Published Apr 2, 2001
I am currently a Purdue nursing student, and I am trying to write a paper about what a nurses role in euthanasia and assisted suicide is or should be. If anyone has any comments, suggestions, or stories, please let me know. Thanks.
When I was in nursing school, I did my senior paper and presentation on a similar subject. Mine was more about living wills and people's right to decide whether or not to have life support and/or nutrition removed. I took care of a patient during my rotation in Neuro ICU who was brain dead from a ruptured cerebral aneurysm. Her family had a living will from the state of New York stating her wishes and they wanted her removed from the vent immediately. The doctor had some objections (I forget all the deatils) and the case was taken before the hospital's ethics committee. In the end, the vent was d/c'd. I got to pull out her ET tube and be with her and her family while she took her final breaths. It was interesting to note that her husband had been one of my English professors in college, so I think that helped them to open up to me and trust me more. One of the staff nurses in the unit did definitely have a problem with stopping this patient's ventilator, so I volunteered to do it. It turned out to be one of the most formative experiences I had in school. Good luck with your paper!! Hope it goes well.
That's a big, controversial topic and there's a lot to cover. If you search the internet, you should be able to find something. Assisted suicide is, of course, illegal in most states. Euthanasia gets into passive and active and there are a lot of gray areas in this issue. If someone is removed from a vent, some do not consider this euthanasia but technically it is a form of passive euthanasia. I know nurses who stopped working with ventilator patients in ICUs because this was against their beliefs.
I work on a Vent unit & yes we do what we term "Terminal Weaning". When I first started on this unit I questioned the legality of this as well as concern for my hard earned license was well informed about the lengthy process this requires to occur. I was also given the option of NOT caring for a patient that was terminally weaning if I objected or felt uncomfortable with it in any way. Our Protocol requires the use of pain medication..usually morphine unless allergy prohibits..also the tube is NOT removed it is used to give O2 to prevent an uncomfortable,painful & undignified death.This is not an immediate death despite what TV may portray we don't just "Unplug them"!! No Offense but I can't imagine the scenario posted above (especially if there were opposing legalities involved) of allowing a student nurse to decannulate a pt.?? Observe yes... If you have any questions please feel free to ask me.
I agree with the above posts. But it makes it easier on all of us, nurses, doctors, and especially the family members if the patient has a living will and has discussed this issue with their family. I have a living will and every year I look it over and remind my wife where it is and what it says. She doesnn't like it but she knows it is necessary. I also have told my workmates in the ER and ICU what my wishes are and that I have it written in the living will. It also has to do with what your beliefs are. Again, family discussion is so important.
This is a very interesting subject because It goes on in ICUs and ERs everyday. I have wittnessed euthanasia and assisted suicide several times. It was not called that of course because that would be very un-pc. We call it The right to refuse medical treatment. What is the difference in a Jahovas Whitness refusing a transfusion for abdominal bleeding that could be easily treated with transfusions, and euthinasia? The question still ponders me. Or taking an asthma patient off the vent because she doesn't wish to "live like that".
Death is so difficult for us to understand. We are supposed to fight for life but we have to respect the wishes of our clients and their families as long as that discission is made with the knowledge of all of the patients options.
When I worked in the icu, I remember many times having conversations with my co-workers where we would say "If I am ever in that situation, I hope some one loves me enough to take me off the vent or D/C antibiotics and withhold feedings".
There are life situations that in my opinion have to be worse than death, but who knows? Only the person experiencing the situation.
Just a comment on the living will thing...as a woman of childbearing age, I also felt it necessary to include in my wishes that if I am pregnant and on full life support, if my husband wishes to continue keeping me on life support for the duration of the pregnancy in order to save the baby, that is okay. Just something to think about, ladies.
just on the light side of a heavy subject...hmmmmm unless an allergy to morphine...what are they afraid of?...an anaphylactic reaction?....
Dplear, I agree!!! What a great observation. I've never thought about it.
buckboomer, BSN, RN
10 years or so ago, in MN, a large teaching hospital tried ending treatment to a persistently vegetative person. It received national attention. The hospital lost the court case. A nursing supervisor wrote a paper on it from a religious point of view, (catholisism). The spiritual aspects of the person, caregiver, etc are an issue. My parents both died painful deaths and suffered for months. I used to think that man has no right killing another. Now I feel some patients need a free referral to Dr. Jack Kerkovian. We live in a pluralistic society, and we should have that opportunity if we request it. However, ethical councils would be very helpful with pain management, psychology, clerical, and others involved when this need occurs. A friend of mine chose the terminal weaning and was barely 30, with three beautiful daughters. He was very coherent and not clinically depressed, according to the report. I worked on that floor, with others that knew him well. We still have a tough time dealing with that issue, and can not speak of him. His wife was a nurse and said he was a burden to his family. He did the deed after a Vikings game on a Sunday. I am getting choked up just remembering some of the details. Part of nursing is to allow peaceful deaths, or at least assist with that process. Since none of us is immortal, we in nursing deal with mortality every day. I have a living will, and so do most of my close friends. I also plan on getting a tattoo some day on my chest, DNR, DNI. Good luck with your article.
Shellys, As a homecare nurse who has taken care of hospice patients, we have given morphine q1h as per drs. orders. Also I believe this is done in the hospital to terminal cases. We all know one of the biggest side effects of morphine....respiratory depression. When you have a patient who is already very ill, in pain constanly, and is not taking very deep breaths, how many injections of q1h morphine do you think it takes? It is not something I talk about much..but all of us as nurses know it is done. I really don't think the public realizes how prevalent this is. But when the big uproar was going on about Kovorkian, I just couldn't believe so many people didn't know about this. So all you are doing is following drs. orders, and trying to keep the patient pain free...but I wonder what the family thinks really makes them pass on?
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