Hospice Patients Alliance: Consumer Advocacy

Hospice Nurse Observes Illegal Euthanasia in Hospice

by Christina Brundage, RN - March 13, 2003 report

[Note: the following is an account of what I observed in a hospice case where I was a "friend" at the bedside and not the nurse caring for the patient.]

I will call this patient "Joe." Joe has been ill with progressive [terminal illness] for approximately 4 years. I used to take care of him on occasion. He became too rigid for me to help him walk and his wife, Ellen, has been hiring male CNAs to help since then.

Two weeks ago Ellen asked me to check Joe - he had a "sore" on his coccyx which she was told by the nurse or nurse practitioner was "sheet burn". I found Joe to have an inflamed area on his buttocks and a necrotic area, approximately 2" by 1", with blood oozing around the edges. A large area, about 6-8", around the necrotic area was mottled, reddened, with yellow exudate. Ellen had been told to use Silvadene on the area.

I talked to a nurse and told her what I observed and suggested a visit ASAP and a culture. The next day Ellen related that the nurse practitioner visited, said "it didn't look as bad" as I had said and told her to continue the Silvadene. She arranged for a visit to a wound care center the following week and ordered some antibiotics.

Early this week, Ellen called me and said the necrotic area was larger, the bleeding more, and the wound had a foul odor. She was concerned about a fever which she treated with Aleve with some success. We discussed various options - taking him to the this hospital or that one, etc. The following day Ellen called the nurse practitioner who suggested Joe be admitted to the Hospice unit the next day (3/12).

I visited Joe today in Room ___ of the Hospice Unit. Ellen was upset because she said the staff had told her she was "forbidden" to feed him or bring him any food or water because of the danger of aspiration. (The morning of admission he had had a scrambled egg and a full glass of Carnation Instant breakfast without difficulty and was walking with help). She was also upset because they were not giving him his antibiotics or anything for the fever. She was told that the decubitus was probably in the bone and was too far gone to treat.

At that point, the charge nurse, ________, R.N., came into the room. I asked her why he was "forbidden" water or food and she said it was their policy, also not treating symptoms or problems such as infection, bed sores, etc. She said she was just following routine practice to deny food, water and antibiotics (even though the patient was able to eat, drink and needed antibiotics). She said he was not in pain. I asked why he wasn't given Tylenol for his fever as he was very hot and flushed - she got a digital thermometer and tried several times to take his temperature in the ear. She said the battery wasn't working right. Finally it worked and she said his temperature was 98.7 even though I could feel his skin to be quite warm and hot. As an experienced nurse, I knew that his temperature had to be higher, but did not argue.

She said Joe was getting 20 mg. of liquid Morphine q 8 hrs! When I told her I was an RN with a Hospice background and that I never gave anyone not in pain 20 mg. Morphine, she said that was what was ordered but he wasn't getting it all the time. She then said 3-4 times clearly, standing next to the patient's head (he had his eyes open and appeared to be hearing), that he would die in about 3 days and that they didn't need to treat the infection because he was going to die soon.

Ellen was crying and upset because she realized they were practicing euthanasia. I reported the incident right away to Hospice Patients Alliance and plan to take further action.    Christina Brundage, RN

The next day: The same charge nurse came in and when Ellen asked if he couldn't have some water, the charge nurse said "You don't seem to be comfortable about his dying." She used the word dying three times right in front of him. She said she would have someone else come and talk to her because "you're not getting it." She repeated this phrase twice. We told her Joe is speaking and she said "He isn't saying anything purposeful." Yet, he had just asked me, "where is Ellen?" his wife. The hospice "routine" of depriving him of food and water, and antibiotics and giving him unneeded morphine continues. It is obvious what they are doing to him. Soon, he will be unable to speak or do anything. They will have snuffed out his life way before his natural time of dying!

Two days later: Joe is now comatose with rapid breathing, extremities cold, minimal urine output. Ellen said she was told he had pneumonia, though as an experienced registered nurse and hospice case manager, I saw no indication of congestion while observing his breathing during the entire time I was present. While I was talking with Ellen out in the hall, we overheard a nurse on the phone and Joe's last name was mentioned. Ellen asked the nurse what she was discussing. The nurse said she was getting an order for morphine for Joe. Ellen said, "But he's not in pain." The nurse agreed, thought for a minute, and said, "But that bedsore must be very painful." She said the order from the doctor was for 2-6 mg. "prn" (as needed) and that it would be given intravenously. Ellen again questioned the need for it, and the nurse said that it would only be given if he was in pain. Joe died that night.

Note from Ron Panzer: what is interesting about this case report is the casual attitude of the hospice nurse ... how routine it is for her to "forbid" any food or water from a patient who was eating and drinking the very morning that he entered hospice and who now, suddenly was "forbidden" to eat or drink. Next, the failure to treat the infection in the beginning, the refusal to treat the infection when asked to treat it, and the consequent overwhelming (formerly treatable) infection created in the patient. Next of concern: the high dosage of morphine given to the patient when the patient did not have severe pain.

For those who may not know, an adult with a broken bone may get 5 to 10 mg. of morphine for pain. 20 mg is commonly given for patients with severe pain, and dosages much higher may safely be given when the patient has quite severe pain, however, it is a high dosage for a patient who is not in pain and who has never had narcotics like morphine before.

Next to notice: the cold, callous manner the hospice nurse spoke to the wife (in the patient's presence, as if the patient were not even there hearing) that he would be dead in three days. The routine, cool and absolutely certain way the hospice nurse presents the "news" to the wife that her husband will die in three days provides evidence that this hospice nurse has "done it before" many times. It comes as no surprise to her that the patient would die in three days, because through overdosing the patient, removal of food and fluid and failure to treat infection, she is certain of the outcome.

The original hospice mission and practice would be to provide food and water as long as the patient could swallow and absorb the food and water, so long as it would not cause harm to the patient. There is no regulation or law that says it is legal to withhold water and food from a hospice patient who is capable of eating and drinking as well as absorbing it! There is no law that says it is legal to withhold antibiotics from a patient who has a treatable infection (given early enough one could have at least tried to treat the infection]. And it is not within the standards of care to administer morphine when there is no clinical need for it! This is a very typical scenario in many hospices, but it is not hospice care which meets the standards of care in the industry!

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