Your Opinion on This Situation Regarding End of Life Scenario POLL

  • Thread starter Thread starter WhiteDove
  • Start date Start date
Status
Not open for further replies.
W

WhiteDove

Guest
I am posting this from work. This is a poll regarding this particular end of life scenario of one of my patients that I have tonight.

She is an 84 year old woman who suffered a massive intercranial bleed. The family is at the bedside, and only wants what we call “comfort care” measures. No IV fluids, no oxygen. They don’t even want vital signs taken. When they want help with the patient, they call the staff. They are peacefully waiting at the bedside for her to die.

The patient is barely responsive, but does move her left hand. So, what is your view of the ethics of this situation? If the patient were to recieve fluids, I’m sure she could be kept alive.
 
White Dove, we just don’t know much about intracranial bleeding… what is the prognosis? Is it terminal or could she recover?

If she is merely disabled and not terminal, then I think that’s horrible to starve her to death. If she is dying already, and you are just letting nature take it’s course, that’s different.
 
Will the fluids create more suffering? If so, that is one thing. But, if what they want is comfort care, I would think that part of that is fluids.
I don’t say that you should do extraordinary measures, but I think that dehydration is such a horrible thing…I have been severely dehydrated before. It is terrible! I can’t see how they can ask for comfort care, & then deny her the comfort of hydration.
This is a very difficult decision, but I have to say that my instinct would be to provide fluids.
 
…in my book, food and water is not “extraordinary measures”… but that said, unless the state has a say, i vote for bowing out of the families business… it’s their call, IMHO!
 
Is she dying? Are her body systems shutting down? Will food and fluid cause more problems? If the answer is no, then she needs the food/fluids. Do you know this family? If you do and you have a good rapport with them, maybe talking to them will help. Otherwise, there probably isn’t much you can do. Except pray-that’s always a good thing.

P.S. When you pray, pray that you will have the strength to keep doing your job well. We nurses tend to burn-out and when a Catholic nurse sees this kind of thing time after time, it can wear you down.
 
The Catholic position is that food and fluids must be provided as long as they can be metabolized. A Catholic cannot even voluntarily refuse food and water.

Other means – such as artificial heart and lung action – need not be provided in terminal cases.
 
Food and water, no matter the route of administration, are obligatory as long as food and water do for the patient what food and water are designed to do.

Death secondary to starvation or dehydration is typically euthanasia by an act of indifference. This is grave matter.
 
According to the chart, the husband was advised that the chance for neurological recovery is totally grim. The patient had verbally spoken of her desire not to be kept alive under these circumstances to her family. The husband, as the next of kin, had signed the POLST form and had made this decision, after consultation with the doctor.

This patient had been in the hospital a few months ago, as I recall, with some sort of bedside vigil which she apparently survived. As far as her physical status, she was tolerating the lack of fluids for a few days with only the drying of her oral mucosa. She had a foley catheter that put out 100 cc dark urine for my 12 hour shift. The patient did not seem uncomfortable, we turned her once during the night, per the family’s request. I washed her body and applied lotion to her back. That was the extent of my care to her.

The patient has an IV access line, merely for morphine as needed, but the family had not requested that and there was no sign of pain.
 
From what you tell me, the patient seems comfortable. Except maybe for the liquids. I suffered from Crohn’s disease for over 20 years…dehydration, blockages, resections, etc. It is very uncomfortable to be dehydrated. The least drop a minute would not keep her that much alive but maybe just enough to keep that part comfortable. Her tongue may not stick to the roof, etc.

I think this is so minimal and it doesn’t make the patient alive for too much longer…I would guess. I am not a nurse or doctor.

I just think it would make her a little more comfortable even if she is not too aware…

Just my 2 cents worth…and canadian to boot! 😃

Would you even be able to talk the patient’s family into receiving an IV anyway?

Blessings,
Shoshana
 
OK, I have talked with my closest friend. She is a licensed practical nurse with a speciality in geriatrics. She said she will be praying about this situation, but that fluids are comfort care, that they do not have to be highly nutritive fluids–such as would go through a feeding tube.
She feels you are being put in a very bad position…which was my take too. It is the job of the doctor to order what care is to be given. It is for the social worker to discuss this with the family. But they all seem to be putting their responsibilities on you & the other nurses. She had a suggestion, which occurred to me earlier. Can you find another nurse to substitute for you with this patient? Can you not say, that this is contrary to my religious beliefs?
If she has an IV line in, there is no reason that she could not be kept hydrated. I think they are asking you to do something you should not be asked to do…
JMHO.
I am praying for you. God bless.
 
I would ask that another nurse take over as the Church teaches that food and liquids should not be withheld as in the Terry Shivo case.

The Church does not allow mercy killing in any circumstance, I would advise the family or your superiors that you think it is wrong and you should remove yourself from the care of this person.

You should not be put in a situation where you have to choose between what your faith tells you and a mercy killing.
 
40.png
wcknight:
I would ask that another nurse take over as the Church teaches that food and liquids should not be withheld as in the Terry Shivo case.

The Church does not allow mercy killing in any circumstance, I would advise the family or your superiors that you think it is wrong and you should remove yourself from the care of this person.

You should not be put in a situation where you have to choose between what your faith tells you and a mercy killing.
Click to expand...
You think that this is a mercy killing? No one is doing anything to actively kill her. Wouldn’t this be something else?

I really don’t think it is appropriate for this woman to be in the hospital. We weren’t providing any skilled care for her at all. If the family wants to allow her to die naturally, they should take her home and do it, rather than demanding the nursing staff to stand idlly by like this.
 
40.png
WhiteDove:
You think that this is a mercy killing? No one is doing anything to actively kill her. Wouldn’t this be something else?

I really don’t think it is appropriate for this woman to be in the hospital. We weren’t providing any skilled care for her at all. If the family wants to allow her to die naturally, they should take her home and do it, rather than demanding the nursing staff to stand idlly by like this.
Click to expand...
I don’t understand. Are you saying dehydrating and starving a woman is “allowing her to die naturally”? Doing nothing to actively kill her - well, you can do nothing actively to kill an infant and still kill it by dehydration - it is still killing. I assume her body would be able to absorb and use the water & nutrition? In that case, you’re absolutely obligated to give it to her. Don’t kid yourself - this is the same as Terri Schiavo. Her age makes no difference. Your friend is right, hydration is comfort care, and so is nutrition, as long as her body can assimilate it.
I can’t believe you referred to dehydration as “letting nature take it’s course”. What would you call it if someone locked you in a room and witheld food and water from you? Letting nature take its course? After all, you’re going to die eventually anyway…
 
What is being described in this thread is an act of passive euthanasia see CCC 2277 "…*any act or ****omission ****which by itself or intention causes death…constitutes murder… *

The exceptions envisioned by CCC 2278 have recently been clarified by the Church as recently as last March. The provision of food and water do not meet these exceptions.

This is properly treated as murder in the CCC and is the same as watching someone choke to death, only slower.

It does not matter that the patient is in a situation that is terminal. It does not matter that the patient is apparently free of discomfort. It does not matter that the family thinks it is best and concurs.

Food and water are obligatory as long as food and water does for the patient what food and water are designed to do in everyone else.

Do not be deceived. This is grave, grave matter for you and all involved.
 
Food and fluids must be provided as long as they do not add to the suffering and make ther person worse . This is what The Church teaches and what seems to me the moral thing.
 
Well, an update on my patient is that she continues to live. She is mostly unresponsive, but the daughter was concerned that she was having periods of discomfort at times, saying that she called out a few times, unintelligably I believe. The husband did not want her given morphine as he believed her brain was totally gone. The daughter thought that her mother was still capable of feeling pain, therefore wanted the freedom to ask for morphine and have the nursing staff back her up. She did not ask for morphine throughout my shift this evening.

The patient had a period of tachypnea (rapid breathing) at the end of my shift at around 2300 (11 PM). She put out 200cc med yellow urine from her foley. The daughter began to sob at the impending loss of her mother. The patient’s husband of 63 years went home, unable to bear any more of this for now. We turned the patient twice during my shift at the request of the daughter.

I did email my manager regarding the situation, expressing my concern about the appropriateness of our having the patient in the hospital and allowing her to die of dehydration, with no skilled nursing intervention on the part of the staff. Meanwhile, I provided compassionate and respectful care of the patient and the family.
 
White Dove can’t you swab her mouth with those rasberry colored water sponges?
 
Hi Lily,
Yes, I always provide good oral care for any patient with a dry mouth. There are many things that can cause that.

BTW, this lady died yesterday morning at 9:30AM, I was told when I arrived for my evening shift. The family was very happy with the emotional support they received from the staff. My manager returned my email by say that the patient was on hospice and was there for respite care.
 
It’s good her struggle is over. Sometimes it’s hard for families to let go.
When my dad was dying, my husband took care of him and gave him ice chips. I know that is a big no no, but technically he WAS being hydrated. That’s why I asked about the swab for the mouth, isn’t that a form of hydration?
 
40.png
WhiteDove:
Hi Lily,
Yes, I always provide good oral care for any patient with a dry mouth. There are many things that can cause that.

BTW, this lady died yesterday morning at 9:30AM, I was told when I arrived for my evening shift. The family was very happy with the emotional support they received from the staff. My manager returned my email by say that the patient was on hospice and was there for respite care.
Click to expand...
Code:
God bless you WhiteDove and I am happy to hear that Jesus in His mercy has taken our sister to Himself…

Blessings,
Shoshana
 
Status
Not open for further replies.
Back
Top