Patient doesn't know he's terminal

allnurses Guide · Jan 25, 2010

this thread reminds me of when my mom was dying.
she had been dx'd w/all and became septic as a result of being immunocompromised (chemo).
she was unconscious and i was pushing to get all txs dc'd, and to start her on a morphine gtt.
her pcp, oncologist and palliative director, held a meeting, actually pressuring us to continue with everything, in essence so she could "possibly" wake up and say her good-byes.
i slammed my foot down, adamantly maintaining that mom would never want this...
that to leave her unconscious (and unaware) would be kindest and truest to what we knew of mom.
why am i writing this?
haven't a clue.
leslie:o

Your mom is probably up in heaven thanking you for not allowing these people to bully you into what you knew your mom wouldn't want. They were saying that they knew better than your mother's own family about her process of saying her goodbyes. :mad: grrr I don't think my mom's oncologist would do that- thank God. But when her time comes I won't hesitate to get right up in their faces, either.

Tewdles- thanks for providing more detail about the internal workings of hospice care. There's a lot to learn about family dynamics and the impending death of a relative seems to bring whatever dysfunctional stuff that had been simmering right up to the surface, and you probably want to grab these people by the shoulders and say, "what are you thinking??" but that's not an option. .sigh. . .

destiny5 · Jan 26, 2010

Once you get your license you are the PATIENT ADVOCATE- and lying to a patient about his condition is unethical especially if he is competent. As a student however, its a good issue to bring up with you instructor during post conference- Under no circumstances should you inform the patient about his diagnosis especially when you've already been told not to. I guarantee- since clinical sites are so difficult for schools to secure, you'd probably be reprimanded at best, at worst kicked out of the program. At the school I graduated from, theyd kick you out especially if the family and hospital complained. Just a word to the wise...

jnette, ASN, EMT-I · Jan 26, 2010

Wonderful, wonderful thread. Thank you all for ALL your well worded insight and input. :)

leslie :-D · Jan 26, 2010

this thread reminds me of when my mom was dying.
she had been dx'd w/all and became septic as a result of being immunocompromised (chemo).
she was unconscious and i was pushing to get all txs dc'd, and to start her on a morphine gtt.
her pcp, oncologist and palliative director, held a meeting, actually pressuring us to continue with everything, in essence so she could "possibly" wake up and say her good-byes.
i slammed my foot down, adamantly maintaining that mom would never want this...
that to leave her unconscious (and unaware) would be kindest and truest to what we knew of mom.
why am i writing this?
haven't a clue.
leslie:o

phew....talk about a brain boof.

the reason i wrote this, was to show you that there are indeed, some folks who truly don't want to know they are terminal...

such as my mom.

heck, she fought the aging process from waaaaaay back, even asking me as a child, "do i look old"?

and even in her 60's...."do i look old"?

granted she was a beautiful woman, albeit a bit too vain for my taste.

but she sooooo didn't want to ever, ever look old.

and i remember looking at her, and stroking her hair while in the icu bed...

thinking to myself, how amazingly young she looked.

i mean, her skin was so taut...not a wrinkle or sag to be found (she was 74)...

only to find out after her death, my sister told me she had microdermabrasion (sp) done.

little rascal...she led us to believe she was au naturel. :lol2:

anyways, if a pt doesn't want to learn of their terminality, that truly needs to be honored.

leslie

ktwlpn, LPN · Jan 26, 2010

I'm still lost here. How does the OP know that the Pt. was not told or that the Pt has asked not to be told ?
I'm reading the different replies here, but I don't think anyone would say to not tell someone of the severity of their condition, but there has to be something in place (written or verbal) for the family or the PT to not want to hear the news. If not, this is a lawsuit waiting to happen. The doc can't just arbitrarily hold information.

The OP stated this happened in her clinical. I'm sure there were notes all over that chart and it was probably the talk of the unit. At the very least this info was passed on in report. I've seen this a few times and it happened in my own family,too. There are doctors that will bow to this type of pressure from family members -they would rather avoid confrontation then advocate for their patient. I'm in LTC now and have family members who will call their loved one's doctor and dictate their care from hundreds of miles away. They want to control-they want to d/c or order meds,they want to d/c PT,they want 4 ensures daily etc. And the doc COMPLIES. It's often detrimental to the resident and takes days to fix-We have had to call the DOH more then once.It happens. Sure-it's "a lawsuit waiting to happen" It's the family that will say "If you tell Pop he's dying I'll sue you...

ktwlpn, LPN · Jan 28, 2010

In clinicals today there was a pt. who had been in hospital for about a week. He was not aware he was terminal with cancer, but the family was aware. They had not told him yet and didn't want the staff to tell him about his dx. The pt was cognitively/emotionally intact. How can a pt. not be informed of his serious health situation, and what right does the family have to withhold that from him?! As a nurse, how can you be asked to lie to a patient if they ask how they are doing, believing they just have a minor health problem that they will recover from when they are actually terminal?

I was wondering if you have been back to your clinical site? Do you know if this situation has been resolved?

nursenow · Jan 29, 2010

It is not about the nurse being unhappy about the situation. It is about the families right to do what they are doing. Sometimes you just have to stay detached and let things play out. If you can't, it makes life difficult at times as a nurse. Especialy when you don't have all the facts. This is one of those situations where you have to accept the fact that someone else with more information and in a different position than you will deal with it.(even if it is the family)

AmericanChai · Jan 29, 2010

I was wondering if you have been back to your clinical site? Do you know if this situation has been resolved?

Yes I heard it was resolved. I was more interested in the scenario than in the specifics of this case because I'm sure it happens a lot.

LiverpoolJane · Jan 29, 2010

Yes I heard it was resolved. I was more interested in the scenario than in the specifics of this case because I'm sure it happens a lot.

Could you tell us if the patient had given any indication that he didn't want to know or if the patient had asked questions of the medical staff and been lied to?

I have not experienced anyone being told lies to direct questions, I have experienced patients who have said that they didn't want to know or have declined the opportunity to ask questions about their condition.

I have experienced relatives being kept in the dark at the patients request, which brings problems when the patient is deteriorating and the family are very concerned and asking for answers.

tewdles, RN · Jan 29, 2010

It is not about the nurse being unhappy about the situation. It is about the families right to do what they are doing. Sometimes you just have to stay detached and let things play out. If you can't, it makes life difficult at times as a nurse. Especialy when you don't have all the facts. This is one of those situations where you have to accept the fact that someone else with more information and in a different position than you will deal with it.(even if it is the family)

The problem is that sometimes the family does not have the RIGHT to do what they are doing! The nurse is the professionally designated patient advocate...it is part of our job to make sure that the care provided is in the best interests of the patient, yes?

LiverpoolJane · Jan 29, 2010

The problem is that sometimes the family does not have the RIGHT to do what they are doing! The nurse is the professionally designated patient advocate...it is part of our job to make sure that the care provided is in the best interests of the patient, yes?

The OP doesn't actually say what the family are doing though. There is nothing to suggest this man has been lied to, he may well be the type of person that would rather not know. I have asked the question of the OP, it the man had asked and not been told the truth, he may well be happy for his family to be in control. I have nursed patients who I have known are terminal and have gently probed what their understanding of their condition is. Sometimes they are keen to know everything and will ask direct questions other times it is clear they would rather not know if it is a bleak outlook. As patient advocate it is my job to ensure the patient is not subjected to being told facts they don't feel able to accept. It is a burdeon for the family having to keep this knowledge to themselves and act normal in front of their loved one, so I really can't see form the OPs senario that the family are not acting in the patients best interest.

tewdles, RN · Jan 29, 2010

The OP doesn't actually say what the family are doing though. There is nothing to suggest this man has been lied to, he may well be the type of person that would rather not know. I have asked the question of the OP, it the man had asked and not been told the truth, he may well be happy for his family to be in control. I have nursed patients who I have known are terminal and have gently probed what their understanding of their condition is. Sometimes they are keen to know everything and will ask direct questions other times it is clear they would rather not know if it is a bleak outlook. As patient advocate it is my job to ensure the patient is not subjected to being told facts they don't feel able to accept. It is a burdeon for the family having to keep this knowledge to themselves and act normal in front of their loved one, so I really can't see form the OPs senario that the family are not acting in the patients best interest.

I certainly have no disagreement with this. I simply caution newer nurses that they cannot assume that what the family is doing is actually their "right" or is in the best interests of the patient. I would encourage nurses faced with this too common delimna to investigate the facts, document them clearly in the chart so that those coming behind you are well informed, and advocate for the patient.