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A Heavy Heart | Where’s the Moral Compass for Informing End Stage Patients?

Breakwater, Photo credit: Johnny Berg
Fighting the fight is all well and good until the fight needs to be ended…ended in time to allow for time…

I cannot get into specifics but I have a question for all of you fellow nurses. What do you do when you have a patient that is young, experiencing end stage metastatic cancer and they do not know it. The oncologist has not given them the realistic and total picture of their disease process NOR have they been given the tools to deal with the fact that the treatment they are undergoing IS NOT WORKING.

I worked in hospice many years ago and I had a bitter taste in my mouth then, as I do now, when the oncologist continues to throw one chemo/radiation therapy after another at a person who is just getting worse… and then they die in the midst of treatment and everyone around them, including often times their children and spouse are left with the thoughts of “but they were getting better….the doctor said the treatment was hopeful.”

While I was a nurse in the hospice world I had a voice and I could council my patients as they directed me to…I could also have a voice with the team that was treating the patient. I often feel left out in the wind while working these people in the ER. My role as the ER nurse is to deal with the situational issues that arise with this patient population, not to have a role in their treatment plan. I feel like I’m standing in the corner of the room with duct tape on my mouth and my hands tied behind my back…watching from afar as this confused, sick and often times dying patient enters our doors and needs help…and the most sickening part is they and their families are so unaware of what is truly happening.

As a nurse we have the obligation to provide the total and holistic range of care that each of our patients needs and deserves…I cannot help but wonder where the moral compass points on this issue for both nursing and with the medical professionals who treat these types of patients. The “never give in and never say die” attitude with which many oncologists practice is all fine and good to encourage hope and strength in the patient population, but when is it okay to tell the patient the truth from the facts of their case… I know that it is a struggle of thought that when you tell the facts…the patient may lose the will to fight or may give up…but what if that patient and their family needs that information to stop the insanity and come together for some last weeks of time with saying goodbye?

Each person that we come in contact with has the right to be told the truth of their situation…and sometimes that truth is, “we have done all we can do and now we need to make you as comfortable as possible so you have some good weeks left to be with your family, free from treatment and free from pain, to have the strength and mind to say goodbye. Fighting the fight is all well and good until the fight needs to be ended…ended in time to allow for time…

What is your experience?

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