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A Time to Live and a Time to Die. Who Decides?

By February 7, 2019March 17th, 20224 Comments

I have been a nurse in clinical practice for over 35 years in a wide variety of settings including cardiac telemetry and cardiac ICU (CCU). I am a bit old school and remember when a lidocaine IV drip was the gold standard to treat ventricular arrhythmias (before amiodarone), and cardiologists treated every PVC on the monitor.

How times have changed!

That was over twenty years ago. I continue to care for patients in the CCU and am troubled with the advancement of technology that at times can be both a blessing and a curse.

Life-Prolonging Technology

Patients who would have died from cardiac arrest are surviving after hypothermia for 24 hours post-arrest (cool-it). Extracorporeal Membrane Oxygenation (ECMO) is used to bypass the lungs, heart or both when a patient presents with life-threatening heart or respiratory failure.

Another technology becoming more prevalent for end-stage heart failure are LVADs or left ventricular assist devices. These devices do not replace heart function entirely but are surgically implanted proximal to the heart with mini motors that hum at several thousand RPMs and require an external battery/power source.

Some patients wake up and have incredible outcomes and go back home with cognitive functions intact while others have irreversible neurologic damage or complications that leave them with a trach, vent dependent, gastrostomy tube, then transfer to a skilled care facility for the rest of their lives.

I am conflicted. Some nurses openly share their struggles with how this technology is used or abused.

Remember the classic song from the 1960s “Turn, Turn, Turn” by the Byrds? Well, it was a bit before my time too, but this hit song and the link from YouTube is based on a principle first written by Solomon over 2,500 years ago.

He is acknowledged as one of the wisest men of ancient history who wrote in Ecclesiastes:

“There is a time for everything, and a season for every activity under the heavens, a time to be born and a time to die.”
Ecclesiastes 3:1, 2

There is a time to die, but who decides?

Using Technology Wisely

I am not a Luddite and do not want to go back to the days before ventilators, and lack of other life-saving treatments.

But just because we have the technology does this mean that we should always use it? Because for some, what are we extending? The inevitable…death.

Is this living?

The underlying unspoken premise that modern medicine and that our culture reflects is that life on earth is all that matters. That regardless of the quality of one’s life, the fact that you are alive and keeping you alive is what is most important.

This is where worldview and faith of the nurse, patient, and family can allow a different perspective that challenges the assumptions of culture and modern medicine.

A worldview is simply the faith, values, and assumptions that serve as a lens that you view the world through and influences every choice you make.

Every person has a worldview; even an atheist who believes that there is no God. This belief also influences the choices that they make.

What about you? As you reflect on your faith and values, what are your assumptions about the value, worth and sanctity of human life and the patients you serve and care for? Your worldview influences why you are or want to become a nurse.

Physicians and specialists also have a worldview and for some, it is to preserve life at all costs even if it conflicts with what the patient or family may want.

This can be observed in physicians who aggressively advocate for life-saving treatments at all cost while the family may be ambivalent or unsure if this is what they want.

Knowing and identifying the values and worldview of the patient and their family are an essential responsibility of the nurse and part of the “art.” These values and want the patient would want need to be identified, validated and supported by the nurse.

This is why the nurse must embrace the responsibility of being a patient advocate and do what is needed to be heard.

Since nurses are immersed in healthcare culture, we are sometimes unaware of the assumptions and values present in the current culture of medicine and of the physicians who are providing medical care and making treatment decisions.

Step back and reflect on what you observe or have witnessed in the practice setting. We need to make these hidden assumptions visible to our students to help them navigate what they will experience in practice.

In Closing

In addition to thinking like a nurse, developing the ethical and professional comportment of practice needs to be a priority in nursing education.

In addition to developing the thinking, make it a priority to strengthen the ethical aspect of the practice of your students and how the nurse can embrace the role of patient advocate when facing these or other dilemmas in practice.

Do this, and your students will be well on their way to better prepared for both licensure and clinical practice!

 Clinical Dilemmas are case studies that address the most common dilemmas students will most likely experience once in practice.

My best topic in this series is Medical Futility. Now on sale through Sunday 2/11.

What do you think?
What is the difference between life and living?
Share your thoughts in the comment box below…



  • Jonda Hennosy says:

    What a great Blog! I have Been practicing for over 30 years. I struggle with the quantity vs quality of life. I make it a priority to discuss this very issue with my students every chance I get. Thanks for sharing!

    • Keith Rischer says:

      Great job Jonda in making it a priority to talk about this issue with your students! As nurses, we are often caught in the middle and students need to be as prepared as possible to navigate the ethical challenges if experienced in practice.

  • Mary Ann Irwin says:

    I have used almost the exact same language to describe my position on this: just because we have the technology, are we obligated to use it? I tell my students that as a society we are technologically more advanced than we are morally or intellectually, and thus the dilemma.

    • Keith Rischer says:

      Great insight Mary Ann and totally agree. We need to make this clear to our students so they can identify the real issues in these types of dilemmas they will soon experience in practice.