Helping or violating free will?

[Diana]

I perform a specific procedure at work where I insert a long term version of an IV into patients that need long term access or central access for critical medications. Many times, these patients are intubated which hasn't bothered me until I performed a couple on patients that weren't. One was a chronically ill patient who suffered a traumatic brain injury years ago. He's awake and somewhat aware but nonverbal and just looks around. Sometimes he seems as if he's fighting back but you can't really tell. Yet his family always gives consent to whatever needs to be done to keep him alive.

As I was doing the procedure, I started to feel bad about it while wondering if he really wanted to live like that. It's not his choice obviously since he has no control over anything that happens. This caused me a bit of introspection into whether I'm violating these patients free will. I try to think about the whole all is well thing but on an individual scale, all I can think about is whether they want to live or die. Maybe this was their plan all along? That doesn't bring much solace though. Am I really helping or am I a part of their continued suffering? It's a fickle thing 

I have a friend who is a geriatric nurse. She works within the system, and has for many years. The way she deals with this sort of thing is to do what needs to be done according to the parameters you mention (family wishes, medical protocols, etc.), but she gives her patients huge amounts of love (which, just being around her you feel) and she also tells them it's okay to go. She calls it "her speech" and when she can feel from someone that they are struggling with letting go, she tells them it's okay.

When I was in my early 20s, going to college and working midnights at a developmental center for the mentally challenged, I worked in the chronic care hospital unit. There was a man there who was profoundly mentally and physically challenged, about the size of a 3-year-old and nonverbal. His name was Richard. I would sometimes give him his tube feedings and I could see that something was wrong, that he wasn't tolerating them well, and he would stare into my eyes. So I charted it and told the nurses, and advocated for him until they paid attention, and found he had stomach cancer. I can't imagine the suffering he was in. He had been just laying in bed his whole life, being poked and prodded and fed and changed, I can only think that another human showing genuine love and caring for him might have felt like an oasis in a desert-like existence.

So, my point is that just care and love are valuable. Easing someone's suffering is valuable. Because the family decision is to extend the life of the loved one, and that involves for example, intubation to create an airway, then what can be done is to do this with love and care (which I imagine you are already doing), and to acknowledge the patient. You can't control others' decisions (the family), though there is the option of sharing your observations without judgment, and hopefully help the family so their decisions are better informed.