My best friend in nursing school was ordered to terminally sedate a stroke patient.

[Love767]

He was comatose and given little chance of recovery (but was breathing on his own). His family wanted nothing to do with the guy because they said he was a child molestor. A medical review board at the hospital made the decision. Here's what bothers me. My friend was ordered to give 2mg/hr IV. (as needed), but told that he would need the medication every hour. Our instructor said that this will kill most patients within a couple of days, and that respirtory depression wasn't "such a bad way to go". She said that this is done in hospitals everywhere only it's just not called what it is. I'm not sure how I feel about euthanasia (there are good arguments on both sides), but the point is that I thought that it was currently illegal in the United States. Is this true or is my instructor just wrong about this dose killing most people within a few days? If it is true is this really common or what? Seems like an attempt to implement a policy (euthanasia) without a public debate on the issue.

[gypsyatheart]

I'm not sure of the role of the student here, most programs don't allow for pushing IV narcs until your senior semester, if at all; but I agree this story sounds "fishy"...the OP doesn't seem to have a lot of specifics here....I don't know something just doesn't "feel" right w/this story....

Maybe it's just a student, very new clinical student, not really understanding what was happenning....?

And what happenned to these students (medical) ethics classes, BTW?

I don't see how a student would be allowed to a)use a PCA or b) IVP morphine. Most programs I know prohibit both. Something sounds fishy with this story...

[Vsummer1]

In my program, we are not allowed to push morphine or to even do anything with the PCA pumps. This may be hospital policy, or the comfort of the instructors and their licenses. However, we are dealing with these patients and these issues. We just are not the one to give the shot.

[caroladybelle, BSN, RN]

It is not unusual for MS to be give in this way to a terminal patient and certainly does not describe euthanasia in my mind. Someone please explain why they believe this instructor is so wrong, immoral , etc...

It is euthanasia because the drug is clearly not being given to ease suffering.

It is being given to kill a patient or to hasten their demise and for no other reason, whatsoever.

At NO point in the OP is pain or suffering even remotely mentioned or indicated in the post. The patient is not suffering from a condition that is generally painful in most cases. The vast majority of terminal strokes (though not all) go quietly and peacefully in the death.

There is nothing whatsoever to indicate a painful death in this situation. Therefore morphine is not indicated.

The other issue is the instructor not adequately explaining the situation. My position is, if you can't explain to the student, it is probably the wrong thing to be doing in front of them.

I wish nurses would get a back bone in these issues. If all side rails need to be up, get a darn order from the MD. He won't order it, chart his repeated refusal. The MD wants to hasten a death. Make him get his butt out of bed, come in do it himself, and stay by the bed while it happens. The family wants us to "help" the patient die, well they can take them home if that means so much to them. Let them go to court.

But it is not my job to kill them.

There is a difference between giving morphine to a terminal patient that is pain and has slow respirations...and set up a drip for no other purpose other than to kill.

And we should be teaching students the difference, ...which obviously did not occur in this case.

And "slow" codes and "snowing" patients is a wimp's way out.

[sbic56, BSN, RN]

caroladybelle

I was not so sure there was no suffering. I'd rather give it and be sure the patient was pain free than not give it and risk the terminal patient being in pain of any kind if I could make it otherwise. Kind of goes along with the idea that we know people can feel pain in their sleep, thus we medicate, so why not in a "comatose" state? The OP said nothing about what the patient was dying of, only that they were terminal. It is my job to ease the end of life; if it means shortening it a little in the process, I can live with that, too. I'm not quite sure who you meant was the wimp, the nurse or the patient, but at any rate I disagree with this statement totally:

And "slow" codes and "snowing" patients is a wimp's way out.

[PMHNP10]

:rotfl: For crying out loud people the patient was a child molester! If someone kills a child molester that's a good thing! I wish I could have been the one giving him the drug. What's wrong folks Don't we have enough child molester's already! What a lucky student to be able to do such a wonderful service for humanity!

Here is the thing (and I'm not agreeing/disagreeing with you) but as you said "kills a child molester" is murder regardless of who the person killed is; esp since the nurse wasn't the original victim. Second, and in all sincerity I'm curious...from your point of view, wouldn't it have been better to let the patient die a slow agonizing death, than make the pt comfortable. I'm not flaming, but inquiring.

[DNRme]

WHAAAAT?????

First of all, thank goodness that as students, you are questioning this. You seem to be showing better judgement than your instructor.

We, as registered professional nurses, are all responsible for our own actions. Just because a physician orders somenthing done you are expedted to act as any "prudent" nurse would do in the same situation. If you have any question about the ethics or appropriateness of something you can, while following the appropriate channels, refuse. For example, an order is written for 650 mg of Tylenol for a 2yr old. While the MD is held to account for writing the order, you are expected to know the appropriate dose of any med you are giving. You must also document, document, document.

The fact that the man is a child molester should have no bearing on the care we render. While I would probably feel the same way the family does, if he is my patient I am to help him to his "greatest potential for wellness."

Finally, the physician can give the med if he/she wants to. Just be veerrrrryyy clear in your notes about it.

[PMHNP10]

So many things are going through my mind about this one. I say medicate for comfort. I'll not claim to be an expert at this time, but I don't know that there is any sure fire way to determine if a person is in pain/discomfort without them telling you--only indicators. Also, I came close to posing this question as a new thread, but I wonder what people would say if we assume the role of the pt? I for one say medicate me, even if death mercifully results. Very sticky subject for sure, because as pt advocates/caregivers, we cannot project our feelings. As for the experience...what an opportunity for a student to have.

[KBnursestudent]

:rotfl: For crying out loud people the patient was a child molester! If someone kills a child molester that's a good thing! I wish I could have been the one giving him the drug. What's wrong folks Don't we have enough child molester's already! What a lucky student to be able to do such a wonderful service for humanity!

WOW, i hope this was in jest. I was molested as a child for many yrs along with my sister by my mothers husband. It ruined me inside but I would never want him to be murdered. I for gave this man. I do not forgive what he did but I forgive him. We shouls never think things like this lightheartedly. When we become nurses we take an oath to save lives to the best of our ability. We are never to wish someone dead no matter what they have done or who they are.

[caroladybelle, BSN, RN]

caroladybelle

I was not so sure there was no suffering. I'd rather give it and be sure the patient was pain free than not give it and risk the terminal patient being in pain of any kind if I could make it otherwise. Kind of goes along with the idea that we know people can feel pain in their sleep, thus we medicate, so why not in a "comatose" state? The OP said nothing about what the patient was dying of, only that they were terminal. It is my job to ease the end of life; if it means shortening it a little in the process, I can live with that, too. I'm not quite sure who you meant was the wimp, the nurse or the patient, but at any rate I disagree with this statement totally:

As one who works with the terminally ill and very generous with the meds...even if they shorten life IF THEY ARE INDICATED. But I do not kill people.

As a general rule. if there is pain, there will be some indication (moaning, elevated vital signs, twitching, writhing, sweating, tightening of muscles, rapid respirations).

And if you are worried about the patient not "showing" pain, there are plenty of drugs for pain that will not "terminally sedate" them. Yet there is no indication of any of those drugs being used or tried...just straight to the MSO4 drip.

And there is no indication of the patient having any pain whatsoever!!!!!!!

The title of the thread includes the phrase "a stroke patient". Therefore we do have a diagnosis.

And the wimp phrase is in regard to nurses/MDs/family that will not be honest about what they are doing. If the MD wants the patient to be a no code but is too gutless to address it with the family or to write it, code them and make the MD deal with the aftermath - don't play stupid con games with "slow" codes and things that we are afraid to voice. We need to give appropriate pain relief, but not play G-d. If the family wants the patient dead...let them take him home and do it themselves. Let us be honest about what we do or not do it at all. Anything else is childish and demeans us as a profession...it is also unprofessional and a lie.

As onco nurse, I have enough difficulty getting people to accept DNRs, hospice and comfort care..they worry enough about being oversedated or treatable conditions ignored, and consigned to the"they are dying let's just drug them up, get it over with and ship the body out" body pile - they voice these concerns to me on a daily basis. It is makes it even harder when people play little semantic games with crap like "terminal sedation" and "snowing".

There is a difference between pain control that may result in death and euthanasia.

[PMHNP10]

His family wanted nothing to do with the guy because they said he was a child molestor.

Keep in mind also that just because his family had nothing to do with him in life means nothing about what they'll have to do with him in death. In other words, this wreaks of a possible lawsuit.

[IowaKaren]

Students can't push morphine??????????? Been so long I forget, but I'm pretty sure in my surgical rotation I pushed narcs.

Yes, student's can push morphine/opiods, change PCA pumps when ordered/needed but ONLY with an instructor present. If there is a medication waste, it must be noted by another nurse along with student and instructor. I experienced this during my 3rd semester in my program anyway.

[sbic56, BSN, RN]

caroladybelle

OK...sorry, missed the stroke piece. I'll let this go as, I know I am too heavily influenced by my own experiences and biases. Quality of life issues are huge to me and this man has none left. If I were in this state, I would wish for the nurse to give the MS. To me, lying in bed, unable to move and waiting to die for days on end would be far worse than death itself. (I guess you know where I stand on the euthanasia debate!)