I am an RN student and I am really struggling with this.
If the family has decided that the pt is not going to learn that they are dying I have a really hard time doing care for the patient without letting my feelings show.
Aren't we an advocate for the patient?
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.
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
Gotta agree with Leslie on this one ... if a pt asks a direct question, I answer truthfully or, if I'm worried about the emotional fallout, I explain that such a discussion has to happen with the doc and family.
I've found that we need to be VERY careful when we try to break down a person's denial ... as Leslie said ... it's there for a reason. It's part of the process and serves to protect the person from the abject terror and grief of knowing the end is coming soon. Furthermore, it's her/his process, not mine. I've learned from years of doing end-of-life care that I do not have the right to force a patient to go through this my way, just because I've decided that it's the right way to do it. It is certainly a fine line to walk and requires a fine sense of boundaries.
I think the ethical issue becomes a bit stickier when it's the family's denial that's in play ... then it's time for the ethics committee to get involved, especially if the patient is asking questions I'm not allowed to answer.
I have not yet had to go through the experience of facing my own terminal diagnosis, but I am a widow. I know that it is offensive, intrusive and hurtful to have someone decide for me where I should be in the grieving process and try to enforce that. Grief, and that's what dying people are going through, is a fluid, non-linear, non-rational process of healing from loss. As a stage in that process, denial protects from overwhelming pain and/or panic. If we, in our disapproval and/or discomfort, short-circuit that protection, we'd better be ready to handle the consequences. That includes unecessary suffering, fear and possibly even suicide.
We're all different. To paraphrase Kubler-Ross, the right to a good death is the right to die in character ... that is, in our own infinitely diverse ways. Heron
many families do not wish the pt to know the truth because of their fears and anxieties about death.
even if they are not cognizant of it then, it comes to consciousness later in the process.
they're not protecting the pt...
they're protecting themselves.
one time i had a poa bring charges against me r/t me telling the pt about his terminality.
the pt was in our palliative care unit and knew he was dying despite txs.
yet his parents were begging him to continue, and that he would indeed get better.
the md had noted that pt likely had wks to live but was respecting mom's/poa's decision to not tell pt.
(can't really divulge why pt had poa w/o revealing too much info)
pt and i had great rapport and he trusted me, begging for insight and truth.
i conferred w/mom (w/doc present) sev'l times.
mom couldn't deal with it and refused.
i encouraged doctor to step up to plate.
he wouldn't.
and i finally did.
i had told mom what i was going to do, and would she like to be present when i told her son?
she threatened to haul me off to court.
i took that chance.
after i told pt, he cried.
when mom went to see him, she was furious that her son was crying "see what you did???!!!"
i gently told her that his response was perfectly appropriate.
next day, pt started making goals/plans and moving forward.
he finished a lot of stuff that had remained undone and peacefully died 3 wks later.
mom never went forth w/charges.
but even if she had, i do believe i would have been vindicated, knowing i did everything in my power to allow pt to live out his life, the way he wanted.
I am an RN student and I am really struggling with this.
If the family has decided that the pt is not going to learn that they are dying I have a really hard time doing care for the patient without letting my feelings show.
Aren't we an advocate for the patient?
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.
Can someone help me with this?
Another thing that I haven't seen mentioned is the "power surge" many people have before they die. I have seen many patients (this includes my dad) get this flow of energy, they feel better than they have in months etc. just prior to passing away.
As another OP has stated, we really don't know the family dynamics.
heron, ASN, RN
4,661 Posts
Gotta agree with Leslie on this one ... if a pt asks a direct question, I answer truthfully or, if I'm worried about the emotional fallout, I explain that such a discussion has to happen with the doc and family.
I've found that we need to be VERY careful when we try to break down a person's denial ... as Leslie said ... it's there for a reason. It's part of the process and serves to protect the person from the abject terror and grief of knowing the end is coming soon. Furthermore, it's her/his process, not mine. I've learned from years of doing end-of-life care that I do not have the right to force a patient to go through this my way, just because I've decided that it's the right way to do it. It is certainly a fine line to walk and requires a fine sense of boundaries.
I think the ethical issue becomes a bit stickier when it's the family's denial that's in play ... then it's time for the ethics committee to get involved, especially if the patient is asking questions I'm not allowed to answer.
I have not yet had to go through the experience of facing my own terminal diagnosis, but I am a widow. I know that it is offensive, intrusive and hurtful to have someone decide for me where I should be in the grieving process and try to enforce that. Grief, and that's what dying people are going through, is a fluid, non-linear, non-rational process of healing from loss. As a stage in that process, denial protects from overwhelming pain and/or panic. If we, in our disapproval and/or discomfort, short-circuit that protection, we'd better be ready to handle the consequences. That includes unecessary suffering, fear and possibly even suicide.
We're all different. To paraphrase Kubler-Ross, the right to a good death is the right to die in character ... that is, in our own infinitely diverse ways. Heron