Question

Mrs. R., an 87-year-old patient, has a past history that includes coronary artery disease, a previous stroke, and advanced Alzheimer’s disease. Ten days ago, Mrs. R. was hospitalized for aspiration pneumonia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family members visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days, but can be contacted should any change in Mrs. R.’s condition occur. Her primary care physician has practiced in this community for multiple years; he is well-known for his reluctance to discontinue any type of life support for any patient. When questioned, Dr. G.’s consistent response is, if this were his frail 92-year-old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major medical center, where she can receive more advanced care, including vigorous rehabilitation and physical therapy, so that she may eventually return to a long-term nursing care facility. Questions: How might the nurses in this scenario respond to the physician’s request? What ethical principles have potentially been violated in this scenario? How would this scenario begin to cause moral distress among the nursing staff? What are actions the nurses can take to have moral courage in dealing with this situation?

Answer 1

• Nurse must not accept a request due Physcian would write separate request for same patiet other wise it violation of ethics  
• RN is the not person to decide that patient trasfer of facility status
• RN comfortable care in this case and physical therpay and occupotinal therphay

Comfort care is an essential part of medical care at the end of life. It is care that helps or soothes a person who is dying. The goals are to prevent or relieve suffering as much as possible and to improve quality of life while respecting the dying person’s wishes.

You are probably reading this because someone close to you is dying. You wonder what will happen. You want to know how to give comfort, what to say, what to do. You might like to know how to make dying easier—how to help ensure a peaceful death, with treatment consistent with the dying person’s wishes.

A peaceful death might mean something different to you than to someone else. Your sister might want to know when death is near so she can have a few last words with the people she loves and take care of personal matters. Your husband might want to die quickly and not linger. Perhaps your mother has said she would like to be at home when she dies, while your father wants to be in a hospital where he can receive treatment for his illness until the very end.

Some people want to be surrounded by family and friends; others want to be alone. Of course, often one doesn’t get to choose. But, avoiding suffering, having your end-of-life wishes followed, and being treated with respect while dying are common hopes.

Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. Their families need support as well. In this section, you will find a number of ways you can help someone who is dying. Always remember to check with the healthcare team to make sure these suggestions are appropriate for your situation.

Physical Comfort

There are ways to make a person who is dying more comfortable. Discomfort can come from a variety of problems. For each, there are things you or a healthcare provider can do, depending on the cause. For example, a dying person can be uncomfortable because of:

• Pain
• Breathing problems
• Skin irritation
• Digestive problems
• Temperature sensitivity
• Fatigue

Pain. Watching someone you love die is hard enough, but thinking that person is also in pain makes it worse. Not everyone who is dying experiences pain, but there are things you can do to help someone who does. Experts believe that care for someone who is dying should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse.

Quality of life is the third topic that must be reviewed to analyze a problem in clinical ethics. The idea of quality of life is difficult to define. However, it is often raised in complex cases and must be addressed. This patient is already intubated and already on mechanical ventilation explaining the concept of quality of life, analyzing its implications for clinical decisions, and suggesting certain distinctions and cautions that should be observed in discussing this concept in clinical care. Need to approach palliative care of clinical care in which quality-of-life considerations often loom large, namely, end-of-life care, including termination of life-support and physician-assisted dying