This time of year, we get them. Patients so gravely ill that they must be placed on life support. Ventilator, pressors, art lines, central lines, Swans, trans venous pacing, CVVH. And when all of these have failed, or are failing, the families want to keep their loved ones 'alive' until the holidays are over. I'm talking about patients for whom the term "futility of care" was created. And I just don't know which is worse...The families who want their loved ones to maintain a heartbeat until the holidays are over or the physicians who acquiesce to their demands.
Have we, as a society, become so reality averse that the thought of a family member passing during the holiday season is simply unbearable? Which would people have as a last memory of their loved ones? Passing peacefully at home on hospice...? Or tied to multiple life support systems as their systems shut down, they weep from every extremity and their skin sloughs off to the touch?
Too many families faced with this insist on 'everything' being done for their loved ones with no real comprehension of just how much and how far 'everything' can go. And the healthcare community won't stop and educate them as to just what 'everything' entails. It's a sad fact at this time of year, and it will continue so long as physicians fail to make the situation crystal clear to families with a loved one at the end of their days. Such cases not only use up valuable resources and critical care beds, they deny access to those who would benefit most from them. Never mind the emotional toll such patients take on the staff assigned to care for them, as they watch their efforts go for naught. And all because people fear their own, and their loved ones, mortality. Fear begins when you suspect your mortality and ends when you accept it.
i'm not sure who you're referring to here, but i'll bite:
what gave you the right to pass judgement on a nurse who is off duty, posting on a vent thread. you have no right to comment on the nurse's capabilities; i doubt you even know what those capabilities are. nor is it your place to advise someone to relinquish their job.
i write not as a nurse, but as a family.
and if your capabilities are surpassed, then by all means, please relinquish that position to another.
I too have had families request momma be kept alive until the next social security check could be cashed. Most recently saw a 70 y/o intubated *against her will* at insistence of the family who lived (illegally) in her subsidized apartment and had no where else to go. Therefore momma had to be kept alive at all costs. Last I knew this unfortunate woman was still alive, on the vent, and unweanable. She was going to be sent to some facility that could manage her long term vent needs. No idea how long it will take TPTB to figure out she doesn't need her subsidized apt.
To me, these are the worst (and quite common, as I hear from friends who work critical care). Some may be surprised that the SS check will have to be paid back for the rest of the month (e.g., Grandma "dies" on 1/2; the prorated amount for 1/3-1/31 has to be paid back), but this is probably not true for some private pensions and other payments. Families' greed can be unbelievable and very discouraging...
... and we all know that if they had to pay for part of their "loved one's" care, even a small percentage, they would be very quick to pull the plug!
Specializes in RETIRED Cath Lab/Cardiology/Radiology.
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Sounds like you are saying that the doctor gets to decide when to discontinue any and all treatment; is that correct?
Yes, actually he does. The physician is the ONLY person who can order or discontinue treatment. He may do so in agreement with family, consulting physicians or on his own. A doctor will STRIVE to involve and teach family enough to have them in accordance, but when there is strong disagreement, the physcian will make the final call. So, yes, you may want Granny on "everything possible" , but your wishes are NOT the ultimate influence.
Families often want the wrong things, for the wrong reasons. The original dilemma we were discussing had to do with that very tricky dilemma, and the recent problem in medicine about how too many doctors will not spend the time counseling patient's families unrealistic hopes and goals.
Yes, actually he does. The physician is the ONLY person who can order or discontinue treatment. He may do so in agreement with family, consulting physicians or on his own. A doctor will STRIVE to involve and teach family enough to have them in accordance, but when there is strong disagreement, the physcian will make the final call. So, yes, you may want Granny on "everything possible" , but your wishes are NOT the ultimate influence.
Families often want the wrong things, for the wrong reasons. The original dilemma we were discussing had to do with that very tricky dilemma, and the recent problem in medicine about how too many doctors will not spend the time counseling patient's families unrealistic hopes and goals.
I thought that's what you were saying, and this is exactly the kind of thinking that gave rise to the idea of "death panels."
Sounds like you are saying that the doctor gets to decide when to discontinue any and all treatment; is that correct?
I'm saying that. If the treatment is medically futile the doctor can decline to provide it. A simple example would be someone with multiorgan failure whose family demands dialysis. Dialysis won't fix or even slow down all the other problems, so it is futile. Of course declaring futility lies on a continuum, some cases are very clearly a disaster, and some are debatable. Legally, and according to the medical board docs can decline to treat because nothing can fix the problem. Most will go through the motions because they hope in a few days the family will see the light, or for practice, or because they want to ward off a lawsuit. Years of fighting a suit is more painful for them than treating an obviously dying patient for a few days. In the meantime they can call in every consultant in the hospital to back them up.
Even though they CAN refuse to treat it's much easier, lucrative, and more PC, to flog diligently and be beloved by the family for trying so hard.
I have no problem with families insisting that their loved one (whose death is relatively imminent) be kept alive over the holidays, a certain special date or event, etc.
However, I think said family should foot the bill for this futile care and not the taxpayers. I bet that many of them would change their minds quickly.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i have no problem with families insisting that their loved one (whose death is relatively imminent) be kept alive over the holidays, a certain special date or event, etc.
however, i think said family should foot the bill for this futile care and not the taxpayers. i bet that many of them would change their minds quickly.
i used to work with a physician who was quite proud of the fact that he'd screwed the state out of a lot of money. prisoner came in from jail with a massive head injury or stroke or something. he was more or less -- but not quite -- brain dead. doc pronounces him dead and wants to withdraw life support. prison bureau says he can't withdraw life support because that would be shortening the prisoner's life sentence. they fight about this for days until the prisoner's heart stops, thereby rendering the debate moot. now he's well and truly dead. everything is well and good until the hospital bill arrives. state pays the hospital bill . . . up to the point where the doc originally pronounced the patient, but they won't pay one penny more. they don't have to, you see. they aren't liable for health care expenses after the prisoner dies. hospital won't eat the bill (state hospital, by the way) because they wanted to withdraw support but the bureau of prisons wouldn't let them. bureau of prisons doesn't want to pay the bill because they don't have that much in their budget. the state should pay -- which ever branch of the state pays for prisoner's hospital bills. the state won't pay because the prisoner was dead as of march 12 at 1400 and they're not paying one cent for charges accrued after that point. it went round and round for years and is probably still going round and round with three different arms of the state suing each other for that hospital bill and all of the attendant attorney's fees . . . . .
it would probably solve most of our health care budget woes if people who wanted to "do everything" against the best medical advice had to pay for "everything" out of pocket!
Specializes in Spinal Cord injuries, Emergency+EMS.
I thin ruby's post immediately above just sums it all up ... futility is best decided by clinicians, if you want a cross check then you mandate that the decision on futility is confirmed by another relevant senior doctor ( which in a lot of cases is going to be an intensivist or oncologist.
combine this with community education on DNAR and what it actually means along with reasserting the rights of the clinician to discontinue none productive interventions and the problem is far less of an issue . this has become an issue in the USA because for hospitals and Doctors - someone else is paying ...
sadly the media may be our ( healthcare professionals) enemy in this you only need to look at the response of the tabloids in the Uk to the Liverpool care pathway
I thought that's what you were saying, and this is exactly the kind of thinking that gave rise to the idea of "death panels."
You are now simply being inflammatory. The original discusson was of reconciling unrealistic expectations of families and loved ones vs. the cost, both financial and patient-borne, of keeping terminal pts alive beyond any hope of recovery.
Hey @dzadzey, MSN, RN you seem like a straight shooter. I appreciate that. I am a nursing student working in an ICU, with hx working in Hospice, home health, ems, etc. My current place of work, from my perception, prolongs life to the point of what appears inhumane, practices extraneous procedures, and does not always hold the necessary conversations of advanced care directives and what we can REALLY do for people. Can you help guide a nursing student? I approached my manager and stated I was having difficulty navigating this, and I walked away with I will either accept it or I won't... So if you might shed some light? If so, I just am concerned that these things are going to haunt me in my career, no matter how much I love helping those who will make it off our unit and have a quality of life, no matter no much I love the science...thanks.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I realize this is a very old thread but....
My grandmother passed on Christmas Day many years ago. Christmas was never the same after that. But I learned to focus on the living around me and try to keep the memories alive, in their place.
No one wants to lose a loved one on what is a sacred or special day for them, but it does happen. Letting people suffer to alleviate our own discomfort is indeed, very selfish, IMO.
Katie5
1,459 Posts
i write not as a nurse, but as a family.
and if your capabilities are surpassed, then by all means, please relinquish that position to another.