96 year old refuse treatment

MunoRN, RN · Mar 11, 2015

If the patient is competent and refusing treatment then it would be highly unethical to provide that treatment anyway.

CrunchRN, ADN, RN · Mar 11, 2015

Absolutely should follow her wishes.

IVRUS, BSN, RN · Mar 11, 2015

Yes, she can make her own decisions, as an A&O person. If she desires to merely remain comfortable, that is what your company should work to provide. This really shouldn't be an issue.

allnurses Guide · Mar 11, 2015

Lots of people have differing opinions. Since she is completely alert and oriented, can't we follow her wishes? Why does everyone want to medicalize mortality here? Its a war with some people!

So, those people who feel treatment should be done, regardless of how the pt feels...

How do they suppose to give this treatment to a person who doesn't want it?

My fear is someone will cite her age and claim she is "too confused" and she'll be sent to ER for her CHF and "passive suicidal ideation". Then they will d/c her hospice so she can go to a geri-psych ward for "treatment"... hell, she might even get a little combative and say she wants to die, at that point. Good thing she's in geri-psych, eh?

If you think what I just said was unlikely or crazy... it's not.

We have cases like this come to us once or twice a year and we are just livid when it happens!

Last year, I had a lady who passed away the day after her discharge! What good did any extra treatment do? What was the point of taking her away from the comfort of her home to stick her with us?

At what age do we lose our rights and at what age are we allowed to be okay with dying?

Honestly, part of dying is "acceptance" and it sounds alright to me that someone is just willing to accept and take things as they come... at 97 years-old!

It's all so infuriating and sad.

icuRNmaggie, BSN, RN · Mar 11, 2015

I wish that we could teach the families of dying ninety year olds to use good judgement and help their loved one pass over.

Whatever happened making someone warm and comfortable, and letting him or her go peacefully and then calling the funeral home?

Why do people resist allowing a natural death?

These days, they call 911 because they can not or will not deal with death and dying, and for some reason, prolong what is inevitable, and that usually involves mechanical ventilation and pressors and an expensive and futile ICU admission. Nearly every night, I feel so conflicted and I just want to know - why are we doing this?

elkpark · Mar 11, 2015

Actually, there is more to whether someone has the mental capacity to make decisions for themselves than just whether s/he is alert and oriented. I work on the psych consultation-liaison service of a large academic medical center, and we talk to people all the time who are alert and oriented but have no clue about what is going on with their medical condition, risks, prognosis, etc. When it comes to people refusing life-sustaining treatment, it's a much bigger issue than simply whether they know where they are and what the date is.

I'm not advocating for treating this woman against her will -- just want to clarify, since people always say, "well, if they're alert and oriented, then ...," that that is not, by itself, any indication of capacity.

MunoRN, RN · Mar 11, 2015

Actually, there is more to whether someone has the mental capacity to make decisions for themselves than just whether s/he is alert and oriented. I work on the psych consultation-liaison service of a large academic medical center, and we talk to people all the time who are alert and oriented but have no clue about what is going on with their medical condition, risks, prognosis, etc. When it comes to people refusing life-sustaining treatment, it's a much bigger issue than simply whether they know where they are and what the date is.
I'm not advocating for treating this woman against her will -- just want to clarify, since people always say, "well, if they're alert and oriented, then ...," that that is not, by itself, any indication of capacity.

And actually a patient can be not alert and oriented but still be considered competent to make their own decisions. All they have to do is be able to express what is generally wrong with them, what is being proposed to fix it, and what could happen if they refuse. So long as they are basically oriented to situation, they can also think it's 1972 and still refuse.

Vtachy1 · Mar 12, 2015

I can honestly say that I would not want lasix, if I were her either. Meds are and can be considered extraordinary and heroic measures. At 96, let nature do its normal and natural thing. Keep me content, peaceful, comfortable and in my home if possible, not at the doctor's office.

martymoose, BSN, RN · Mar 12, 2015

This is because FAMILIES want everything done.

They have already had those discussions.

why else do we have pts who have ulcers big enough to put your hand into, are incontinent into said ulcers, have tube feeds with large residuals, and are vented.

Religion plays a big part too. Somewhere people were taught that to do nothing is to kill the pt.I have a family member who believes this, despite my explaining what I see daily.

CamillusRN, BSN · Mar 12, 2015

I wish that we could teach the families of dying ninety year olds to use good judgement and help their loved one pass over.

The DPOA who keeps his/her 90+yo family member a full code when the patient clearly states s/he's tired of living in pain. Signing a DNR AFTER the rib cage cracks during CPR is, in my opinion, one of the cruelest things to do to a loved one. Successfully bringing them back to an unwanted life of continued pain and misery is a very close second.

spacemonkey15 · Mar 12, 2015

Sounds like we're approaching a stage where there are no longer any deaths in the world, just unwitnessed cardiac arrests.