Oncology Clinical

[AlisaGrace]

Hello Everyone! I had my first clinical on the oncology floor last week and I would like to know everyone's opinion on one ethical issue that has bothered me since that clinical. I had a patient who had stage 4 breast cancer who was being kept a live by her bi-pap machine. This patient had two daughter's. One daughter was ready for her to go, while the other wanted her to stay on the bi-pap as long as she could. The daughter who wanted her to stay around as long as possible was the patient's advanced directive. The patient was still some what alert and oriented but just kept screaming in pain. I can understand that one daughter didn't want to loose her mother but I couldn't stand to see a loved one screaming in pain continuously. I had to leave the room for a little while because it broke my heart. What would the ethical dilemma's be in this situation? Also when can someone step in to say enough is enough? Thank you!

[SoldierNurse22, BSN, RN]

Is the patient alert and oriented? The daughter only has power of attorney if the patient is in some way incapacitated and unable to make decisions for herself. Otherwise, this is a scenario you will see often in nursing, especially oncology.

Here in the US, we have a problem with accepting death. We think that anything--including intense suffering--is better than dying. As a result, you'll see many, many families in denial, refusing to "surrender" their loved ones to death out of fear and the cultural conviction that to die is to give up and fail.

You can try to educate the family in an attempt to better explain the physiological process of death, the end stages of the disease process, and that sort of thing. We had a CNS who would talk personally with each family, and she was a wonderful lady. Very knowledgeable, very caring, very respectful, but also a strong advocate for the patient. She was able to educate and help many a family accept the nearing death of their loved ones, and as a result, that death was a quiet, peaceful one, and not the painful kind you often see in oncology.

However, if the family refuses to listen (or has ulterior motives to keep the patient alive--such as a government check!), there is very little you as a nurse can do other than collaborate with your physician colleagues and make the patient as comfortable as possible.