Hospice nursing

[ryburn]

Is it a sin to assist patients and families who have decided not to seek further medical treatment and want only comfort measures? Is it wrong to consistently give narcotics if patient having difficulty breathing and family and patients want the medication for comfort?

 

[SaintNobody]

No it is not a sin to only give comfort measures, if that is what the patient wants. Or if the patient can’t give his consent, then I would say that it would have to depend on whether there is a realistic chance of improving the patient’s state of health. If there’s no chance of real progress, then it’s fine.

Narcotics are fine as medication. The moral problem would arise over the issue of giving large, potentially lethal doses. So long as the intention is to treat the pain, and there is no other means to treat the person, giving potentially lethal doses of narcotics is permissible.

The problem is not only the morality, the problem also has to take into account circumstances and advances in medicine and treatment. To me, that’s what makes answering these questions hard. I’m sure some people could fill in the details.

 

[Jessi_Thomist]

God bless you in your work. I cannot imagine how difficult it is to be a hospice nurse, and yet how I know from the nurses who cared for my grandmother, how much of a blessing are hospice nurses are who care for their patients and their families.

To answer your question-- if the person is dying then there is no need to prolong life. If, however, the person is ill but able to recover, then treatment must be given.

Also narcotics that are used for the purpose of reducing pain are totally acceptable, if the person is dying, even if this will reduce the length of life. If, however, the intention is to reduce the length of life, then it is not.

Unfortunately, prudence is needed in particular cases, and it can be difficult to discern when you are acting as a proxy for someone else’s will. Always act with the end of care.

Peace.

 

[Melissa]

No, of course it’s not a sin.

Some conditions are (barring a direct miracle) incurable with a very short-term prognosis (the norm is 6mo or less of expected life remaining at the time the patient is admitted to the hospice program). While active measures might still be undertaken, if there’s no expectation that it will cause an improvement–you may actually be robbing the patient of valuable time which could be spent properly preparing for death.

I’ll give as examples my two grandmothers. The first case is my paternal grandmother, diagnosed w/ cholangiocarcinoma twenty years ago. At the time of her diagnosis, she was given a prognosis of 8-12 weeks. She was immediately admitted to the hospice program. She did, in fact, live 11 weeks after diagnosis. The pain of terminal cancer is intense, and narcotics approaching lethal dosages are necessary to manage pain, and it’s really not possible to say that the usage of narcotics shortens the life by any concrete measure of time.

My maternal grandmother was diagnosed with lymphoma five years ago, and given an 80% chance of survival if she underwent a 16 week course of chemotherapy. She was 84 at the time, and decided to go for treatment. She was able to take one week of chemotherapy and then had a catastrophic cascade of side effects which rendered her incapable of continuing chemotherapy or leaving the hospital. She died 8 weeks after diagnosis from the complications of that week of chemo. It is unlikely that her death would have followed as quickly if she had gone for no treatment beyond palliative care. Was it wrong to undergo chemo? Well, in retrospect, yes–but with the knowledge at the time, it seemed like the best decision, but most of those 8 weeks were spent comatose or in surgery.

When a person’s condition is terminal (6mo or less for expected life), choosing strictly palliative care may afford the patient more time to be properly disposed for death. Remember, we do not believe death is “the end” and that all possible measures must be undertaken to postpone death.

The use of pain control such as narcotics may be done for the comfort of the patient, but may not be done to deliberately end the life of that patient. For the terminal cancer patient, potentially lethal doses may be the only way to reduce the pain to a manageable level. Recognizing the potential lethality does not, however, equate to willing the death of the patient; rather it falls under the double effect (particularly since the bad effect of patient death cannot be avoided regardless of action/inaction w/ respect to pain control).

 

[Jermosh]

Unless you are forbidding them normal care then no. JPII refused medical care when he was ill at the end.

This is a good question though, this gets muddled with euthanasia some how and they are not the same thing by any means. Its perfectly fine to have DNR or other legal papers making a wish for refusing medical care in certain situations. Remember that Human dignity is a large part of Pro-Life as well.

 

[cam100]

To answer your question-- if the person is dying then there is no need to prolong life. If, however, the person is ill but able to recover, then treatment must be given.

Actually, there are cases in which one could refuse treatment, even if that treatment might result in a recovery. If the treatment would cause great hardship or pain, one could be morally justified in refusing it. If a treatment carries a risk of severe side effects, one might also refuse it. These situations require a case-by-case judgment call, but such cases do exist. To quote the Ethical and Religious Directives for Catholic Health Care Services of the USCCB:

A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

The entire document can be found here: usccb.org/bishops/directives.shtml

 

[Jessi_Thomist]

Yes, you are right, I was unclear-- one is obliged to proportionate means to save one’s own life-- Which means that if the treatment WILL save your life you are obliged to take the treatment. If a treatment has only a possibility of success then you may use your prudence.

But you need to be careful about these proportionate means as well-- they never include normal care of a person, even if the person is dying. Even if it ‘excessively burdensome’ to keep a person who is permanently unconscious on a feeding tube- it is never acceptable to not give it or to remove it. It is the same with any means of normal care. (evangelium vitae, only discusses imminent death when he refers to treatment that can be refused to secure a precarious and burdensome prolongation of life)

 

[Joe_Kelley]

. . . .
But you need to be careful about these proportionate means as well-- they never include normal care of a person, even if the person is dying. Even if it ‘excessively burdensome’ to keep a person who is permanently unconscious on a feeding tube- it is never acceptable to not give it or to remove it. It is the same with any means of normal care. (evangelium vitae, only discusses imminent death when he refers to treatment that can be refused to secure a precarious and burdensome prolongation of life)

Note that excessively burdensome means burdensome to the recipient, not to the givers and others.

 

[Melissa]

But you need to be careful about these proportionate means as well-- they never include normal care of a person, even if the person is dying. Even if it ‘excessively burdensome’ to keep a person who is permanently unconscious on a feeding tube- it is never acceptable to not give it or to remove it. It is the same with any means of normal care. (evangelium vitae, only discusses imminent death when he refers to treatment that can be refused to secure a precarious and burdensome prolongation of life)

Feeding via tube can be discontinued, however, when there is no benefit being provided to the patient, as is the case with the patient who is actively dying. From my previous example, my maternal grandmother was being fed via tube, and then her body stopped processing the food and continued tube feeding caused her to bloat and be in great discomfort. Tube feeding was discontinued a maximum of 6-1/2 hrs prior to her death (the decision was made at midnight, she died at 6:30am. But it’s pretty obvious when death is that imminent–every other system is shutting down, too.

 

[Jessi_Thomist]

In the case, and only in the case, in which the feeding tube will not do its job is it alright to discontinue the use. In cases in which the body does not absorb the nutrition, as in the case you describe or in advanced cases of stomach cancer, etc.
JPII was clear about artificial nutrition and hydration-- it is normal care, and normal care cannot be removed.

 

[Mary_Gail_36]

Feeding via tube can be discontinued, however, when there is no benefit being provided to the patient, as is the case with the patient who is actively dying. From my previous example, my maternal grandmother was being fed via tube, and then her body stopped processing the food and continued tube feeding caused her to bloat and be in great discomfort. Tube feeding was discontinued a maximum of 6-1/2 hrs prior to her death (the decision was made at midnight, she died at 6:30am. But it’s pretty obvious when death is that imminent–every other system is shutting down, too.

Good point, the removal of the tube feeding did not cause her death. We normally don’t eat at night anyway.

Unfortunately, a family member did not get a feeding tube when she was admitted to the nursing home, or IV fluids. She lived 14 days. She wasn’t in the best health but she was in her nineties and somewhat senile. She had an infection, and probably could have recovered if given food and water and other care.

This scenario didn’t seem to bother too many family members at all. It also put the nurses in a terrible position to have to care for this woman (bathing, changing linens etc.), but not being permitted to feed her,

I pray the OP doesn’t face this scenario. I believe that Catholic hospices are not permitted to do this.

 

[elts1956]

I have a question about hospice/palliative care. A friend of mine was diagnosed with ovarian cancer. She was at the point no medical treatment would help her live much longer than a month, or two. While she was in the hospital, she received fluids and food through an IV. In hospice she did not get either of them intraveniously. She could have what she wanted by mouth, whatever she could eat. She didn’t eat much even before this. She also received pain mediction to keep her comfortable. Were these the appropriate measures, or did she just starve to death? I wondered especially about depriving her of fluids by tube?

She died within a week of entering hospice.

Thanks.

 

[elts1956]

Good point, the removal of the tube feeding did not cause her death. We normally don’t eat at night anyway.

Unfortunately, a family member did not get a feeding tube when she was admitted to the nursing home, or IV fluids. She lived 14 days. She wasn’t in the best health but she was in her nineties and somewhat senile. She had an infection, and probably could have recovered if given food and water and other care.

This scenario didn’t seem to bother too many family members at all. It also put the nurses in a terrible position to have to care for this woman (bathing, changing linens etc.), but not being permitted to feed her,

I pray the OP doesn’t face this scenario. I believe that Catholic hospices are not permitted to do this.

Wouldn’t this be an instance of euthanasia?

 

[roveau]

I am very impressed at the quality of the replies to this question. For a dying person pain management is of prime importance. I’ve seen several dying people in great pain due to insufficient pain management. There will be a time when the morphine needed to control the pain becomes also a danger to the life of the dying patient. My view is; as long as the morphine is not given with the purpose to shorten the life.

I understand the problems regarding tube feeding of the dying but I am very much against (depending on the case) water being withheld (tube or IV).

Just make sure that you spell out what you want when you get to the end of your life. A lot of nursing homes now have ‘not to be revived’ options. For example if a resident has a cardiac arrest or a stroke.

Rove

 

[dashso40]

It is not a sin to keep people from suffering from their illness…narcotics will actually help ease their breathing…My grandpa was in Catholic hospice and they kept him comfortable until God took him home…

 

[ryburn]

Thank you all for your replies. Unfortunately I have been without a computer for a couple of months. I wanted to try to answer the questions about IV fluids. I have worked in hospice for one year now and we have never had a pt on IV fluids. I just read a book on hospice and pallative bedside nursing care and they stated multiple times that starting an IV for dehydration, electrolyte imbalances were standard of care. We have case conferences every two weeks so I am going present this question. I love my job but if I feel we are in anyway shortening a patients life I will no longer work for this company. I don’t in a very large community and have no catholic hospice around so that is not an option

God Bless You All