Ethics
As a new graduate of six months working night shift on a small cancer unit, I am faced with a dilemma. Mr. V has been in and out of the unit several times over the last few months. He has liver cancer and has gone through several episodes of chemotherapy. His wife has been staying with him since his admission. There are two RN's on this unit.
Mr.V recently joined the hospice program. His current admission is for pain control with orders to start a morphine drip to be regulated for pain control.
The only set parameters indicated by hospital policy are to decrease the drip when respirations are less than twelve breaths per minute. Mr. V has requested that the drip be increased several times during my shift. Even though he does not appear to be in any discomfort, I increase the drip. On my final round of the shift, Mr. V requests that the drip be increased again, stating that the pain is increasing. I note that his respirations remain stable at 12 breaths per minute.
An Ethical Question
This man is dying of liver cancer. For a while, morphine will control his severe pain. However, it may further reduce respiration. As a medical professional, I feel responsible to give this patient enough morphine to ease his suffering without causing him harm. However, I must consider the legal and ethical issues at hand.
On one hand, if I continue to increase his pain medication, I may be accused of overprescribing narcotics or hastening death. On the other hand, my patient has a right to proper pain management. For most terminally ill patients, pain can be controlled and, as a hospice worker, I am responsible to provide pain control.
In the past, many nurses did not fully understand pain control. As a result, many terminally ill patients were denied enough medication to relieve their pain because nurses were afraid of addicting patients or of killing them.
The medical industry and the public believed many untrue statements...
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