exist because one of them had POA. Once a family member has made up their mind and all the paper work is in place it is not any body's place to change what the family member wanted period.

Up Vote Up Vote ×
Specializes in Med-Surg Nursing.

What happens a LOT where I work is a pt comes in A&O and wishes to be a Do Not Intubate..but then their condition deteriorates and the family with the Doctors consent changes the patient to be a full code. Just recently this happened where I work, pt was Do Not Intubate but crashed one night and the Dr talked the family into intubating her, which only prolonged her life by 36hrs..pt was 89 yrs old.

Another pt came in with a living will which stated she did not want intubated, tube feedings, blood or antibiotics. She ended up with the last 3.

Why even HAVE a living will if family or Dr's can override them?? IMHO it ought to be a criminal offense.

Up Vote Up Vote ×
Specializes in LTC, Hospice, Case Management.
If the patient wants one thing and that is DNR and they have directives and a living will, why is the family given any considerstion, that is not right. My Dad had everything in place in case he was going south and my sisters walked all over what he wanted done as if it didn't exist because one of them had POA. Once a family member has made up their mind and all the paper work is in place it is not any body's place to change what the family member wanted period.

The family is given consideration because they are the one(s) who will be around to sue you! It is the sad but real truth. That piece of paper is only as good as your weakest family member. I am confident that even my two teenage children could make a reasonable decision for my care and could "let me go" without guilt as they have heard for years how I feel about all of the futile care I have seen in long term care. And, I would like that DNR tattoo on my chest just in case. :)

Up Vote Up Vote ×
Specializes in Mental Health, Medical Research, Periop.
The family is given consideration because they are the one(s) who will be around to sue you! It is the sad but real truth. That piece of paper is only as good as your weakest family member. I am confident that even my two teenage children could make a reasonable decision for my care and could "let me go" without guilt as they have heard for years how I feel about all of the futile care I have seen in long term care. And, I would like that DNR tattoo on my chest just in case. :)

WoW! GOOD POINT! I never even thought about lawsuits!:eek:

Up Vote Up Vote ×
Specializes in Trauma Surgical ICU.

Nascar Nurse.. I am still debating how to have it written so it still looks "good".. Right over my chest so if they go to do compressions or shock; they will see it and stop... My husband and my children know how I feel about this.

Up Vote Up Vote ×
Specializes in Med-Surg/Oncology.

Nurses have a unique perspective on end of life matters because we get the full picture, thanks to our access to information about the patient that the family may or may not have and we have the knowledge and experience of how to apply that information to come to a reasonable and expected outcome. Being an outsider looking in, we KNOW when a situation is hopeless, we KNOW when a patient's quality of life is a bit on the negative side of the column.

But for some/most people, when faced with that critical moment of making a critical decision, there are many reasons they hope against hope: they do not want to be the one to "pull the plug" for fear it is not what the patient wanted (guilt that they "didn't fight" for mom/dad/sister/brother/etc); they do not want to be the one to "pull the plug" for fear they will be demonized by the rest of the family; they believe the patient will miraculously make a turnaround if they just hold on a little longer.

As a previous poster said there is usually a very strange and sometimes vindictive family dynamic at play when it comes to arguing over DNR/no DNR.

You have to realize that people who insist everything be done for their family member who clearly wants to be let go often do not care about the big picture, they do not consider suffering of the patient, they can only see their own intense despair at being without mom/dad/sister/brother/etc and cling relentlessly to the patient; they would rather have the patient physically there, even if comatose, than let go. Sometimes they come to peace with this and finally allow us and them to let the patient go. Sometimes they don't.

Up Vote Up Vote ×

Don't make your POA a family member.

Up Vote Up Vote ×
+ Join the Discussion