Moral Issue Question...

fultzymom · Mar 29, 2007

Well, the thing about that is that it is the doctor's decision to make, not the nurse's. We have nothing to do with it. If a family asks my opinion about those kind of situations, (I work LTC so it is usually about starting/stopping a tube feed or something of that nature) I try to give them the facts about what it will do for the patient, how it will help them, or how it won't depending on the situation. I try to keep things factual so that a family could not say that I attempted to force my opinion on them. Now as for turning off life-support, I would assume that the doc does that but I have never worked in the hospital setting so I do not know for sure. Nurses do not have to make those kinds of calls. Our job is to educate the family et support them in any way that they need with the decision that they make.

jmgrn65, RN · Mar 29, 2007

well if the patient is on a vent. the family will have to d/w the Doctor, and consult the patients living will (if there is one). If the Doctor does indeed order to be taken off the vent. It is usually a one way wean, meaning the patient is slowly weaned off the vent. Keeping the patient comfortable.

Honestly I have yet to see or meet a nurse that is against this. Because we know that it isn't assisted suicide, it is letting nature take its course and not torturing the patient any longer. If you have a problem with it, then you would ask one of your co-workers to take over for you while you take care of their patient.

TazziRN, RN · Mar 29, 2007

There is no moral issue here because if a nurse or other person pulled the plug based on a request from the pt or family, that person could be held for murder. The family and pt need to make an informed decision to withhold life-saving measures with the physician and guidelines have to be followed.

gonzo1, ASN, RN · Mar 29, 2007

In my four years as a nurse I have found that the people you work with are very understanding. If you are ever in a situation where you have to care for a patient that you are not able to for whatever reason, someone will trade with you. Also, nurses don't pull the plug, neither do doctors. There really isn't a "plug" to pull. It usually works as a gradual elimination of services as agreed upon by family and doctor. If you are not comfortable talking to families about any aspect of care, someone will step in and assist. Eventually, you will become able to discuss these things, or find another line of work.

Thepreacherswife · Mar 29, 2007

Thank I really value all of your guys in put. As far as me not being able to talk about it with the family, there is no problem there I could talk to them about it. I was just talking about the physical act of removing/ stopping whatever care was being given to keep the patient alive. Thank you for letting me know the Doctors (most times) are the ones who stop a certain aspect of care. Its great to know that co-workers will be understanding hopefully! Thanks to all of you for the help!

HenryH0 · Mar 29, 2007

I always wondered how I would feel about letting a pt go. I think that people sometimes glorify what a really sick, close to death person in the hospital looks like and what they go through on a day to day basis. I always thought that it looked like the movies and was quiet and peaceful but then reality slapped me in the face. Once you see what these people go through you may change your mind about how you feel. Just keep and open mind.

I always thought that I would have a hard time not pulling out all the stops to save someone and that it was moderately cruel not to do everything in your power to help them.

Then I got placed on a unit with very sick people and quite a few of my patients were palliative or were diagnosed as palliative while I was caring for them and I changed my mind. I know now that if it were me in the hospital bed with no cure in site, people changing me 2x a day, feeding me because I can't feed myself, drugged up with every narcotic in sight to keep the pain at bay and having to eat (not drink) all my fluids because I could no longer swallow that I would rather move on.

gitterbug · Mar 29, 2007

No moral issue here. I do not pull plugs, that is murder. I give end-of-life care. Pulling the plug is for the doctor, family, ethics committee, and minister to accomplish. Allowing someone to have death with dignity, as pain free and comfortable is possible is my moral issue.

caroladybelle, BSN, RN · Mar 29, 2007

I have been wondering about moral issue with nurses and patients. For example say a patient is on life support and the family wants you, or maybe even the patient requests the "plug" be pulled. Say, you as the nurse believe that is suicide for them to not want to do everything possible to stay alive. I know I obviously could not force my morals on others, or do something against the patients wishes, but do you think that asking another RN to "pull the plug" would be appropriate or do you think the RN who was asked to do it would accept that?

Nurses do not make that decision. Nor is there an ultimate "pulling of the plug".

I see much of what we do often as interfering with G-d's plan for us, sometimes when we fight death at all odds. And when we stop some interventions, that we are ultimately letting G-d's will be done.

If there is a "miracle" to occur, the terminal weaning from the vent is not going to stop that miracle.

I also believe that the miracle when a family comes together to pray for life....the miracle is the coming together and the resolution of longstanding issues, NOT a sudden "cure" miracle.

I also see nothing G-dly in brutalizing a 90 y/o pancreatic cancer pts body by breaking their bones during CPR and venting them. Or subjecting to surgeries with no reasonable chance of cure, and a great deal of harm.

Thus I have not trouble ceasing treatment per pt wishes. I WOULD have a problem with interventions that hasten death unnecessarily. But in 13 years as an RN (working in Oncology and HIV units), I have never dealt with medical orders to that situation, though have had patients/family/SOs ...even very right wing religious ones, ask me privately to hasten death inappropriately.

Nothing like seeing a politico/known figure that preaches against abortion, birth control (which this individual considered as a form of abortion), and pickets to prohibit the removal of feeding tubes...turn around and ask staff to OD a loved one.

Dixiecup · Mar 29, 2007

I think I may have posted this before, I can't remember!

I worked in corrections for 13 years. It was a maximum security,level five institution where they did executions.

Even though these people committed heinous crimes, there were some nurses who had a real moral and ethical problem with the executions. And we did not participate in the executions, outside nurses and doctors were contracted to carry out the medical portion of the executions.

Anyway, nights when there were executions, (I was the DON) I would just schedule those nurses off for that shift.

TazziRN, RN · Mar 30, 2007

we did not participate in the executions, outside nurses and doctors were contracted to carry out the medical portion of the executions.
Anyway, nights when there were executions, (I was the DON) I would just schedule those nurses off for that shift.

Why were outsiders contracted? To keep the staff safe? Just curious, I had no idea that the prison medical staff had no part in it.

CRNI-ICU20 · Mar 30, 2007

A Withdrawal from Life Support order is only written by the doctor, and only after he or she has consulted with the family and legal POA for healthcare of the futility of life support. This isn't assisted suicide. The patient has been declared by usually more than one physician as not viable without life support, and the "risks of keeping them on life support, outweigh the benefits" as outlined in most living wills, etc.

The actual "pulling the plug" does not occur by the nurse...typically, the resp. therapist and sometimes the dr. will extubate the patient.....

Not always, do people die right away....they may linger for several hours or days after extubation, depending on their underlying illnesses.

To look at it another way, if the patient was suffering 50 years ago, they would not have the life support systems we now have, and would never have survived anyway.....so...truly, we are in some ways, through technological advances prolonging life that naturally would have ended.

That is not assisted suicide.

Many nurses have a harder time with abortion....or assisting with one, as opposed to withdrawal from life support.

I think that position is a much more difficult one.

But again, it's the patient's decision and their loved ones....not ours....

I have assisted with many withdrawals from life support.....it is a part of my job....just as much as intubating them in the first place is. I would never impose my personal beliefs on them......this is highly personal....and very intimate for the family. I am, at that point, an onlooker, who provides comfort, dignity and support....

I consider my nursing to be not only one of saving lives....but also one where I assist people in finding comfort in the last moments of their living.....however that may be achieved....

Nurses don't arbitrarily pull the plug....even if the family wants it done....that discussion and action has to involve a dr. order and follow through....

So much of this is highly individual....if you have a brain infarcted patient who is only breathing because the ventilator does the work of breathing....and the heart only beats because of ventilatory support, and you know through brain death studies....ie cerebral blood flow study, cold caloric....EEG....etc. that the patient is braid dead....why would anyone with any MORALS want to keep a body alive that no longer has any brain function? They will never wake up....a miracle at that point is not realistic....and we are now dooming this body to be brutalized in a sophisticated process of needle sticks, iv lines, and tubes to do what???

There are many sides to this issue....

It does take soul searching....which is good....because our bodies are temples....and we do owe one another respect with that....we also owe our patients respect for their wishes to be withdrawn...