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What would you do?

If you had a terminally ill patient who was in agonizing pain whose son or daughter had power of attny for healthcare and wouldn't allow you to give narcotics because"I want mom aware so she can pray for healing". Seriously, would the hospital petition the court for guardianship? Would this be an ethics committee thing? All the while she is suffering and SHE(daughter) is the legal decision maker. Mom is coherent but refuses to go against kids wishes.

Thanks.

nialloh, RN

Specializes in IMCU/Telemetry.

If you had a terminally ill patient who was in agonizing pain whose son or daughter had power of attny for healthcare and wouldn't allow you to give narcotics because"I want mom aware so she can pray for healing". Seriously, would the hospital petition the court for guardianship? Would this be an ethics committee thing? All the while she is suffering and SHE(daughter) is the legal decision maker. Mom is coherent but refuses to go against kids wishes.

Thanks.

Power of attny dosn't kick in until the pt is incompatent. While the daughter should have a say, I would have no problem disregarding her. I would fight her all the way.

meownsmile, BSN, RN

Specializes in Med/Surg, Ortho.

Mom is coherent, can make her own decisions. Daughter has POAHC for when mom cant make her own decisions. There is no legal right of anyone to step in if mom and kids are in agreement.

About all you can do is offer pain management, and ask the doctor to speak with them regarding comfort. It would actually be a violation if you even asked their pastor to speak with them regarding care issues.

I know its hard, but sometimes thats the situation you have to deal with. We arent there to impose our opinions on our patients.

nialloh, RN

Specializes in IMCU/Telemetry.

:angryfire

Mom is coherent, can make her own decisions. Daughter has POAHC for when mom cant make her own decisions. There is no legal right of anyone to step in if mom and kids are in agreement.

About all you can do is offer pain management, and ask the doctor to speak with them regarding comfort. It would actually be a violation if you even asked their pastor to speak with them regarding care issues.

I know its hard, but sometimes thats the situation you have to deal with. We arent there to impose our opinions on our patients.

Agreed. I was very fast to reply as I hate to see my pts in pain. But if mom agreed to pain meds, I would give them to her, and to hell with her daughter.

If the pt was confused and asked for pain meds, I would think long and hard, but probably give them anyway. If she is alert enough to ask for them, she is alert enough to get them. JMHO

BTW My pet peave is family members who leave mom/dad in pain for their own reasons.As I said before, I HATE PEOPLE IN PAIN. :angryfire

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Daughter doesn't have power of attoney yet, because mom is a&o. But if it's mom's wishes not to take pain medicine, then you really can't do anything.

However, I agree an ethics committee should be called. They should meet with the daughter to realistically speak to her and the patient, with chaplin services to explain while healing God doesn't want her in to suffer.(just my opinion). Sooner or later mom isn't going to be able to make her own decisions. Sad situation.

Daughter doesn't have power of attoney yet, because mom is a&o. But if it's mom's wishes not to take pain medicine, then you really can't do anything.

However, I agree an ethics committee should be called. They should meet with the daughter to realistically speak to her and the patient, with chaplin services to explain while healing God doesn't want her in to suffer.(just my opinion). Sooner or later mom isn't going to be able to make her own decisions. Sad situation.

Suffering has its beneficial aspects. One Saint said something to the effect that you can't avoid suffering in this lifetime, and if you do, you will suffer in the next.

Just room for your diversity thinking...

NurseFirst

Uh-oh. I think I may be doomed. :o

I was in a situation very similar to that and we had an ethics committee. I wish I could say something positive came of it, but nothing really did. The patient expired.

Its very difficult. You should at least share the burden of this patient with your coworkers, and discuss the issue with your NM. You guys probably need some support... situations like this are traumatic for everyone, especially nurses.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Suffering has its beneficial aspects. One Saint said something to the effect that you can't avoid suffering in this lifetime, and if you do, you will suffer in the next.

Just room for your diversity thinking...

NurseFirst

Uh-oh. I think I may be doomed. :o

Buddha said it too "life is suffering". The Road Less Traveled begins with the sentence "Life is tough" or something like that.

But also Jesus came to relieve suffering, heal the sick and the pain. Whose to say the nurse or the doctor or the pain medicine isn't Jesus talking.

I'm very diverse in my thinking, which is why you have to walk a fine line with respect of the persons beliefs and you're own.

Uh-oh. I think I may be doomed right along with you. :)

Pain is the fifth vital sign, right? OK, there is no excuse for disregarding the patients pain. I think I better tattoo it on my forehead... DNR and MDP (morphine drip please!) muah.. love yas

Suffering has its beneficial aspects. One Saint said something to the effect that you can't avoid suffering in this lifetime, and if you do, you will suffer in the next.

Just room for your diversity thinking...

NurseFirst

Uh-oh. I think I may be doomed. :o

I respect you for being a healthcare professional, but please do not make decisions based on your religon..for my own sake if I were a patient... I have different views.... and I AM the one suffering...

Alicia18

Specializes in Geriatrics.

Originally posted by NurseFirst

Suffering has its beneficial aspects. One Saint said something to the effect that you can't avoid suffering in this lifetime, and if you do, you will suffer in the next.

Um, yeah, I agree to that (I'm Catholic), and that's great for those of us who choose to use their suffering as a way to salvation. But the patient involved may not make that choice, and if they don't intend to use their suffering in such a manner, it doesn't do them much good, and we as their caregivers are failing our job for letting them be in pain without any relief. Of course, if they (or their loved ones if they aren't able to decide for themselves) don't want painkillers, you can't do much about it.

Sorry if this doesn't make much sense, but I'm in a hurry b/c I need to flee the computer to go somewhere.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Pain is the fifth vital sign, right? OK, there is no excuse for disregarding the patients pain. I think I better tattoo it on my forehead... DNR and MDP (morphine drip please!) muah.. love yas

Excellent idea!

I agree - If a patient is suffering (in pain) I am not doing my job very well. Back to the original question. While working in Onco I came across this a lot (family wants mom awake to talk with - Forget the fact she is in so much pain all she does is scream) anyway I would always give the pain med in that situation (I would ask the Patient if they wanted it - They always said yes!!)If the med knocked them, we would add a little ritulin to it and that would usually perk them up a bit so they could talk with their loved ones - Thanks to all & God Bless - Gary

Um, yeah, I agree to that (I'm Catholic), and that's great for those of us who choose to use their suffering as a way to salvation. But the patient involved may not make that choice, and if they don't intend to use their suffering in such a manner, it doesn't do them much good, and we as their caregivers are failing our job for letting them be in pain without any relief. Of course, if they (or their loved ones if they aren't able to decide for themselves) don't want painkillers, you can't do much about it.

Sorry if this doesn't make much sense, but I'm in a hurry b/c I need to flee the computer to go somewhere.

Hmm...never heard of the ritilan and pain meds. Well What happened?

If you have and ethics committee I would go to them. Seen this in ltc. Even if pts is confused...I will still give the med. I'd love to speak with the family and ask how they view pain and suffering. I'd be curious to see if this is their religious belief or just something else. (I know its none of my business) Then I would try to educate the family that pain relief doesn't always mean sedation.

Whole other thread, but can't stand family not wanting pain meds because old confused mom (demetia) doesn't really know they are in pain. :angryfire

You can involve your Ethics Committee and the Chaplain. Perhaps if the Mother had a scheduled time for prayer, then was given pain med, all the stipulations would be met. The daughter has no rights at this point.

We would add the ritalin on and it would wake them up quite a bit - it only would work for 2 weeks or so, and then it is not quite as effective.

Hmm...never heard of the ritilan and pain meds. Well What happened?

If you have and ethics committee I would go to them. Seen this in ltc. Even if pts is confused...I will still give the med. I'd love to speak with the family and ask how they view pain and suffering. I'd be curious to see if this is their religious belief or just something else. (I know its none of my business) Then I would try to educate the family that pain relief doesn't always mean sedation.

Whole other thread, but can't stand family not wanting pain meds because old confused mom (demetia) doesn't really know they are in pain. :angryfire

You are supposed to be the patients advocate. If you agree or not with the decisions they make.

Except it doesn't sound like its the patient who has made this decision. Being the patient's advocate in this situation would involve advocating for adequate pain control, IMO.

I can't help but thinking maybe a little open communication would help. Maybe if they could get a pain management specialist involved who could identify some options that wouldn't leave this woman so gorked, her family would be more likely to agree to a pain relief regimen.

After all, it is part of the patient's bill of rights to be free from pain. Pain interferes with every body function. The woman isn't truly there and mindful for prayers or other spiritual activities if she's in excruciating pain.

I hate to hear that pain is undertreated, or not treated at all.

We would add the ritalin on and it would wake them up quite a bit - it only would work for 2 weeks or so, and then it is not quite as effective.

When my Dad was dying, I asked if it made sense for him to be on the pain meds and the modafinil (sp?) (aka provigil) that one of his docs had prescribed for him d/t the tiredness from cancer. His PCP said no. Once we put him on pain meds, he became rapidly unavailable to us--and when people are about to leave this earth, there may just be some useful conversations to have. Even if the patient, themselves, thinks they have prepared everything well in advance.

NurseFirst

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