ABSTRACT
This chapter focuses on what the nurse does on her own when becomes aware that there is "nothing more to do" for the patient, and changes her primary goal from recovery to comfort. The doctor may talks the nurses that a patient is dying, but usually not that he is in the "nothing more to do" phase of dying. The pressure of this attempt often makes a nurse wish were maintaining comfort under the cover of a closed awareness context; for then the patient, still motivated to recover, will put up with some pain—and leave it up to her to manage it. The goal of painless comfort must be pursued, but under these conditions it is very difficult to achieve, for when a patient says little it is hard to ascertain how much a given dosage reduces his pain. Loose sedation orders give the nurse enough latitude to administer potentially lethal doses in the hope of achieving painless comfort.
