This exchange took place earlier today on the thread about "choosing a date to die." I think it's clear that those of us who work in hospice need to work harder to educate not only the general public, but also fellow health care workers.
We withdraw fluids and nourishment allowing people to die slowly of dehydration and starvation. If they are alert we often forbid anything by mouth in fear of aspiration so no last meal. Some doctors and nurses are overly cautious of giving pain medications. We do a terminal wean on a ventilator patient to extubation and then try to decide whether the patient will die within the next hour or if they have to be moved to the floor to free up the ICU bed. The patients linger on and on. The family watches the patient gasps and gurgles. The family leaves the bedside stressed and often the patient dies alone. But, as long as we don't call our actions "assisted suicide" we can justify what we put these patients through.
This is very true. And it's incumbent upon the patient and family to make sure theri wishes are known and followed.
Our largest local hospice company just recently began admitting vent patients to their inpatient unit for terminal weaning. The unit is across the street from the hospital-a short ambulance ride away.
That's the way it should be done. Not in some ICU.
I tell all my patients that they too have to advocate for themselves or their family members, in addition to nurses advocating for them. However, as nurses isn't it ultimately our responsibility to ensure we know our patient's wishes and see they are followed through?
This is an awful way to die and it does sound like someone dropped the ball there in regard to pain control. But to play devil's advocate for a sec about the nutrition/fluids, I've seen the reverse- patients dying and being administered IVF or nutrition- and it is much worse. The patient will basically slowly drown if given fluids when their bodies are shutting down. Dehyration in this circumstance is a natural process that actually helps to give a more comfortable death. It is also quite natural for the body to refuse food as it is dying- this is not starvation but a natural defense mechanism. As the body slows down to die, food would just sit in the bowels and rot causing a whole lot more discomfort. Death is a horrible thing to witness, especially when the death is that of a loved one. I am very sorry about your mom, though
Spidey's mom, ADN, BSN, RN
11,305 Posts
Maybe so.
I'll bow out.