To think something is not quite right about my elderly aunt's way of looking after her brother

Yes, my FIL was diagnosed with cancer when he was in his 80s. They wanted him to have chemo. He just wanted to die quickly and fortunately did.

As someone who cared for a dying relative last year who was told they had months and now has another ill relative I think she likely followed his wishes. My relative had a dnr and wanted no life sustaining interventions. What would be the point of getting medical help for him or putting him in a hospital when he was dying anyway and possibly would of lived for longer in pain and with no quality of life. Sometimes life quality is more important than quantity and if he didn't like or want to be in hospital why send him there.

That's good to read OP. There's absolutely no reason not to be at peace with the manner of your uncle's passing, even while you're grieving for him.

Pleased to read your update OP. I'm glad this thread has helped you.

I’m sorry for your loss and perhaps isn’t the time to read by opinion which is based on my recent loss.

Lived for what? Just to continue slowly dying? We have a culture in the UK of keeping people alive for as long as possible it’s something Chris Witty raised as one of the big concerns of NHS care. Pneumonia used to be called the old man’s friend now dying people with it will routinely be admitted to hospital and treated with IV antibiotics only to be returned home a couple of weeks later much weaker and worse than before. I watched my Mum go through this. I’m not sure we have it right.

I really think more support needs to be put in place for families as well as an emphasis on how hard it might be and what to expect caring for a dying loved one. When my grandfather was in hospital with cancer, they were getting ready to release him home but another nurse or doctor flat out said that my grandmother wouldn't manage him at home. At the time it seemed very blunt and your natural instinct is to say "of course we'll manage, we love him-we'll all care for him!" but now I realise what can happen I appreciate her being truthful about the reality.

He died in hospital before he even got a chance to come out and I think even the nurses struggled and had to put him on a morphine pump-then he died very quickly. It's insane to me to think anyone even contemplated he could be released home-unless they had a plan for lots of palliative support in place, which I don't know if they did. So I don't think family should be put in the position of caring for someone unless they're being heavily supported at home-professionals know what to expect and need to be more open with family about the reality of the progression of a disease.

Obviously cancer is a different illness to the man in this case, but anyone dying at home can be a traumatic and overwhelming experience for loved ones. It's quite possible the aunt has regrets about what happened herself, or questions if she could've done anything different-but I don't think family questioning the care she gave will help anyone-especially in hindsight.

I'm a doctor and what your aunt did was exactly what she should have done (and what I would do for anyone I cared about, and would want them to do for me). She respected his wishes to die peacefully at home with a loved one beside him. There's no indication from your post that he had any symptoms that meant he couldn't be managed at home - even if a patient is for palliative care only with a plan to die at home, if they had symptoms like uncontrollable pain, then absolutely, calling for help, and potentially being admitted to a hospital or hospice for control of that symptom is appropriate.

With gradual organ failure as you describe, even when admitted to hospital, the underlying problem is not going to be fixed, and admitting him to a hospital where there is a language barrier, nowhere comfortable for his sister to sleep while she is with him, and potentially unpleasant experiences like getting blood tests/having a catheter put in that won't alter the prognosis, attached to pinging machines, or being in a ward where there is noise from distressed/disturbed patients and multiple machines and alarms going off all night, staff moving about etc is not peaceful, and that's not even considering the fact that he may wait for hours in A&E, or worse, in the back of an ambulance as there is no room in A&E or in a corridor, when he didn't need to be there.

At the end of life we focus on symptoms and quality of life, not prolonging a poor quality of life at all costs. A decent amount of my job is drawing a line under people's well meant but futile interventions, and stopping them.

I appreciate that this is because most people don't work in healthcare and a lot of people have little understanding of the realities of dying and death, but you are being unreasonable.

The way things are going with A&E departments I think there will be more people preferring palliative care at home rather than long periods on trolleys in corridors.

Completely agree!
As a nation we really need to have a look at ourselves. It's just plain cruel the way we keep elderly people alive for years longer than they would have naturally lived just to live in more pain, fear and suffering. And I'm not even taking about assisted dying, that's a completely separate issue. I'm taking about medical treatments to extend suffering as long as possible.

He was terminally ill and hated hospitals. Why make his last few weeks unbearable? Sounds like she was acting in what she believed were his best interests.

A couple of weeks ago doctors said his organs were slowly deteriorating. They estimated he had 4 months left to live and said he should receive palliative care at home.

I don't think you understand what "palliative care" is, OP. It means not trying to prolong life, but making it easier until the end comes.

It is quite probably that your uncle also had a DNR notice, which stands for Do Not Resuscitate. So the paramedics wouldn't have done that anyway.

YAbu. He didn't like hospitals and I can understand why.

The NHS is keeping people alive far past the time when is sensible in my view. My nan had had a number of strokes and was then kept alive on medication in a care home for 3 years not able to do anything.

Your uncle is at peace now.

I am sorry for your loss. Just wanted to remind you that your aunty comes from a culture where looking after elderly relatives is something the family does and is culturally expected to do and it is seen as a privilege and sign of respect.

Similarly it is a culture where people don’t go to hospital to die, they stay at home and are cared for at home.

Maybe medical intervention would have prolonged his life for a bit but what sort of life would it have been?
A few more months in a hospital bed, which it sounds like he would have hated

Did he have pain relief at home? I think it would be right to ask for medical support at home, if he wished for that. But since he was dying anyway, it's not helpful to send him into hospital if it would only cause him stress and unhappiness.

You should thank your Aunt, your uncle died at home where he was comfortable. If he had gone to the hospital, he would have spent his last days on a trolley in a corridor.

I agree.

He once had a stroke in the evening and she didn't call the doctors until the next morning. I'm not medical but I always thought something like that needed urgent medical attention.

My uncle had a stroke but his family had no idea until it didn't improve the next day and called the Out Of Hours doctor, my aunt thought it was a bad migraine.

You seem to have all sorts of opinions about your uncle's health care, did you help out in any way?

I saw a friend’s day that lived in Spain had throat cancer and was sent home to die they said he had two weeks. His wife nursed him - no carers. He couldn’t swallow - they liquidiser food for him and a straw and he just withered away and died - took 6 horrendous months.

My very elderly but fit uncle went in for an operation and they botched it - coming out of his throat and he had major surgery to repair his throat. He was 68 but when I visited they just put a tray down with food and he couldn’t lift it or swallow so they took it away again - literally he was so dry and couldn’t speak. My aunt was unable to visit every day and had her own health issues and the last time I saw him - I could see in his eyes how much pain he was in and his lips were all cracked and his mouth dry and skin dehydrated. He could swallow but I got some cotton wool and made it wet and put it in his mouth and he was literally dying of thirst. He literally died of dehydrated and lack of care and should never of died in Swansea hospital over a routine minor surgery the botch was bad enough but the nursing care or lack of it - haunted me. I was very young, and I was what 30 odd years ago but horrific.

I agree with how your aunt handled it. What she gave him was basically palliative care.

Why drag him to hospital and have him pushed and pulled and prodded, when he hated it?

What are you hoping to achieve by this?

Unless you were actively involved in your uncles care yourself, I don't think you get much say.
It sounds like he died as many millions of people before him have died - quietly at home, after a long period of illness, and then a sudden decline. Heck, that's how the literal QUEEN went.

Your aunt isn't wrong in her opinion about the NHS. And it sounds like your uncle would have been much happier at home, in his own surroundings, speaking his own language, with his sister by his side. Not on his own, in unknown surroundings, struggling to understand what is being said and done to him, by strangers.

Yes, he might have been "saved" in the hospital - but if he was already terminal, what's the point? I think your aunt did exactly the right thing, and I can only hope I'd have the courage to do the same if I were her. I certainly don't think it's nuts. I think she did him a great kindness.

Exactly. Why on earth do people want other people to keep on living and living? It is so selfish.

I hope that I have a relative like your aunt when I am close to dying. I don't want to end up in hospital being kept alive for nothing and taking up a valuable bed that could be given to a younger person.

It sounds like.he was on end of life palliative care. He had chosen to die at home. He may possibly have signed a DNR as part of the palliative care process.

So if he was in the palliative care system there would be a team that could be called to administer end of life medications for things like pain relief and to support of he needed help with the toilet, being turned in bed etc

It sounds like that team could have been called if he wasn't comfortable but not to "help him live".

Some people go downhill very quickly. My Mum.was one. Two days and she was gone. We only had chance to call the palliative nurse in twice anyway due to the speed.

I'm sorry for your loss but he died at home which was his wish.

Lived for what? Another 4 miserable months with failing organs?

I think your aunt did the right thing. She respected his wishes. She knew he wouldn't want to go to hospital and it would only make him anxious. She allowed him to pass in the comfort of his home.