Still Reeling From This

16 Fellow nurses, I recently was involved in a case where I feel that there was a terrible breach of ethics and it still has me upset. I will be vague to protect the privacy of those involved; there is a complicated back story but the gist of it is:

Patient is actively dying with no hope of recovery- not a candidate for dialysis and in severe renal failure, volume overloaded, profusely bleeding esophageal varices, tachypneic, sounds as though they are breathing under water- you don't need a stethoscope to hear it, looking miserable and exhibiting air hunger and pain behaviors.

MD refuses to write for comfort measures and withdraw futile treatments including IV FLUIDS on an anuric, volume-overloaded patient because they want to keep patient alive for the next-of-kin (who the patient had previously expressed was not the person they wanted making decisions for them but because the MD had declared the patient incompetent this wish was dismissed). Next of kin was supposed to come in the morning and still hadn't arrived by 8 pm. (I refused to continue the IV fluids and eventually MD relented)

I contacted the nursing supervisor and ethics and the Ethics on-call agreed with me and contacted the MD but nothing was done. I paged the MD about 6 times and they stopped returning my pages. The charge nurse and social worker got involved and paged the MD. Every single person agreed that this was cruel (including the MD) but the MD wouldn't listen and actually started a sentence "Ethics are nice but...."

I don't know how this ended as I left when my shift was over. I don't know what to do with this. This is a new MD and I know my relationship with them has gotten off to a terrible start-esp. since I went over their head and there will probably be repercussions for them. I also don't trust this person to act in the best interest of their patient now although I am going to do my best to start over with a clean slate.

This is my day off and I still feel drained and angry. I need to let it go. Words of encouragement would be nice. I hate feeling as though I have failed my patient even though I did everything I could think of.
You didn't fail your patient. You kicked butt and advocated for your patient. You cannot control the response of others but you can follow protocol and move up the chain of command. If there is a debriefing perhaps an ethics & palliative/hospice care refresher class might be suggested. Take a break. You did well with what you had to work with. You refused to carry out a ridiculous order-- fluids for a hypervolemic, anuric patients. You may not have yet won the war but you won a few battles.

Kudos to you. Your courage as a patient advocate exemplifies what nursing is all about. Just taking a stand - drawing a line in the sand and saying "no more" -- can make a huge difference. Maybe not for this patient, but I promise you that it did have a positive effect on everyone who witnessed your behavior. I once refused to participate in a futile code - terminally ill ICU patient had clearly expressed his wishes for 'no heroics'- knowing full well that it could result in loss of my job. But you know what? Not only did it NOT get me fired, the hospital chaplain (who was also involved) invited me to join the Ethics Committee case consultation group. We're very proud of you.

You are awesome!! I am on the Ethics commitee at a large psych hospital so you can only imagine how many consults we do. It is strange to see how ingnorant this MD was in this particular case but don't ever let this deter you from speaking out again. If it feels right it probably is right.Nice work!!

You absolutely did the right thing. If ever I am in a position like that of your patient, I hope I'll have someone like you looking out for my best interests and not the MD's license.

Thank you all. I am looking into how to get involved on our ethics committee because I'd really like to help prevent future cases such as this one.

What a horrific experience for you to have to deal with. It sounds like you did everything right. Not every nurse would have the courage to keep going up the chain of command and refuse orders the way you did. I can understand why you're still reeling, but you deserve a huge pat on the back for your patient advocacy.

You did your best to protect a helpless, suffering patient. Never regret that. Some battles are worth fight."Ethics are nice, but ..." Yeah, and that guy should get some.

You are awesome, and you rock. I firmly believe you will make a difference in the future related to this one incident. It's normal for us to grieve certain situations at work....I wish I could have let certain things go over the course of my years, but it seems they mold us and shape us....make us more passionate about our stance. Such as this episode, it brought out the best in you....not the best in the doc. Hopefully the situation will cause future patients to have more dignity with dying than if that doc is involved . You did good. (((Hugs)))

You behaved with professionalism and courage to advocate for your patient who had NO VOICE themselves. I salute you for your willingness to stand in the gap and insist on what was right.

Quote from MECO28Thank you all. I am looking into how to get involved on our ethics committee because I'd really like to help prevent future cases such as this one.

you are awesome!

5:11 pm by MECO28Fellow nurses, I recently was involved in a case where I feel that there was a terrible breach of ethics and it still has me upset. I will be vague to protect the privacy of those involved; there is a complicated back story but the gist of it is:Patient is actively dying with no hope of recovery- not a candidate for dialysis and in severe renal failure, volume overloaded, profusely bleeding esophageal varices, tachypneic, sounds as though they are breathing under water- you don't need a stethoscope to hear it, looking miserable and exhibiting air hunger and pain behaviors. MD refuses to write for comfort measures and withdraw futile treatments including IV FLUIDS on an anuric, volume-overloaded patient because they want to keep patient alive for the next-of-kin (who the patient had previously expressed was not the person they wanted making decisions for them but because the MD had declared the patient incompetent this wish was dismissed). Next of kin was supposed to come in the morning and still hadn't arrived by 8 pm. (I refused to continue the IV fluids and eventually MD relented) I contacted the nursing supervisor and ethics and the Ethics on-call agreed with me and contacted the MD but nothing was done. I paged the MD about 6 times and they stopped returning my pages. The charge nurse and social worker got involved and paged the MD. Every single person agreed that this was cruel (including the MD) but the MD wouldn't listen and actually started a sentence "Ethics are nice but...."I don't know how this ended as I left when my shift was over. I don't know what to do with this. This is a new MD and I know my relationship with them has gotten off to a terrible start-esp. since I went over their head and there will probably be repercussions for them. I also don't trust this person to act in the best interest of their patient now although I am going to do my best to start over with a clean slate. This is my day off and I still feel drained and angry. I need to let it go. Words of encouragement would be nice. I hate feeling as though I have failed my patient even though I did everything I could think of."I understand that you do not wish to provide too many details in order to protect the patient's privacy. I am wondering if the patient had an Advance Directive. I am wondering too what discussions may have taken place between the patient, the person with decision making authority, other family members, and the physician, that perhaps you were not privy to. From your post it is not clear what the patient wished to happen in this situation, or what was decided between the patient, the person with decision making authority, other family members, and the physician. It was clear in your post that you felt strongly that you needed to act in order to protect the patient from suffering (i.e. protect the patient from further care that apparently would only prolong the patient's life without possibility of cure, and would prolong their physical suffering), but I am wondering if the patient may have chosen to continue suffering to prolong their life until they could see a certain family member. Such situations are not unknown. Patients do have a right to choose to prolong their lives, even if there is no hope of cure. Much information is not given in you post, appropriately and understandably, in order to protect the patient's privacy, which renders the total situation ambiguous, and thus it is difficult to provide meaningful comment.