The following case has been submitted to the ethics committee at St. Mary’s Hospital by the attending physician: A 77-year-old male with stage IV Gold COPD was admitted to the ICU for an acute COPD exacerbation. Patient has a signed DNR order, and has elected his eldest son as his medical durable power of attorney (MDPOA). The patient chose to forego intubation, and his acute COPD exacerbation was treated with steroids and supplemental oxygen in order to keep him comfortable while awaiting a hospice evaluation. While the family was in the midst of choosing a nearby hospice facility, the patient began showing symptoms that he was actively dying and the family chose to keep him in the hospital rather than transferring him to a hospice facility.
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With regard to pain management at the end of life, the ERD’s specifically state, “Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death” (p. 32). Therefore, in light of Catholic teaching, pain and suffering should be adequately treated at the end of life in order to keep the patient comfortable. These medications should however be used in appropriate doses in order to avoid decreased consciousness or overt over …show more content…
Education should be provided regarding the side effects of pain medication, and the concept of proportionality in order to curb any unwarranted worries regarding the patient having respiratory arrest following the administration of pain medication. The provider should also educate the family on non-verbal signs of discomfort, as well as explain how and why air hunger is treated. I propose that the family is not intentionally trying to cause any pain or discomfort to the patient, but rather that they lack knowledge regarding end of life care. By framing the patient’s symptoms as a byproduct of his chronic disease, the family may come to understand that by administering pain medication and by removing or decreasing his supplemental oxygen, they are simply making him more comfortable during the natural process of death. The argument should also be made that by making the patient more comfortable, they may even be prolonging his life as untreated pain may actually cause more stress on the body. A discussion regarding any religious reasons for avoiding pain medication should also be explored, as some cultures believe that some degree of suffering or pain is expected, and should be experienced at the end of life as a
With regard to pain management at the end of life, the ERD’s specifically state, “Patients should be kept as free of pain as possible so that they may die comfortably and with dignity, and in the place where they wish to die. Since a person has the right to prepare for his or her death while fully conscious, he or she should not be deprived of consciousness without a compelling reason. Medicines capable of alleviating or suppressing pain may be given to a dying person, even if this therapy may indirectly shorten the person’s life so long as the intent is not to hasten death” (p. 32). Therefore, in light of Catholic teaching, pain and suffering should be adequately treated at the end of life in order to keep the patient comfortable. These medications should however be used in appropriate doses in order to avoid decreased consciousness or overt over …show more content…
Education should be provided regarding the side effects of pain medication, and the concept of proportionality in order to curb any unwarranted worries regarding the patient having respiratory arrest following the administration of pain medication. The provider should also educate the family on non-verbal signs of discomfort, as well as explain how and why air hunger is treated. I propose that the family is not intentionally trying to cause any pain or discomfort to the patient, but rather that they lack knowledge regarding end of life care. By framing the patient’s symptoms as a byproduct of his chronic disease, the family may come to understand that by administering pain medication and by removing or decreasing his supplemental oxygen, they are simply making him more comfortable during the natural process of death. The argument should also be made that by making the patient more comfortable, they may even be prolonging his life as untreated pain may actually cause more stress on the body. A discussion regarding any religious reasons for avoiding pain medication should also be explored, as some cultures believe that some degree of suffering or pain is expected, and should be experienced at the end of life as a