Question

You are a new grad of 6 months working the night shift on a small cancer unit. There are two RNs on this unit and you are the most senior. Mr. V. has been in and out of this unit several times over the last few months. He has liver cancer and has gone through several episodes of chemotherapy. His last admission, however, was for an unsuccessful suicide attempt. At the time, you learned that he had made several such attempts in the last few weeks.

Mr. V. recently joined the hospice program. His current admission is for pain control and the orders are to start a morphine drip to be titrated for pain. The only set parameters are to decrease the drip for respirations less than four per minute. Mr. V. requests that the drip be increased several times during your shift. Even though he does not appear to be in any discomfort, you accept his assessment and increase the drip. His wife has been staying with him since his admission. On a routine check, you note that his respirations are now four per minute and he is unarousable. You turn off the drip, telling the wife that you will turn it back on if he arouses at all or shows any signs of being in pain but that his respirations are dangerously low. After about an hour be begins to arouse and you resume the drip at a lower level. After about 10 more minutes, Mr. V. wakes up and is furious with you, accusing you of bringing him back from death. "I have a do-not-resuscitate order; you are supposed to let me die." You reply that you did not bring him back; you stopped pushing him toward death.

1. How do you ethically define what is happening in this situation?

Answer 1

Morphine is a opioid analgesic. Used to relieve pain.

Do not resuscitate order means allowing the person for natural death. In this situation it is not a natural death. It is due to medication error. In here overdosage of morphine is occured. Over dose of morphine lead to bradycardia or shallow breathing. So while in this situation if the patient is die it is considered as an medical crime. So the nurse in charge, physician and the hospital are responsibile for the death. They should face the legal consiquences. And also its against the medical ethics.

So the do not resuscitate order allow natural death of person. This cannot be considered as an natural death.