Nursing and Euthanasia?

[mustangsheba]

When the time comes to die, with or without morphine, respirations are depressed. The objective is comfort. I have seen obtunded patients whose BP's were sky high. I give medication until BP is more WNL, assuming but of course not really knowing, that there is effective pain relief. If patients appear in pain, I give medication. I too am having a tattoo on my chest.

[leeriza]

Did you know that Euthanasia is now legal in Netherlands just this year ? I think you have better chances of doing your paper better if you can contact or find a website about it. Try surfing the web for this particular country. iI am sure you will learn something.

[TrishJ]

I agree with you all. My mother died just three months ago from terminal cancer. It truly was hell watching a once vibrant woman fade away and to watch the pain she had to endure was the worst. I too have mixed feelings about euthanasia. I don't believe it is always wrong. It truly is up to the patient I believe. I have seen so far in nursing school that alot of the time the docs keep patient's going that have no chance of recovery or rehabilitation. It is sad. :-(

[LasVegasRN]

We had a 19 year old cystic fibrosis patient in our Medical ICU. He had reached the point where he could not be weaned off the vent and was terminal. His secretions were so thick, we had to devise a "tag-team" method of suctioning him where we would have to change the suction cath within an instant because the secretions would clog it up and we'd attach another to finish - we couldn't use the inline suction cath's for that very reason. He was alert enough to write a note to our chief of staff requesting to be removed from life support. His family was there, mother, father, and sister, and they all sat in his room with the chief of staff and senior attending while he wrote his wish.

It's strange, but I still get emotional about this 11 years later. Anyway, our chief of staff was always extremely stoic to the point of being abrasive and insensitive - or so I thought.

That night, when the patient met with his family for the last time and say their goodbyes, we started the Morphine drip and titrated to comfort. The tube was kept in, and we made him as comfortable as possible.

I have never had to witness something so heartwrenching in my life as watching him slowly die. Yet, I knew he was tired and was ready to "go home". He was drowning to death, in his own secretions, and there was absolutely nothing we could do to help him.

When he went flatline, the sobs from his father got to me the most - total and absolute pain. Our unit was so quiet and it seemed like all the other patients, no matter what state of consciousness they were in, held a silent vigil in respect.

At change of shift, when the chief of staff was doing rounds with the residents, as hard as he tried to be his usual self, he had to stop the rounds because he was so choked up he could barely speak, and eyes burning from trying not to cry.

I never regarded this as "euthanasia". We save life, but in this case, we saved death. Make sense?

[NurseDennie, BSN, RN]

I read this thread this morning at work and knew it was going to be a BUSY one, but didn't have time to comment. So I'm back now.

There is (to *me*) a BIG difference between euthanasia and not treating or even ending treatment. Also a big difference between euthanasia and administering pain meds that MAY hasten an already-imminent death.

For me, I think the nurse's role in assisted suicide and euthanasia should be nothing. Nill, Not involved. Somewhere else. Etc., etc., etc.

On the other hand, along with mustangsheba, I have administered morphine to someone who was obviously on the way out. And did it with absolutely no burden on my conscience about it.

Did it decrease the patient's time on earth? That's hard to say. I've given morphine to a patient who was working so hard to breathe that I feel absolutely certain that he lasted LONGER because of that relief. Have I at other instances, limited the time the patient spent in extremis doing this? I don't doubt it. And I have absolutely no regrets.

But I was NOT giving medication **intended** to shorten anybody's life. I was giving medication to alleviate pain, panic and air hunger. I have given people enough comfort to make goodbyes by doing that. To me, the intention was to make what time was left better.

I have to say that I've also cleaned people that I was fairly certain would not survive being turned in bed. I can think of one instance in particular. I'd called the patient's family to tell them I felt the end was near. I knew they were only minutes away. As you know, often the bowels discharge at or near death. So my choice was to clean him and perhaps he would die before his family could come, or not clean him and let them find him in that condition. I felt that there was no guarantee that he would remain until the family got there, and I also felt that I wouldn't want their last memory to be of him soiled like that.

So that's my take on it. I am very sure that I would not participate in euthanasia or physician-assisted suicide. BUT - a person I love and I have agreed to ... Well, perhaps I should leave the rest unsaid.

I think this is a VERY important topic for nurses to discuss and share ideas and feelings. I think every single one of us should be very secure in her or his own knowledge, feelings, soul on what he or she is willing and able to do under difficult circumstances like this.

Love

Dennie

[RNed]

I am not sure we need a policy regarding euthanasia. This question poses the idea that we can assist someone who determines their quality of life is not ideal or tolerable and after this evaluation take acts that terminate life.

I question whether we need to have a euthanasia debate. I believe the problem lies much earilier in the equation.

People seem to die fine without our help and despite our help !

The real question is, " should we intervine with massive support to postpone a death event.' The fact that we can - does not mean, we should.

I may be out-of-line here, but I don't necessarily believe withdrawing ventilator support is euthanasia. The cause of death is underlying lung disease. This person was not born with a ventilator and the fact that a ventilator is not available or choses not to be available is not the cause of death. Many people have died because service was not available or the technology had not been developed. Never-thel-less their cause of death was not do to lack of intervention, but do to underlying disease.

In summary, do we need euthanasia or do we need stronger laws regarding patient rights and choices in how much medical care is utilized? Absolutely, we need to continue education of society in the application of medical interventions. Society needs to have a full understanding of what we can do and can not do.

The questions regarding euthanasia becomes mute, if we do not apply the full weight of medical intervention. In short, euthanasia is closing the barn door after the horses are gone. We need to ask these types of questions long before we call for the ventilators, tube feedings and pacemakers.

Its not magic or mystical to keep someone alive, but to have them think, interact, respond and smile that is magic !!!

[LasVegasRN]

RNed, you raise a good point. In that same MICU I worked in, it got to the point where I felt like I was torturing some of our patients because the family did not want, or could not bring themselves to let go.

I'll never forget one resident who referred to our unit sometimes as the "Michelin" unit because so many of our patients ended up looking like the Michelin-Man before they died. Literally disfigured and left unrecognizable from all the Levophed, Dopamine, Ampho-'terrible', etc. that we would pump these bodies with until there was nothing left to administer.

There was one 32 year old male that came in and once he got Swan'd we knew he was not ever leaving. Always seemed like when the bone marrow rejected and they ended up in the MICU the Swan spelled certain doom. Anyway, he was another 'Michelin-man'. His sister brought in a picture of him and put it on the wall above his bed - a good thing as it made everyone really stop and realize that yes, this is an actual human here; and a bad thing because he was so horribly disfigured from all our attempts at keeping that mean arterial pressure up no matter what.

That's why I eventually left the ICU and from patient care totally. Somedays I felt I was helping, more often I felt like I was hurting. And, when the patients died, I felt like part of me was dying also. Somewhere along the way, I lost the ability to hand out tissue without having to take some myself. I just couldn't do it anymore.

[micro, RN]

BOY, HOWDY,

This brings back a memory of my high school days.......when in government or something like that.......we had debate teams.......and I was chosen to defend euthenasia.......

My teacher commented during and after that he had never realized that I had such powerful opinions about this subject and that many were way above what he had expected coming from somebody my age.....

No, I am not Dr. J. but guess I still haven't changed alot in my opinion.........

This should be a choice..........but yet......how do regulate the choice and make sure that choice is not abused............or criminally used as to when the patient is no longer able to determine or make decisions for themselves.......

Anybody remember the movie "Solvent Green" or "Logan's Run"........now that goes too far.........

Tough and very very controversial questions.........this is a great one for us that deal with this everyday in our workaday lives.......let alone we are human too.

micro

[lindalee]

This is the first time I have replied to this group. This topic is one I have pondered for years. I am an RN, started practice in 1965 so I have seen many changes and taken care of thousands of patients. I spent 17 years in the Neuro ICU, left that environment 3 years ago. My parents health failed and I simply could no longer manage all of the problems with them and the death issues at work. The toll on me was awful. Dad died rather quickly, just six months after entering a nursing care facility. My mother died a very slow death from a progressive dementia over 5 years. I watched her lose everything that made her a person. She eventually lost the ability to eat. I did not allow a feeding tube. It took nearly 3 weeks for her to die after she quit eating. That was the hardest thing I have ever had to do, although I knew it would have been her choice and was the right thing to do. Knowing how very difficult this was for me with all my experience and knowledge of my mother's feelings when she was able to express them, did help somewhat with understanding why families cannot make a decision to stop treatment when it is obviously no longer helping. My mother died without a bruise on her body. She looked younger than I did by the time she died. She was in a coma and looked extremely peaceful for nearly two weeks before she left us forever. I still at times have nightmares that I caused her to die by withholding the feedings, but by daylight I know that I did the correct thing for her. It was really pretty awful, I was able to help patients at work when in pain but could do nothing for my mother to help her pass over. There were orders in place for medication if she struggled but she did not. You can believe though that while sitting there I really wished I could have given some medication to help her let go. My family was very supportive through all of this but my brother was very grateful that I had to make all the decisions. He said he would not have been able to withhold the feeding tube. The way we were called and asked daily really tore him apart. We got a call about three days before her death. The RN wanted to do a CXR. I asked why? She said I think your Mom has developed pneumonia. I asked what a CXR was going to do to change her care, she got very quiet. I immediately called her physician who was very upset that I had been called (yet again) When we arrived that day we got a formal apology from the nursing director. Yes, I am in favor of assisted suicide, but could not be the one to assist. I also think nurses should not question families daily about decisions that are in place. This situation is difficult enough without feeling like you are being questioned every time you visit. My mom had asked me about 7 years before her death if I would help her end her life if she ever had to go into a nursing home. Thank God I told her I could not do that. I am almost certain she knew she was starting down a dementia pathway. She never wanted to go into a home, but that was not to be. She was full care for five long years.