life support and ethics

[GraceAbounds]

Hello!

Thoughts and opinions desired:

preparing for an extensive philosophy project on end-of-life care and life support legal aspects...

What is an ethical dilemma you have ever faced as a nurse regarding these subjects?

Did you ever find that the law "worked against" you as a nurse?

Tangent: My nursing professor tells a story of years ago when she had very well-off patient apparently alone at the hospital with a presumably very sizeable inheritance to leave behind. The patient stated that if he coded he wanted "everything done." The nurse overheard this statement. Later, the patient coded, and was started on life support clearly unconscious and incompetent. Suddenly the family showed up and asked for the machines to be turned off.

Physician told nurse to turn machines off.

Nurse told physician of patient's expressed wishes.

Physician insisted on nurse following orders from wishes of the family.

What would you have done?

[DiscGolfNurse, BSN]

I would have gotten the patients wishes in writing or helped them get an advanced directive set up to avoid this situation. I have never been in this position but many of my colleagues have been. I wonder if we ever do what the patients want in these kinds of situations. I over heard some coworkers talking about a patient who had his wishes in writing but the daughter kept fighting them. It wasn't until after intervention that she came around and accepted that her father was dying. I'm not sure if the nurses did what the daughter wanted but I do tend to see that more. Is this right?

[Undone]

Asaenz12, if that is your real picture you may want to change it. Best to be as anonymous in online forums as you can.

[HeySis, BSN, RN]

I had a patient that had a DNR, this patient would get sick (LTC), transported to the hospital (with her DNR), code and the kids would insist on having the medical team do everything. The patient ended up with rounds of CPR and on a vent multiple times.

Then when the patient was well enough to come back, was infected with MRSA and had permanent neurological deficits with hallucinations and dementia. The children would then come to the nurses station and ask "why does my parent have to suffer like this?"

This was many years ago before the educational campaigns to have an advanced directive, but even then, I have heard physicians say they will follow what the family wants because the patient will most likely not be in a position to sue, but the family will.

This is why I educate patients on an advance directive and having a healthcare proxy that knows and will follow their advance directive. One they have talked with about all their wishes, philosophy's on what a quality of life means to them. When our health proxies understand our priorities and what we hope our life to look like, they can make decisions even when the "never talked about it" unexpected situation arises.

[sailornurse]

Asaenz12, if that is your real picture you may want to change it. Best to be as anonymous in online forums as you can.

A Saenz change your username if this is your real name.