Staying comfortable vs. hastening death

1 I am a new nurse and wanted to get feedback. If a patient is a DNR/Comfort measures and actively dying (say from a GI bleed, or disease process that can't be stopped for whatever reason) and becomes restless and agitated and there is prn ativan available, is it unethical to give a small dose even if it may cause resp depression/hasten their demise? Or is it good palliative care to help them relax and keep comfortable? I'm trying to see where the lines are, they seem so blurred at that point. Thanks.
It is EXCELLENT care to give them Ativan. There's nothing worse than an actively dying patient whose family says no drugs and they pass on a haze of excruciating pain/ anxiety/ maximum secretions- all which could have been avoided. And no: you are not hastening death

No you are not hasting death but offering comfort to a client who is dying

You are not hastening death. You are providing comfort and using the Ativan as it is intended to be used.

If your patient was not dying and had a prn order for a small dose of Ativan available for anxiety, would you give it? I give it all the time. A small dose of Ativan is not likely to produce enough respiratory depression unless a person is extremely sensitive to benzos. A comfortable and relaxed patient is what I like to see.

Yes. Give the Ativan. It will help the patient relax. I will give comfort. You will not hasten death.

Quote from RNMarykayI am a new nurse and wanted to get feedback. If a patient is a DNR/Comfort measures and actively dying (say from a GI bleed, or disease process that can't be stopped for whatever reason) and becomes restless and agitated and there is prn ativan available, is it unethical to give a small dose even if it may cause resp depression/hasten their demise? Or is it good palliative care to help them relax and keep comfortable? I'm trying to see where the lines are, they seem so blurred at that point. Thanks.

Quote from Libby1987Can you explain why the line is blurred managing agitation for comfort care with a terminal illness?

Give as much Ativan as they need (within orders of course) and make sure the family understands what is going on

Not a dumb question, though. There are some extreme - I mean extreme - circumstances when medication adequate to relieve suffering may indeed hasten death as a side effect. I've done it and will do so again, if necessary, if that's what it takes to stop the agony.In almost all cases, though, any differences in the timing of death are minuscule - minutes, not months.

It's unethical NOT to give it. Never, ever, ever withhold pain meds or anxiolytics in the active dying. EVER.ETA: you're not hastening death. Death from a massive GI bleed takes minutes, sometimes a couple of hours depending on the person and the rate of blood loss. Ativan, morphine, etc. only make the death more comfortable for the pt.

JulesA and Libby1987 I think I was just nervous about the line of keeping comfortable/hastening their death and as a newbie RN I have not seen a lot of active dying. When I was a tech I mostly stayed out of the rooms of the actively dying while the nurse did direct care, whereas now I am the one in the room with the pt and their family.I'm trying to speak in hypothetical language rather than specifics of a situation. I just wanted to make sure I had done the right thing.

I think there's widespread misunderstanding of the research on end-of-life care and the potential for hastening death. There is absolutely nothing out there that says medications for symptom management at the end of life cannot hasten death, and actually the established pharmacology and pathophysiology involved suggests that they frequently do hasten death. What the research says is that if we administer these medications in the same way we would to patients who are not comfort care, then it's unlikely to hasten death, but of course we don't do that, that's the whole point of making a patient comfort care. To use the OP's example, in a patient dying of a hypovolemic process, anything that creates an additional relative hypovolemia will likely speed up the process, basic principles of pharmacology and pathophysiology don't magically disappear just because they are comfort care. That being said, there is nothing wrong with prioritizing comfort over trying to prolong the dying process, that's the general purpose of palliative care.