Mom, sisters and Hospice

My mom died of lymphoma in 1983. Prior to her death she elected to enter hospice care. I have four older sisters who are all RN’s also – I was a brand new grad at the time. Four of us took turns taking care of Mom until she died. A huge conflict arose between us because two of my sisters, who were critical care nurses, would not give Mom her pain medications if her respirations were less than 12, even if she was visibly in pain. This parameter had been drilled into them in their practice of critical care, and they could not bring themselves to go against it in the hospice situation, which was completely antithetical to nursing as they understood it.

Sometimes we laugh about it now, but at the time we had tremendous fights over it, even throwing around ugly accusations. It was a tough time.

I believed then, and still do now, that the principle of beneficence (actions should promote good) was working against the principle of nonmaleficence (doing no harm) in this situation and no one knew how to resolve it. The hospice nurses tried to talk to my ICU sisters but it didn’t help. To them, causing respiratory depression by giving her pain medication was “doing harm.” The principles overriding these here, however, are the principles of autonomy and respect for others. Mom chose hospice on her own, without pressure from anyone and was fully aware of what was involved with the choice. Having done this, she had a right to expect and receive care in accordance with hospice principles, which included the administration of appropriate medications for pain relief. It was her choice, and that choice should have been respected, but it wasn’t always.