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.
Yes, this helps and is more clear..lol took me long enough!
What I meant was I personally beleive (not trying to force my beliefs on anyone here) is that no matter how many doctors say this person is dead that there is a chance G-d will let them live. Just my opinion of course. Which is where my original question came in about asking another RN to relieve me while pt is taken off vent.
I just read this article and it so clear now. I am not Catholic so please disreguard that at the top of this article.
I completely understand. You understood how I was thinking, I don't beleive in this at all because the doctors are killing you (IMO) to take your organs, some pt even while they still have a heart beat!
The vast majority of USA MDs accept the definition of death as "brain" death. While organs can continue to perfuse, especially with vent support, for short periods after "brain" death occurs...the patient is still dead. That which made the patient "human" and that could enable them to exist as a functioning being is gone from the brain dead individual. They are not going to recover, therefore it is not "killing" anyone to remove them from the vent. They are not going to be rising from the dead, barring G-d creating a miracle - (and if G-d chooses a to do a miracle, I think that will occur before the transplant team appears at the site). G-d creates miracles where he chooses and nothing that we do could do would stop it.
There are cases of brain dead individuals living on vents for short periods of time. But they are not recoverable and eventially die. G-d did not intend for us to exist that way and body systems break down.
Brain death is NOT the same as persistant vegetative states or comas. Brain death is not reversible, curable or repairable.
Thoracic organs (hearts) must be transplanted from a physically living (or perfused) body to a living host in 4-6 hours MAXIMUM. Given the amount of time that it takes to bring the body from the accident/locale, determine death, determine organ viability, tissue type, check for disease status, get permit to harvest from the next of kin, locate recipient/MDs and prep them......this is not a large window of time. Thus most lungs/hearts come from vented patients that brain death is verified but the bodily systems are perfused until the recipient is identified and everything is set for as little transfer time as possible, before "physiological" death occurs with discontinuation of the vent.
Some countries do not accept "brain" death as death. Japan, for one, does almost no heart transplants. One was done in the 1960's and then they were banned, until 1997. They are still rare, there.
Sometimes, the most moral thing to do is to withdraw care. When you've got a patient who's on the max amount of pressors, high-level vent support, continuous dialysis...when all of their organs have shut down, and the only thing keeping their body alive is the machines, and there's no chance for any kind of recovery; when their heart keeps stopping and they have to be run through the whole ACLS protocol, including multiple shocks, compressions that break ribs, etc; when there's absolutely nothing left of the person that once was there. Continuing care in that situation is nothing more than torture.
There is only one certainty in this life, and that is that we will all die.
Being able to die comfortably, in a caring atmosphere does not cause any moral dilemma for me.
As one of the posters said, even if all the machines and meds are stopped, the actual time of death cannot be predicted. That's up to a higher power....
PW every organ donor of organs such as heart, lungs, liver, kidney etc has a heart beat when the organ is removed from the body. The retrieval process is a surgical procedure,.done in the OR, sterile, sugeons, circulating nurses, monitors, medications, etc, just as if the Dr needed to remove your kidney because of cancer. The donor is on a vent to mechanically allow for the blood to carrie oxygen to the organs,..large amounts of medications are given to keep the blood pressure high enough to profuse the organs, ie keeping the heart beating. Heart cells, renal cells etc become ischemic w/o oxygen and will no longer function. In your situation w/a car accident, being DOA, at the scene, those organs are not retrievable. Now,.with that said,.if the EMT's arrive,.intubate you,.bring you to ER only to discover you have had massive brain injury that it is impossible to correct,.then IF they are able to keep the profussion high enough to get the transplant team to the hospital, get to the OR, then maybe some of the organs could be saved.
The point here is that the mechanical, and chemical intervention is what is keeping the heart beating, the blood moving to those organs. The body would not be able to do this without MUCH intervention from medical professionals.
This is one major reason many are opposed to organ donation. It really depends on how you define "living". If I am at the mall,.a man drops to the floor,.he isn't breathing, he doesn't have a pulse,..I start CPR,.while I'm doing chest compressions you can feel a pulse, when I stop doing compressions there is no pulse, the heart isn't moving,.start compressions again and a pulse,.......is this person alive?
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.
To Preacherswife:
Unless you have an organ donor team at the scene of your accident, (providing you die that way...) you are probably NOT going to give viable organs to a donor....so much has to be assessed, ie, what if you had a lacerated liver from your accident, and bled to death as a result....your other organs are now compromised, because you haven't had blood pumping into them....and so they are no longer viable to be used for donation.
So your idea that being a donor ONLY if you die as a result of an accident in the field, is wishful thinking.
In some scenarios, you could throw a clot to your brain stem....or basilic artery....near the circle of Willis, a common place for blood clots to form, and this then, strokes out your whole brain. You will not live without the benefit of ventilation support, tube feedings via PEG tube, and tracheostomy for airway....you will never breathe again on your own, because the brain stem centers control heart beat and breathing illicitation for our bodies. You will most likely be blind. You won't be able to smell, and may have no hearing. You will have sensory impairment; you may not have normal body temperature regulation, or normal endocrine function. You may not be able to even feel touch, heat, or pain. You may only have sweat glands that work on only one side of your body.(due to afferent and efferent nerve tract interruption)You won't be able to interact at all with your loved ones, or caregivers. You will be destined to a life in a nursing home or ventilator center. You will not be miraculously healed from this event....you will not miraculously wake up, speak, walk, chew food, see, smell, or have normal bowel and bladder function.
What you used to be, is not who you now are....and you won't be that person again, because there is no such thing as a brain transplant. Your body organs are only alive because of ARTIFICIAL intervention. So now you are in a place that is betwixt and between. You aren't ever going to recover to your normal baseline, but you do have a heart beat because the ventilator is supporting your breathing....if you didn't breathe, your heart would stop within just mins......so you see, this REALLY ISN'T LIFE....IT IS ARTIFICIAL LIFE. In this scenario, your organs may be viable, and often are donated, because your brain is dead....the only thing keeping you alive is the ventilator, and possibly vasoactive drugs that help to maintain good perfusion to your other organs, like kidneys, heart, lungs, etc.
I know that some Christians believe that removal from life support is almost tantamount to euthanasia....it isn't. Euthanasia is INDUCED DEATH, via injections, or medications that stop breathing or heartbeat.Withdrawal from life support is not taking away life, because that life was already taken by the stroke. The artificial means of support is all that is perfusing the other organs.
This subject does provoke thought. And it provokes soul searching, because in nursing, we are confronted with this life and death thing every day.
We don't get to choose for another, only ourselves.
This is the prime reason a Living Will and POA for Healthcare is soooo important....because we don't have the ability to know if and when death, or impairment beyond repair may happen.
In all the years I have worked in ICU, there has never been doctors who are anxious to 'pull the plug'....in fact it is quite the opposite....many are more anxious to do all they can to give the patient time to recover if they are going to....
But most, will be completely up front and honest, and tell the family/loved ones what the prognosis really is....because they realize that for many, living in the above kind of state is not what anyone would want for themselves or a loved one....because it really isn't life....
I think there are a couple important facts to remember: Cardiac cells have automaticity. They do not need brain function to continue to fire and contract. They just need O2 and perfusion to keep going. It is blind contraction by cells, not controlled by any higher part of the mind.
The other thing to remember is that as nurses, we are held to "First, do no harm". Harm can be a lot of different things. Harm could be continuing painful or futile treatments on someone with no hope of recovery. It depends on the situation and the patient.
My saddest personal experience with this issue was a case from our NICU. We had an adorable 9mo little girl with severe BPD. Trach'd, vented, NO, 100% O2, constantly medicated for pain/agitation from not being able to breathe. Her parents were holding out hope that she could get a lung transplant someday. Unfortunately, serial MRIs and other tests showed increasing brain atrophy. This means that she would no longer be eligible for transplant.
Her parents, despite the fact she was still able to smile and recognize and things, made the very difficult decision to withdraw her ventilation. They loved this little girl more than anything in the world, but without hope for transplant, all they were doing was prolonging her dying, and it wasn't a comfortable event for her. So they made the tough decision, she was medicated to make sure she wasn't upset or in pain and died in her parents' arms. Some people think that was terrible, but medicine could no longer do anything for her, and instead of waiting and letting her die a long, painful, drawn-out death, she had a peaceful and loving death surrounded by family. It is terrible for the living, but at least now she is happy and free from pain and can breathe.
Things are not always black and white in this world.
We disagree on everything. I am not trying to be harsh but I know you can sit there all day and write there is no hope, they won't recover, that your "medical experience" (which I know you didn't write but you do have lots of years exp.) proves they will not get better. This is where we disagree...I beleive G-d makes that call not you, not I, or anyone else for that matter (just my opinion, once again-not forcing on anyone-just stating mine) But nothing you or anyone say will ever change that. And YES this IS thought provoking at least for me. Maybe one day while in nusing school I will see it isn't for me, I won't be able to do what is being asked of me, morally. However, I doubt this because I can still do this job while still doing what I beleive is right.
LilP-
I do agree w/ you somewhat that things are not always black and white but in this case I beleive the answer is clear to me. It is black and white for me. But again I will say, this is so far off my orginal topic!!!! LOL My simple question was about it being ok to ask another RN to take my place should this situation of taking a pt off a vent ever come up.
I think I have got THAT answered! Haha!
And again I would like to say I don't mean to sound harsh, it's just we disagree plain and simple!
PW, you will change your mind after a few years of nursing. You're right, God does make the decision about when to take someone home. People are just too stubborn to see it right away and we try to delay that journey.
I'm sorry I sent the thread in another direction, but my original intention was to get you to see that your ideas of organ donation for yourself and your feelings about "pulling the plug" don't work together, and that if you truly cannot care for someone that is about to be allowed to die, then you will not be able to care for organ donors also.
I am not trying to be harsh but I know you can sit there all day and write there is no hope, they won't recover, that your "medical experience" (which I know you didn't write but you do have lots of years exp.) proves they will not get better. This is where we disagree...I beleive G-d makes that call not you, not I, or anyone else for that matter (just my opinion, once again-not forcing on anyone-just stating mine) But nothing you or anyone say will ever change that. And YES this IS thought provoking at least for me. Maybe one day while in nusing school I will see it isn't for me, I won't be able to do what is being asked of me, morally. However, I doubt this because I can still do this job while still doing what I beleive is right. 
:lol2:
Thepreacherswife
28 Posts
Yes, this helps and is more clear..lol took me long enough!
What I meant was I personally beleive (not trying to force my beliefs on anyone here) is that no matter how many doctors say this person is dead that there is a chance G-d will let them live. Just my opinion of course. Which is where my original question came in about asking another RN to relieve me while pt is taken off vent.
I just read this article and it so clear now. I am not Catholic so please disreguard that at the top of this article.
I completely understand. You understood how I was thinking, I don't beleive in this at all because the doctors are killing you (IMO) to take your organs, some pt even while they still have a heart beat!
http://www.wf-f.org/NHBD-VatMar2004.html
Tazzi you changed my mind! I have never thought of donations from this aspect with these facts! THANK YOU!