Dear Barbara, My father woke up for the last time at the very end of his terminal illness, like many do, to say goodbye to their loved ones. I believe that last awakening is something you mentioned in one of your books, if I am not mistaken. I’d say that he was agitated and responsive. More specifically, he was saying “no, what are you doing” and “no, don’t do that” to the nurse when she was inserting the needle into his arm to put him into what would be his last sleep. I understand the difference between sleep and death, but consciousness is separate from those two and valuable above all. My question is how are hospice nurses supposed to put patients to sleep, and is previous consent or active consent required for these actions?
Your question, "How are hospice nurses supposed to put patients to sleep?" is hard to answer because each patient is unique depending on their disease and condition at the time of giving medication.
The consent you asked about would be implied by the patient being in the hospital, facility, or hospice. Signing papers to be on hospice or in a facility gives treatment consent to doctor's orders. If the patient is unable to sign the papers then whoever signed the admission papers for the patient has given consent to treatment.
The attending physician had to have written an order to give whatever medication was given and when to give it. In other words, the nurse was just following orders.
There are so many reasons your father could have been receiving medicine by a “needle”. I am not fond of IV or giving medication by a “needle” as end of life approaches. Generally, anything you can give by injection you can give by mouth (and if they are not responsive enough to swallow you can give by rectum).
There is generally no need for the invasiveness of needles. That said, I do not know anything about your father’s illness. I would need to know more individual information to say an injection was or was not appropriate in your father’s situation.
There is no specific hospice protocol for "putting a patient to sleep" before or because they are dying. Hospice care is given to meet the individual needs of a person as they approach death not to facilitate their death by "putting them to sleep".
Something more... about Why Did They Put Dad To Sleep?
We will all be affected by dying, death and grief at some time in our lives. The Final Act of Living: Reflections of a Long-time Hospice Nurse is a book on end of life that offers knowledge and clarity to ease the fear and misinformation about dying and death. It explores the topics of living with a life threatening illness, fear of death, understanding the signs of approaching death from disease, the dying process, stages of death, the normal grieving process, living wills and other end of life issues. A training handbook for hospice volunteers and a reference book for anyone working with end of life issues: Lay ministers, social workers, counselors, nurses, chaplains. It is an easy read for anyone interested in dying and grief.