Pt's right to know they are going to die

TazziRN, RN · May 26, 2008

It's something we all struggle with. Unfortunately, sometimes it's a case of the family being the DPOA and able to make these decisions. At other times it turns out we don't know enough about the family dynamics and it turns out to be a merciful thing for the pt not to know.

ballardfam · May 26, 2008

I don't know if I've ever had a patient who was supposedly "in the dark" about their terminal condition who didn't really know and didn't ask. I'm not saying that they aren't out there but my experience is that if they want to know they'll ask if they're going to die. In that case I'll tell them.

leslie :-D · May 26, 2008

When my dying patient tells me very happily that she is goingto quit smoking and start chemo then go back to finish college and I know she only has days to weeks left.

the above statement from the pt, is very telling.

given what she said, along with family wishes, i'd be inclined to agree.

when people are that sick and terminal, they know.

trust me, they know.

yet, if denial is a part of the process, it is not within our rights to inflict 'truth' on them.

conversely, if a pt told me "i know something is wrong and no one is telling me anything", yes, that pt has a right to know and would/have override family/md/poa wishes.

wishing you the best,

leslie

Jules A, MSN · May 26, 2008

It might come down to how the ethics committee decides these things should be handled at your facility also. Personally I have a real issue with it and would reach out and snatch my family members bald if they tried to hide something like this from me but I recently cared for a Pt with a history of depression and since the family knew best maybe they were correct that this person wouldn't have been emotionally able to handle the terminal dx. It was clear there was a loving family relationship so that made me feel better about doing something that I wasn't really in favor of.

Similar situation when there is an Advance Directive and the family won't allow us to honor it and the hosptial won't go against them for fear of litigation. There is no clear right or wrong answer sometimes. Hang in there.

elkpark · May 26, 2008

In my limited experience, it's often the case that the client knows s/he is dying but is maintaining the fiction established by the rest of the family because it's so obvious that the family can't handle the situation and the client is trying to spare the family members.

Family dynamics are v. complicated and messy. So are defense mechanisms. :)

MikeyJ, RN · May 27, 2008

When my dying patient tells me very happily that she is goingto quit smoking and start chemo then go back to finish college and I know she only has days to weeks left.

I agree with the other poster who stated your patient is probably in denial.

I had a 41 year old aunt who died a few years back from alcohol cirrhosis. The doctors had told her that she had a few months left to live. However, she pretended as if nothing was wrong and told me how she planned to quit drinking, get a job, go back to school, etc. Our family chose not speak to her about her impending death because we brought it up a few times and it did no good. She obviously knew she was going to die but acted as if she were in denial.

It sounds very similar to your patient. When a dying patient tells you of their future life plans and how they plan to do this and that, and do those things they never did... they have not yet accepted that they are going to die. Instead, they are probably looking back at their life and wondering why they never did certain things. Even if you bring up her impending death, it probably would not do much. So in this patients case, I doubt her medical prognosis is being kept from her.

KaroSnowQueen, RN · May 27, 2008

That is certainly a grey area.

I had an LTC patient who had been slightly sicker than usual and some routine tests, labs, radiology, showed up she had inoperable cancer.

The family emphatically stated the pt was NOT to know or she would "just fold up and die." We all went along with this for a week or so, with internal discussions regarding the ethics of this, until....

One night a nurse not usually working on this floor was asked by the pt if she had cancer. The nurse told her, truthfully, yes.

By the next night, the pt was visibly much more ill and much weaker. Within three days she went from happy, smiling and somewhat plump to in a semi-coma, pale, and gaunt. Four days later she was dead.

Maybe the family was right. Yes, the pt had the right to know. She had to have had questions about it all, or she wouldn't have asked. Maybe she thought we'd tell her she was ok. I don't know. But I truly believe she'd have lived longer not knowing.

MikeyJ, RN · May 27, 2008

That is certainly a grey area.
I had an LTC patient who had been slightly sicker than usual and some routine tests, labs, radiology, showed up she had inoperable cancer.
The family emphatically stated the pt was NOT to know or she would "just fold up and die." We all went along with this for a week or so, with internal discussions regarding the ethics of this, until....
One night a nurse not usually working on this floor was asked by the pt if she had cancer. The nurse told her, truthfully, yes.
By the next night, the pt was visibly much more ill and much weaker. Within three days she went from happy, smiling and somewhat plump to in a semi-coma, pale, and gaunt. Four days later she was dead.
Maybe the family was right. Yes, the pt had the right to know. She had to have had questions about it all, or she wouldn't have asked. Maybe she thought we'd tell her she was ok. I don't know. But I truly believe she'd have lived longer not knowing.

She probably would have lived longer if she had not known. My grandmother basically let herself die after finding she had lung cancer and after finding that the chemo she was doing was not responding. The mind is incredibly powerful.

towntalker · May 27, 2008

don't discredit the family, they have known this patient all her life and sometime they are able to judge whether or not she will be able to accept this news .

younger people faced with termiinal illnews will look at old people tottering about, people with chemical problems who are wasting they youth and good health and then they feel cheated

hopefully they will live long enough for acceptance and a peaceful death

real question here does the nurse on any particular shift have the right to make a decisin which once made cannot be reverses

Valerie Salva, BSN, RN · May 27, 2008

I've been involved in the care of several terminal pts, who were not told they were terminal, per family wishes. Whenever one of these pts has asked me "Am I dying?" I've responded by asking the pt "Do you think you are dying?"

Depending on the response, I've suggested to the pt "I think that's something you should discuss with your doctor and your family."

loriangel14, RN · May 27, 2008

We have a code of ethics and rights for our pts. This includes the pts right to have questions answered honestly, whether by us or the doctor.This includes honesty about their condition and prognosis if they ask. Generally the pts rights come before the POAs request.