BBC3 - Junior Doctors: Your Life In Their Hands

Original post by 079

Im really confused about one part of the this weeks episode, the patient who died because she stopped eating properly (well thats the reason Lucy gave)

So if a patient at a hospital refuses to eat and drink, the doctors/nurses are not allowed to force them right? Would the death then be declared as euthanasia? Any patient can do this then, if they are being refused voluntary euthanasia, they can just starve themselves and die that way.. :s-smilie:

If the patient has capacity then yes we cannot force them to eat. Although we won't give up so easily, but I've had a few patients go this way due to not eating and drinking despite everything we try and do. She must likely had co-morbidities which also may have contributed to the death, but that's the way it is. The tip is when this happens to document and document! You could argue though that the Liverpool care pathway is a form of euthanasia.

I had a patient yesterday who got put on the pathway, once I removed the oxygen they went quite quickly, was I performing euthanasia when infant the doctor and family requested all treatment (including 02) to be removed?

Reply 2042

Helenia

20

Original post by 079

Im really confused about one part of the this weeks episode, the patient who died because she stopped eating properly (well thats the reason Lucy gave)

So if a patient at a hospital refuses to eat and drink, the doctors/nurses are not allowed to force them right? Would the death then be declared as euthanasia? Any patient can do this then, if they are being refused voluntary euthanasia, they can just starve themselves and die that way.. :s-smilie:

No - euthanasia is doctors deliberately doing something to end a patient's life. In the UK, it is illegal.

If a patient has capacity (i.e. understands the consequences of not eating/drinking) then they are entitled to do as they please and doctors cannot force them against their will. In fact, even if a patient does not have capacity, at the end of life feeding/fluids can be withdrawn if it's not in their best interests. This is not euthanasia, it is withdrawal of unnecessary treatment and is good palliative care.

Reply 2043

079

Original post by Subcutaneous

If the patient has capacity then yes we cannot force them to eat. Although we won't give up so easily, but I've had a few patients go this way due to not eating and drinking despite everything we try and do. She must likely had co-morbidities which also may have contributed to the death, but that's the way it is. The tip is when this happens to document and document! You could argue though that the Liverpool care pathway is a form of euthanasia.

I had a patient yesterday who got put on the pathway, once I removed the oxygen they went quite quickly, was I performing euthanasia when infant the doctor and family requested all treatment (including 02) to be removed?

Original post by Helenia

No - euthanasia is doctors deliberately doing something to end a patient's life. In the UK, it is illegal.

If a patient has capacity (i.e. understands the consequences of not eating/drinking) then they are entitled to do as they please and doctors cannot force them against their will. In fact, even if a patient does not have capacity, at the end of life feeding/fluids can be withdrawn if it's not in their best interests. This is not euthanasia, it is withdrawal of unnecessary treatment and is good palliative care.

Thanks for your response! I understand now

Reply 2044

kingme

Original post by Helenia

No - euthanasia is doctors deliberately doing something to end a patient's life. In the UK, it is illegal.

If a patient has capacity (i.e. understands the consequences of not eating/drinking) then they are entitled to do as they please and doctors cannot force them against their will. In fact, even if a patient does not have capacity, at the end of life feeding/fluids can be withdrawn if it's not in their best interests. This is not euthanasia, it is withdrawal of unnecessary treatment and is good palliative care.

Aren't doctors allowed to give morphine or something if they think it will ease someone's passing (though it will mean the patient dies quicker)?
At what point would this legally become euthanasia?
Is this only allowed when they are definitely on their way out?

Reply 2045

Helenia

20

Original post by kingme

Aren't doctors allowed to give morphine or something if they think it will ease someone's passing (though it will mean the patient dies quicker)?
At what point would this legally become euthanasia?
Is this only allowed when they are definitely on their way out?

It becomes euthanasia when you give someone morphine with the intention of killing them.

You can give morphine at any stage if they are in sufficient pain to warrant it, as long as your intention is to relieve pain (or respiratory distress in some circumstances). It is a fantastic drug when used appropriately - most of my patients are on infusions of the stuff. It does suppress respiratory drive and so you do have to monitor patients, but most of the time hastening death is not a concern.

Reply 2046

Original post by kingme

Aren't doctors allowed to give morphine or something if they think it will ease someone's passing (though it will mean the patient dies quicker)?
At what point would this legally become euthanasia?
Is this only allowed when they are definitely on their way out?

Very very small amounts of morphine or a syringe driver is often used although so small it will make the patient comfortable more than overdose and kill them. It's only allowed when the decision is made by medical, nursing and the family usually when the patient is expected to go in the next 24 hours, it also has to be reviewed every 3 days. It's worth reading up on what's called the Liverpool care pathway, personally I think palliative care is doing shockingly poor in hospitals and you get a lot of patients who are put on the pathway far too late.

Reply 2047

LilithSternin

3

I love this programme! I work as a bank HCA in the hospitals where the first series were filmed, and my cousin and I have a little competition going on to see who can spot all the docs from the last series! I like the look of this series already, I loved the "Fun. Fair...not a funfair" thing :smile:

Reply 2048

Original post by Subcutaneous

Plus I love how they show the weird little rituals nurses do when patients die, like opening the window to let the spirit out!

Holy moly... :facepalm2:

Reply 2049

Original post by digitalis

Holy moly... :facepalm2:

It gets done, even in the most atheist of nurses! I don't open the window as im not tall enough, but I do have a cup of tea after doing last offices (I'm a coffee girl myself) as a ritual and I know one nurse who will leave a paper rose on the body after its been wrapped. It's a way of coping especially in the relationship nurses get with their patients can be quite personal, it can be like loosing a friend sometimes

Reply 2050

Helenia

20

Original post by digitalis

Holy moly... :facepalm2:

I've heard of it being done before. It has the slight downside that the patient is then ice-cold by the time they're certified/seen by family.

Reply 2051

Original post by Helenia

I've heard of it being done before. It has the slight downside that the patient is then ice-cold by the time they're certified/seen by family.

ouch I wouldn't do it then! on wards where the window's aren't out of my reach I've done it during us performing the last offices which is ofcourse done after the family have seen (but sometimes family members do help us perform this) and after certification etc

Reply 2052

e...

Am I the only one who prefers the previous series?

I know it's early days but...

Reply 2053

Original post by Subcutaneous

It gets done, even in the most atheist of nurses! I don't open the window as im not tall enough, but I do have a cup of tea after doing last offices (I'm a coffee girl myself) as a ritual and I know one nurse who will leave a paper rose on the body after its been wrapped. It's a way of coping especially in the relationship nurses get with their patients can be quite personal, it can be like loosing a friend sometimes

Come on mate...

Reply 2054

Original post by Helenia

I've heard of it being done before. It has the slight downside that the patient is then ice-cold by the time they're certified/seen by family.

Not to mention the poor old cachectic biddy in the next bay freezing their *******s off.

Reply 2055

Original post by digitalis

Come on mate...

It's true! Imagine having a patient on say a stroke rehab ward where average LOS is 27 days, you'd see this person an average of 3-4 times a week, for 12hours a day and get to know them, their family and they know you aswell and call you by your first name. You get a really good relationship with them as you're helping them cope with a quite tough time that stroke rehab often is- yet after 30 days suddenly they get pneumonia, and go down hill. I cried for a few days when this happened to one of my patients as we got on really well and he was such a sweet man, his family invited the ward staff to his funeral aswell

Reply 2056

manupalace

11

Original post by Subcutaneous

It gets done, even in the most atheist of nurses! I don't open the window as im not tall enough, but I do have a cup of tea after doing last offices (I'm a coffee girl myself) as a ritual and I know one nurse who will leave a paper rose on the body after its been wrapped. It's a way of coping especially in the relationship nurses get with their patients can be quite personal, it can be like loosing a friend sometimes

Totally agree about the building of a relationship. I built up relationships patients on a cardiology ward who came in regularly, it is really sad seeing them suddenly go downhill and sometimes it would seem like an inevitable progression and you are glad they are no longer suffering (but still sad), but sometimes a patient deteriorate out of the blue.

I've never heard of letting the spirit out but I was taught to and find it easier to talk to them as if they were alive. It was never my favourite job as a HCA though.

Reply 2057

Annora

1

Original post by Subcutaneous

It's true! Imagine having a patient on say a stroke rehab ward where average LOS is 27 days, you'd see this person an average of 3-4 times a week, for 12hours a day and get to know them, their family and they know you aswell and call you by your first name. You get a really good relationship with them as you're helping them cope with a quite tough time that stroke rehab often is- yet after 30 days suddenly they get pneumonia, and go down hill. I cried for a few days when this happened to one of my patients as we got on really well and he was such a sweet man, his family invited the ward staff to his funeral aswell

I agree with this. I'm only a bank HCA so I perhaps don't really get to build relationships with patients like permanent staff do, but I understand how it is easy to get attached to patients. Many nurses have their own little rituals when patients pass away. If a nurse likes to leave a paper rose with them, then what's the harm in that?

Reply 2058