Staying comfortable vs. hastening death

OhioCCRN, MSN, NP · Apr 30, 2015

It is EXCELLENT care to give them Ativan. There's nothing worse than an actively dying patient whose family says no drugs and they pass on a haze of excruciating pain/ anxiety/ maximum secretions- all which could have been avoided. And no: you are not hastening death

Silverdragon102, BSN · Apr 30, 2015

No you are not hasting death but offering comfort to a client who is dying

loriangel14, RN · Apr 30, 2015

You are not hastening death. You are providing comfort and using the Ativan as it is intended to be used.

RNperdiem, RN · Apr 30, 2015

If your patient was not dying and had a prn order for a small dose of Ativan available for anxiety, would you give it? I give it all the time. A small dose of Ativan is not likely to produce enough respiratory depression unless a person is extremely sensitive to benzos.

A comfortable and relaxed patient is what I like to see.

nrsang97, BSN, RN · Apr 30, 2015

Yes. Give the Ativan. It will help the patient relax. I will give comfort. You will not hasten death.

Libby1987 · Apr 30, 2015

I am a new nurse and wanted to get feedback. If a patient is a DNR/Comfort measures and actively dying (say from a GI bleed, or disease process that can't be stopped for whatever reason) and becomes restless and agitated and there is prn ativan available, is it unethical to give a small dose even if it may cause resp depression/hasten their demise? Or is it good palliative care to help them relax and keep comfortable? I'm trying to see where the lines are, they seem so blurred at that point. Thanks.

Can you explain why the line is blurred managing agitation for comfort care with a terminal illness?

Jules A, MSN · Apr 30, 2015

Can you explain why the line is blurred managing agitation for comfort care with a terminal illness?

Personally I think much of it comes from our life's work largely being trying to keep our patients alive and healthy, and also the fear of being sued when someone dies under our care. Many Americans seem to have unrealistic expectations that we should live forever.

Once again if JulesA happens to be your patient please, please administer anything ordered even if it hastens death.

anewsns · Apr 30, 2015

Give as much Ativan as they need (within orders of course) and make sure the family understands what is going on

heron, ASN, RN · Apr 30, 2015

Not a dumb question, though. There are some extreme - I mean extreme - circumstances when medication adequate to relieve suffering may indeed hasten death as a side effect. I've done it and will do so again, if necessary, if that's what it takes to stop the agony.

In almost all cases, though, any differences in the timing of death are minuscule - minutes, not months.

Here.I.Stand, BSN, RN · Apr 30, 2015

It's unethical NOT to give it. Never, ever, ever withhold pain meds or anxiolytics in the active dying. EVER.

ETA: you're not hastening death. Death from a massive GI bleed takes minutes, sometimes a couple of hours depending on the person and the rate of blood loss. Ativan, morphine, etc. only make the death more comfortable for the pt.

RNMarykay · May 1, 2015

JulesA and Libby1987

I think I was just nervous about the line of keeping comfortable/hastening their death and as a newbie RN I have not seen a lot of active dying. When I was a tech I mostly stayed out of the rooms of the actively dying while the nurse did direct care, whereas now I am the one in the room with the pt and their family.

I'm trying to speak in hypothetical language rather than specifics of a situation. I just wanted to make sure I had done the right thing.