Can anyone with medical knowledge help me? My Grandad has had a stroke and is refusing food- what are the legalities?

[MarkStretch]

My grandad is 80yrs old and had a massive stroke last Saturday.

He has been in hospital since.

He has always been a strong man, been a sailor all his life and to see him this way is awful. He has lost the use of one side, most of his speech and is unable to swallow.

They put a feeding tube down his nose which he pulled out. They tried again, failed and since then he has refused to let them anywhere near him. 9 days in hospital now and he has had one 'feed' in total.

Where do the hospital stand with regards to a duty of care? I am guessing they can't just let him starve to death (which I honestly think he is trying to do) so what happens now? Will they sedate him and feed him? They have mentioned putting a tube directly into his stomach but they don't think his heart will withstand a general anaesthetic.

Any answers will be greatly appreciated.

[lou031205]

I'm sorry to hear about your Grandad. Unfortunately, if he is competent, he has the right to refuse treatment, and any forced feeding would be assault.

[CountessDracula]

Not sure
dh is medical negligence lawyer I can ask him but I think Lou is right
They could section him I guess as he is a danger to himself.

[SoupDragon]

Sorry to hear this.

What do you think your grandfather's wishes are?

[CountessDracula]

I tried to call him but he is out on some client thingy - will ask him when he gets in

What a sad situation

My grandmother died of a stroke when she was 90. She had one when she was 80 which she survived and she told my mother if she had known what it would be like she would have made a living will saying she didn't want to be resuscitated

[edam]

Have they had a psycho-geriatrician in to make an assessment? Lou's right, he can refuse medical treatment including feeding tubes and food itself, but they should be making every attempt to make it possible for him to eat/ascertaining whether he is competent to make decisions about refusing food or whether fear of being touched/tubed is part of the after-effects of the stroke itself.

[MarkStretch]

Just heard from my cousin who has been in to see him. The hospital have said they are not going to put the tube in again as he has pulled it out so many times so the decision is up to him and I think he wants to die.

My grandma went in and told him it's ok to let go.

After seeing him at the weekend I am sure he is the same man inside, just trapped in a now unfamiliar body, and I know how much he will be hating it.

Thanks for your replies everyone.

[lou031205]

I am so sorry. Many of the patients I dealt with on a stroke ward would request a 'not for antibiotics' order, for example. It is so hard for relatives.

[FabBakerGirlIsBack]

I am so sorry to hear this.

Your Grandma sounds amazing.

[mermalaid]

Just a thought MarkStretch, its still very early days after his stroke, he must still be feeling shocked and traumatised - has he been offered any psychological support? Its really early days, has his chance of recovery been talked about?

[ScummyMummy]

Sorry to hear this. Poor you and poor your grandad.

He can and should be assessed by hospital staff under the Mental Capacity Act 2005 (MCA) to see if he has the capacity to make the decision to refuse the feeding tube. He has had a stroke so will probably meet the criteria of having an "impairment of or disturbance in the functioning of, the mind or brain."

The capacity test is then whether he can:
1)understand information pertinent to the decision
2)retain that information
3)use or weigh that information
and
4)communicate his decision.
If he cannot do these things, he would not have capacity under the act and he can be treated/fed against his will if it is thought to be in his best interests. If treating him would involve depriving him of his liberty, a further assessment would be needed to decide whether the treatment was in his best interests.

He could also be assessed under the Mental Health Act (MHA) as the effects of a stroke can qualify as "a disorder or disability of the mind". If found detainable under the MHA he could be treated/fed against his will IF it was thought that his refusal to accept treatment was a direct result of his "mental illness".

I think assessment under the MCA is more likely to be appropriate from what you've said though, unless in his distress he is somehow managing to be actively dangerous to those who are attempting to treat him.

If he does have capacity to decide on this and is not detainable under the MHA, he cannot be fed or treated against his will though, as others have said.

Is he drinking/accepting IV fluids? It's amazing how long people can do alright without food if they are hydrated.

Is he responding to you/other family/friends? Whatever assessments are used or not used, and whatever the outcome of those, encouragement and support from loved ones really can be the most important thing. He's lucky to have you around. Really hope things improve for him and you- it all sounds very upsetting.

[ScummyMummy]

x-posted with your update, MarkS. So sorry- it sounds heart breaking. You sound like a lovely family.

[MarkStretch]

Scummy- I had thought about the MCA and wondered if they would assess him under that but it seems like they are just going along with what appears to be his wishes.

His recovery doesn't look good, he hasn't regained any movement really and has failed several swallowing tests so is just receiving IV fluids.

My auntie took him in some magnetic letters and a board so he could spell out what he wanted to say. He wrote 'SOD OFF' and showed it to us all , made me think even more that he's the same person on the inside and he hates us all seeing him like this. (We did all sod off by the way)

Thanks again for your support.

[Platesmasher]

arf at sod off.

[MarthaFarquhar]

Agree that a capacity assessment should be undertaken, as stroke can affect a person's cognitive abilities.

WRT Mental Health Act, he cannot be force fed for under this act. Only treatment for a mental disorder is permitted under this.

[ScummyMummy]

Love the "sod off".

[hijack] That's not quite right, I think, Martha, though I completely agree that MCA would be the better route and that it would be v unusual to use the MHA to treat a stroke sufferer by feeding, even if it could be established that the refusal to eat was a direct symptom of the stroke or depression/another mental illness following the stroke. But ancillary acts to the core treatment for mental disorder are covered by the MHA definition of "medical treatment" according to quite a bit of case law. This includes treating symptoms connected to a mental disorder, so could include feeding if refusal to eat was a direct result of the mental disorder. Case law has held that force feeding constituted medical treatment under the act for anorexia in one case and a suicidal hunger striker with a psychopathic personality disorder (Ian Brady, as it happens). Do you have Jones? He has an interesting discussion on this at 1-710 to 1-721.[/hijack]

[MarkStretch]

mrsjammi- you haven't offended me at all, I totally agree and I think we should all respect his wishes. My Grandma had arranged an army of visitors which she has now cancelled as he has made it clear he doesn't want lots of people there.

No news this morning, guess it's just a waiting game now.

[FabBakerGirlIsBack]

MS - I think you are being amazing along with your Grandma.

[TitsalinaBumsquash]

You all sound Fabulous MarkStretch, sorry your family is going through this.

My Grabdad battled a really long fight with Asbestosis and he wished to be aloowed to pass away at home but the night he did go he fell out of bed and my mum wasnt strong nough to get him back in, she called and ambulance for help and they forced her to let him be admitted even against his wishes. He died the nextmorning in hospital but he said to my mum before he did "its alright Girl, the Boat (he was a fisherman) has come for me now, im going off with Mum and H (his brother)" then he slipped away.

My mum has never forgiven herself for letting the ambulance take him in but she gets comfort from his last words. I really do think people know when its time, i think your really good for respecting your Grandfathers wishes.

[MarkStretch]

Just heard from my cousin and they are taking his drip out tonight and letting him go. Apparently they explained to him that this would mean he would die and he put his thumb up.

It's too heartbreaking.

[FabBakerGirlIsBack]

Oh goodness.

I think you are all incredibly brave and selfless to let him have the end he wants.

{{{{hugs}}}}}

[Clayhead]

Sorry to hear that MarkStretch.

I am in a slightly different but similar enough situation with my grandad at the moment. My heart jumps each time the phone rings.

[Jux]

What an amazing man. I'm so sorry you're experiencing this, but I am really gobsmacked at your bravery. Your family sounds fabulous.

[beesonmummyshead]

my eyes are filled with tears at the bravery of all of your family Marks. Your grandfather sounds like a lovely man, with a great sense of humour. I am sorry he is in the position he is in, but glad he has the choice to die with dignity.

You have a tough few weeks ahead, but it sounds like your family are very strong and will help each other through this. good luck.

[beesonmummyshead]

my eyes are filled with tears at the bravery of all of your family Marks. Your grandfather sounds like a lovely man, with a great sense of humour. I am sorry he is in the position he is in, but glad he has the choice to die with dignity.

You have a tough few weeks ahead, but it sounds like your family are very strong and will help each other through this. good luck.