ordered to give roxanol with resp. of 5

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I was recently ordered to give a dose of Roxanol to a patient with terminal Alzheimers. I withheld the dose due to the fact that his resp. was 5, there were no s/s of pain, no SOB, and no labored breathing. Pulse was slow and weak. No response from stimuli. The MD said I should give it and (I quote) "you can make it a humane death"

I have a problem with this, I always thought that we first do no harm, isnt giving some one something they dont need harm? No signs of distress, just someone busy dying and not having a problem with it.

Specializes in Oncology/Haemetology/HIV.
families often request increase, more frequent dosaging in the presence of anxiety.

furthermore, the process of dying itself, is a relatively humane and comfortable process.

it is when specific disease/trauma processes interfere and so, containing symptoms becomes the focus.

in the absence of these symptoms, continuing to administer morphine could be construed as a form of euthanasia.

as long as there are experienced staff deeming the pt w/no duress, then continuing to give a potent narcotic for the sake of the family, would and should be contraindicated.

Agree with this.

Several other issues. If the MD insisted on the med, then the MD can easily give it himself. That none of the supervisors would give it, indicates that in the judgement of several experienced nurses, very familiar with the case and its aspects, feel that giving it constitutes a breach of ethical care.

There is also nothing to stop the spouse from taking the pt home to hospice and administering the drug herself. Especially with the MD prescribing it in adequate amounts.

Why is that done when it would be an easy solution? Because neither the doctor nor the spouse want to "take the responsibility" of commiting this act...they would rather have the nurse do the dirty work than commit the act.

If the spouse and the MD truly feel that this is the patient's wishes and that he is suffering, despite all evidence to the contrary, there are solutions. That they do not choose to do so, says a lot.

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Specializes in CVICU-ICU.

Unless Im missing something or dont understand correctly I am having a real hard time understanding why anyone would think that this whole situation is ok. From the way I understand it this man was able to eat/drink on his own with some assistance and he was alert up until the decision was made to make him NPO without a medical reason ie inability to swallow and his current mental state (basically unresponsive) is caused by the addition of a powerful narcotic Q 2 hours! I see serious ethical issues.

Let me ask this...if this was a child who had a developmental issue and couldnt function "normally" but was able to eat/drink with assistance and was alert and his parents decided to withhold food/water and then medicate him to the point of severe sedation because they didnt want to have a developmentally challenged child would we consider that ok? No...I dont think any of us would and I think that the parents would be brought up on criminal charges.

Once again unless Im misunderstanding something I see serious ethical concerns with possible criminal indications

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Specializes in geriatrics,med/surg,vents.
the patient in question has end stage alzheimers, his wife stopped letting us take him to the dining room, insisted on trays in his room, said she would feed him. he began losing weight. under orders, we began to feed him after she left, his weight stabalized. she then got an order to make him NPO and ate and drank in front of him. after 10 days she got the order for Roxanol, Q2, routine at family request.

The wife sounds like a real nut case,especially since you said in a later post that he was eating in the dining room.This whole thing would have me worried

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Specializes in Med Surg/Tele/ER.
the patient in question has end stage alzheimers, his wife stopped letting us take him to the dining room, insisted on trays in his room, said she would feed him. he began losing weight. under orders, we began to feed him after she left, his weight stabalized. she then got an order to make him NPO and ate and drank in front of him. after 10 days she got the order for Roxanol, Q2, routine at family request.

When I questioned the DON, I was told not to give it with a rr of 5. the hospice supervisor said not to give it either when they were called. our medical director agrees, as does the hospice medical director.

it has been 14 days since any food or hydration and my facility stands by the decision of not giving the drug with no s/s of pain, dyspnea ect. and a rr below pramaters. he still lives.

What I would have a problem with would be the NPO status. How was this done at her request....? Why was the Roxanol ordered in the first place? My heart goes out to this man...if I thought he was in pain I would have given the dose...

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Specializes in Hospice, Med/Surg, ICU, ER.
I agree. When someone at our hospital is uncomfortable with giving (an unreponsive DNR patient in the hospital for comfort measures) pain meds there is usually someone else willing to give it.

On my unit, in my facility, that is usually me......

The staff all know I am willing to give the meds per MD orders... the morality of it all will have to be sorted out later.

Know this though: I WILL meet my Maker with a clear conscience.

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Specializes in Trauma, Teaching.

Have you considered calling the Adult Protective Services Omsbudman? To address to the wife's decision to refuse to allow him to eat?

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

The gentleman might not be in excruciating physical pain......BUT even with Alzheimer's he knows that something isn't right.His RR are 5.....so what? Mine stay at 8. He obvioulsy had a living will didn't he? It says no extrordinary measures. Roxinol is a comfort measure. His body is slowly leaving him, can't you make him comfortable enough to make the journey?

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Thanks for the extra info. With all the backup of supervisors, etc. it sounds like you were technically ok to withhold the drug. But I still agree with the doctor.

Personally, if I were that man, I would want the morphine given to me, in fact, in situations like this I fail to see why euthanasia would be inappropriate. I know it is technically illegal and some are morally opposed, but when you say "do no harm," do you think allowing a man to slowly die over many weeks is less harmful than giving him a pain medicine that may speed his death as a side effect, when death is inevitable with either option? I think it is fairly obvious that not feeding/hydrating him is itself euthanasia, the only difference is it is passive. I would rather be active and be SURE that he was painfree rather than hoping that inside there somewhere he wasn't aware of his situation.

I hope you live in Oregon. Or look good in jail stripes in the other 49.

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The gentleman might not be in excruciating physical pain......BUT even with Alzheimer's he knows that something isn't right.His RR are 5.....so what? Mine stay at 8. He obvioulsy had a living will didn't he? It says no extrordinary measures. Roxinol is a comfort measure. His body is slowly leaving him, can't you make him comfortable enough to make the journey?

What do you mean, "make the journey"? The journey across Jordan? As in euthanize?

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Why would I assume, as a nurse, that the wife doesn't know more about what her husband would have wanted in this situation than I do.

Why would a nurse assume that the wife has the husband's best interest at heart?

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I don't understand why they would. The person is dying. rr 5/ min? no response to stimuli? What difference is it going to make? In these situations you have to remember that your treating the family also. This is how this person will remember the death of their loved one forever. It sounds like the family member doesn't want to see the patient suffer. The fact that based on our viewpoint the patient looks sedated and in no pain means nothing. Perhaps based on the belief of the family member the patient will suffer until they make it to their final destination. When it comes to death you have to consider these things. You are not preserving the life or quality of life, you are assisting in the quality of their death, and the family's remembrance of a loved one in their fiinal moments here on Earth.

I'll be damned if my patient is the family. And, while I might care about the family and their suffering, don't expect me to compromise my license so they can remember their loved one in a better light. :angryfire

My patient is the guy in the bed. And the family is already going to remember the suffering he has already done. There is no need for me to suspend all my training and education and experience for anyone else's benefit. If the doc wants it given, let him give it. If the family wants it given, get an order for them to give it and hand them the bottle.

But there will be nobody going to court with me if I practice euthanasia. In fact, it is a pretty safe bet to say that the family and doctor will all turn on you and swear up and down that they never gave any indication that they wanted you to do anything but use your nursing judgement to just keep the pt comfy, not end his life more quickly by OD'ing him on MS. Please wake up and protect yourself. How can you say that our viewpoint means nothing? We are the nurses, for God's sake. What can you possibly thinking? :uhoh21: Why are we on the scene if our judgement means nothing?

And don't assume that the family has the pt's best interest at heart all the time. Maybe they do and maybe they can't stand the old fart. Maybe he was a wife-beater and child abuser and an alcoholic and a total destroyer whom they can't wait to be rid of because he does have some money that will now be theirs. You must protect your license, not try to end all suffering of patients and their families. Yes, we try to do the very best we can but we do it within the law, not emotionally or based on presumptions. We follow the law and do the best it allows us to do, even as we work to get more realistic laws passed.

Anyway, if we hasten death intentionally, that person has less time to be dealt with by God on the spirit level. God determines length of life, not us. Maybe God is trying to bring that person to Jesus and to salvation in those final weeks, hours, days, and moments. He is speaking to that person in dreams and visions, on the spirit level, perhaps, about the person's eternal destination. We don't want to interrupt that. Pain here is horrible, suffering here is horrible. But an eternity of them will be even worse.

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of course this is only my opinion but after working w/pts @ end stage life,who are we to determine whether they are suffering or not just because they may not exhibit the text book s/s if i were this pts nurse he would have been given the roxanol in fact i have worked w/hospice nurses who also feel this way to me it is not only dying w/dignity but a way to let this person go without laying in a bed wasting away every hour that goes by. i do empathize with your situation as it seems you may feel some conflict ie this,but do not feel alone there are many of us who have been thru this before and though it is not easy to accept these issues, i would ask myself if it was me what would i want hospice or the md to do for me,i can say i certainly would not want to be laying there in that state. sincerely coop62

You make some good points but your post would be easier to read if you used periods and capitals. Thanks.

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