As nurses, we sort of "lie" to family all the time, particularly in hospice which is what I do and will speak from.

Let me explain non-maleficense: my care is for the patient. Do no harm. The benefit is for the patients benefit only.

Example: Is there anything more we can do for my 92 year old cancer ridden heart disease grandma to get more time? Her son will be here in 4 days!

Yes... I could... fluids subq, o2, meds, pull back the morphine, push Ensure protein drink if they have a feeding tube for calories and less ativan JUST a smidgen and I could def get her a few more days.... and in much more pain and anxiety...

My answer: im sorry, theres nothing we can do.

I dont care that you want more time with your mom or dad or grandma, I will tell you there is nothing more, because there is nothing more for the patient here... it's just needless suffering for the family to benefit from.

And so I offer the pain meds, I offer to increase with MD approval, and with that approval I know I'll be walking them to the veil at this point to cross over. (Let me edit in a disclaimer here: all drugs education and risks are laid out as part of what I do as reflex and training, ww dont mention drugs without risks and benefits, as in "this could be what does it but it will make them more comfortable" etc)

My mind prepares to get you all to acceptance as in 45 minutes, their breathing will stop when it hits. They will blame the meds or say it was too strong etc.

I once had a woman barely retirement age sorta, vomiting blood every 30 min, got the whole family to acceptance, cheered her on telling her how beautiful she looked, how incredible she was doing, how we were almost there and almost done. She smiled, sipped water, vomited blood, I wiped her face, put a cool cloth on her forehead, and gave her more water. She closes her eyes and I offer her pain meds and her dilauded and she said yes. We all smiled and nodded at eachother, tears in our eyes, and she said she felt better, vomiting slowed a little, she had some energy to talk to everyone and I said you need to say all that you can, now.

2 hours later she was gone.

I didn't tell them that I came to assist. It wasn't for them, it was for her.

After she's gone it will be all about the family for the next 13 months. That's a bereavement team, my goal is pre-bereavement acceptance.