Moral Issue Question...

[Thepreacherswife]

Ok, not sure where to put this question, so please bear with me if it is in the wrong section. I just kinda want to see everyones opinion about this situation. I am not in Nursing School yet but I am finishing up my pre-reqs for that and will have my CNA soon.

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? Maybe someone with different beliefs could answer. How would you feel if you were asked to do that for another RN? Has anyone ever been in this position before?:uhoh21:

I don't mean to stir the pot, just this question has been on my mind for awhile and I wanted to know what all of you thought about this. I just need to know if morally there are alternatives for me, instead of compromising my faith as well as letting the patient have thier wishes too.

Any advice, answers or stories are welcome!

[Thepreacherswife]

ICU-20

Very interesting thoughts. I had never really looked at technology as a means of prolonging life but now that you have mentioned it, that is true. I would never force my beliefs on a patient or the patient's family because obviously that would be high un-professional. My beliefs however would never let me assist in an abortion. If that was something I was asked to participate in I think I would be finding another job!:uhoh21: As far as "keeping a body alive" I do not personally beleive I have the right to say that pt will die if you take the ventilator out. I do believe the highest of all has that power, to keep the person alive. But anyways, my questions wasn't about morals! :roll

However, I guess my main point in this thread was wanting to know if asking another co-worker to take my place for awhile should it come down to taking a pt off a ventilator would be appropriate. As I have found out now, that is mostly a doctor's call and procedure. Which relieves me! :) Anyways, thank you for your thoughts, very thought provoking indeed!

[Ophelia78]

The previous posters are correct- it is a decision made between the family, physician, and the ethics committee, if involved. Patients who have treatment withdrawn are dead already or dying. There is only so much you can do to keep a dying person alive. We have a few tools in our orificenal, but it always isn't enough. We'll have patients in the ICU whose families just can't let the dying process happen. We'll have the patient vented, on several pressers, dropping massive amounts of blood products in them. They still die- it just takes longer and they suffer more. Sometimes they'll die and vent will keep banging away- we can't turn it off until the doc declares them. I can't say those deaths look peaceful. For others, the family will say enough is enough. The doc will order to stop pressers, extubate the patient, and provide comfort care. We can give oxygen. Often there'll be a morphine drip- dose prescribed by the doc. I'll turn off the pressers and hang the drip. Respiratory will usually extubate. Sometimes the patient will last a few minutes and sometimes a few hours. I've never seen a death that wasn't peaceful this way.

If you weren't comfortable doing this your coworkers should help you, maybe juggle the assignments a bit. Just remember, the patients aren't being killed by us. The disease state is killing them. We are just ensuring they aren't being tortured as it does so.

I can say with 100% certainty that I would rather have treatment withdrawn than suffer for days or weeks with my skin breaking down, constant needlesticks, alarms going off, being turned, a tube in every orifice, and suffering without being able to communicate my pain.

[TazziRN, RN]

Preacher's Wife, I'm curious: how do you feel about organ donation? Not trying to stir the pot, just trying to bring another thought into this.

[Thepreacherswife]

Morning Tazzi!

I am an organ donor myself. I have the little pink sticker on my driver's liscense. When I am dead and gone I won't need those organs so if someone who is dying can use them because we are a match then that's awesome!:loveya:

On another note, I said to ICU-20 in my last post it wasnt a moral question, I take that back, I meant to say the main part of my question was not about that... Just what to do about the situation. LOL So I wanted to take that back... Tazzi I am interested to see how organ donation ties in with this! :yelclap:

[TazziRN, RN]

Many organs cannot be donated once the body has been off life support, like the heart and lungs, kidneys and liver. In order to use those organs, death has to be declared while the patient is still on the vent and medications to keep the blood pressures up. If you do not believe that a patient is dead until he stops breathing on his own, how do you justify using organs for donation?

[Thepreacherswife]

Hmmmm.. I am not following you. Of course you can use a person's organs if they die, regaurdless of how. They can airlift a heart to the recipient from a donor who just died say in a car accident. They can keep the heart pumping with a machine or put it on ice. Many organs can be used regaudless of how one dies. I think what you are trying to say is that organs can't be used from a pt body who dies when they are taken off life support? If this is what you are saying where are some facts on this?...

[colleennurse, ASN, RN]

Hmmmm.. I am not following you. Of course you can use a person's organs if they die, regaurdless of how. They can airlift a heart to the recipient from a donor who just died say in a car accident. They can keep the heart pumping with a machine or put it on ice. Many organs can be used regaudless of how one dies. I think what you are trying to say is that organs can't be used from a pt body who dies when they are taken off life support? If this is what you are saying where are some facts on this?...

Preachers Wife, I think what Tazzi is trying to say is that in order to use someones organs that is a donor that person has to be kept alive on life support until they are ready to harvest whatever organs they can. You cannot use organs from someone that has been deceased for a while because they are no good. There is only a certain amount of time they have to use the organ once it has been harvested. Blood (which contains oxygen) has to be perfusing the organs in order to keep the organ viable. Someone please correct me if I am wrong :)!!

[TazziRN, RN]

You're right, Colleen, that's what I was getting at. Death is declared while the pt is still vented and pressored. If PW (I am not attacking, am pointing out) has a problem with stopping life support, then how can organs be harvested? In a multi-organ harvest the heart is the last perfusion-dependent organ to be removed because the other organs need perfusion for as long as possible, so by PW's definition of death, the pt is not yet dead.

[Thepreacherswife]

Interesting... I had never known this or thought about this. Maybe I should change my mind on organ donations. Is it possible for one to choose(like myself) to be an organ donor with stipulations? If I was ever on a ventilator obviously I would not want someone (the DR. ) to say "she's dead ok take out her organs because she is a donor."

However If I am killed in a car wreck and my chances of survival are ABSOLUTELY zero (because I am dead) then of course have at my organs!

LOL this is why I love this site, so thought provoking!

[TazziRN, RN]

Doctors to not do that, and it is not a unilateral decision. Tests are run to check for brain function and at least two physicians have to concur independently that the pt is brain dead.

The thoracic organs cannot be used after pulse and respirations have ceased, but skin, bone, and corneas (and other things, not just those) can. You can stipulate what you want to be used.

Here's a personal example for you: my brother was in a coma, on a vent, after a car accident. On day 7 he had massive, sudden swelling in his brain and suffered brain death. This happened in the morning. By the time tests were run to check for brain function and death was determined, it was after 5 that evening.

Organ harvesting teams do nothing until death has been pronounced, and then it can take hours to find matching recipients and get the harvesting teams there. My brother's organs were not harvested until early the next morning. During all that time, if he had shown any signs of life, there would have been time for someone to see it. The organ donor is not left alone until the team is ready for harvest, the harvesting coordinator is doing one to one care with the donor.

What I'm trying to get at is that you are asking about the morals and ethics of being the nurse involved when life support is stopped, yet you believe in organ donation. The two do not go hand in hand. I'm just trying to get you to think.

[Thepreacherswife]

Oh Contraire,

I beleive they can go hand in hand when the stipulations are followed. My example was I only want my organs taken if I am dead from being involved in a car accident. I am talking an accident where I am pronounced DOA. (Which this just happened to a girl I went to HS with Monday-terrible!, now her 6 yr. old nephew is in a coma )If I am ever one a ventialtor then for get it, I want no part in it (organ donation). As fas as doctors "determining" someone is deaceased that's where we disagree. I do still beleive the two can go hand in hand. Just certain situations. I don't see how taking someone off a vent and giving organs from my dead body (that has not been on a vent) have the same principals involved. :studyowl:

I am truly sorry about your brother. That must have been a terrible thing to go through. My heart goes out to you and your family.

[TazziRN, RN]

No, no, what I mean is, the thoracic organs canNOT be used is perfusion stopped before harvesting. If you have stipulations, like "Do not take my thoracic organs", great. If you want your heart or lungs or kidneys to be used, then you have to be vented and pressored. If you are DOA then those organs cannot be used, but other things can, like skin and bone and corneas. If you do NOT want to be vented and pressored pending donation then you need to state that on your donor card.

I'm not sure what you mean about the doctors determining death.

As for being on the vent, someone who is pronounced dead is never placed on the vent because he is an organ donor. Someone that we know is going to die because of the injuries is never vented on the chance the family might want to donate. The vent happens when there is a chance at life, to support the body until it can heal. Very often it goes the other way instead and the injuries are so severe that the body cannot heal. That's when donation is considered.

I hope this is more clear.