I read with interest the article in the January issue of AJN, "Life Support Interventions at the End of Life: Unintended Consequences" by Shirley A. Scott.  I recently cared for 2 terminally ill patients who were receiving life support interventions.

The first patient had laryngeal cancer with metastisis requiring intubation and mechanical ventilation. She initially hoped for a cure and underwent several rounds of treatment.  When it became evident that she was not going to improve, she had a conversation with her physician, nurses, and family and told them she had had enough and was ready to die.  Her "hope" was for a pain free, gentle death and that is exactly what she got.

My second patient had end stage liver disease and esophageal varices and wasn't a candidate for further interventions. Even after massive blood product transfusions and experiencing cardiac arrest several times, he "hoped" for a miracle that wasn't coming.  After lengthy discussions with the physician, nurses, and his family, he finally agreed that these "life support interventions" were not bringing life, but were prolonging an inevitable death. 

As nurses we are in a unique position to discuss end of life options with patients and their families that bring them hope for a kinder, gentler passing.  In both of these cases, the end of life conversations involved physicians, nurses, the patients, and their families.  How does your institution handle end of life discussions?