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

Did he receive palliative care, though? The OP doesn’t make it clear. If not, I’d call it neglect, but it’s too late now, so I’d just let it go.

Ideally your uncle would have had hospice care. Which prioritise quality and comfort. Anyone can refuse medical treatment at any point. If he had a terminal diagnosis, wanted to pass at home then she followed his wishes.

Hospital is not the place to die unless there is no other option, is a belief held by a lot of people.

Just because we can keep someone alive for
longer doesn’t necessarily mean that we should, it’s not always in the persons best interests or what the person wants.

He wouldn’t have lived longer. Hospitals don’t even give you pain relief when they know you’re going to die. Best being at home if that’s what he wanted.

We have medicalised death because we don’t know what to do. It used to be very common for old and sick people to die at home or in nursing homes. In fact it’s the opposite. When people die, the more calm and less traumatic it is, the better and that normally means where they’re most comfortable. Of course they may need access to pain relief, possibly morphine.

In this case I would move on. He wasn’t well and was slowly dying. He died at home surrounded by his own things and his sister. That’s what I would take out of it.

Was the palliative care actually arranged and put in place? Or did he die without adequate pain relief etc?

He had an estimated 4 months left to live which would have probably been a slow and painful death. Instead he died peacefully at home where he wanted to be with his family around him. It sounds like your aunt absolutely did the best thing for him. As someone who works in A&E I wish more people took their relatives wishes into consideration in this kind of situation when thinking about phoning an ambulance, it awful for people to end up
dying on a trolley in A&E or on ward alone a few days later.

Your aunt did the right thing. He was on palliative care so hospital wouldn’t have done anything plus if your uncle doesn’t like hospitals it makes sense that your aunt let him pass peacefully at home.

I don't understand what you think the hospital would have done for someone under palliative care that was any different to what your aunt did?

Have you ever looked after anyone in palliative care? It is different to regular healthcare. You are making sure they are comfortable and as pain-free as possible. There will usually be a DNR in place and the patient will have expressed where they wish to be treated. The can be GP/Hospice at Home involvement if there is time to set that up, but it is not always possible.

It sounds like your Aunt helped your Uncle to die in the way that he chose, at home with her for company. A dignified death, not waiting for paramedics, or hooked into machines in a strange place, full of noise and strangers, or dying on a trolley in a corridor. Please give your Aunt the support she now needs. She has lost her brother. Being with someone when they die is a privilege but also quite traumatic. She needs your empathy and sympathy, not criticism or suspicion.

With all due respect, he may have lived for what? Long enough to die in hospital? To continue to be in pain?
He had organ failure and palliative care was deemed appropriate by medical professionals.

It's really awful waiting for someone to die, you don't want them to go obviously, but seeing them slowly dying, laying in bed, with no life in them is really hard, terribly so. It's much better for them to be at home, peaceful, surrounded by those they love than being just another patient on a ward, alone.

68 is not elderly.

In an ideal world, she should have called the GP and perhaps district nurses could have been in and out to help make sure he was comfortable but ultimately if he wasn't in pain and this is what he wanted, then I don't see any issues. The reality is that if she'd called the paramedics, he may well have died on a trolley in a hospital corridor! But it sounds as though he was were he wanted to be snd had someone to care for him till his last moments.

I'm sorry for the loss of your uncle.

Living a few weeks longer when you are bed-bound with organ failure isn't necessarily the best outcome.

Stroke is a medical emergency, yes, but you're generally thinking of saving a person's life and preserving their functions as much as possible. For a person on a palliative/end of life care pathway, the focus is on comfort and dignity, so a stroke would often be managed at home. The outcome is not going to be different as a patient like your uncle would not be able to engage in rehab.

It sounds like your uncle had the kind of death he wanted and your aunt cared for him in the best way she could. I would try to focus on that instead.

I don’t think keeping someone alive at all costs regardless of their prognosis, quality of life and wishes is a positive thing. It sounds like your aunt followed her brother’s wishes as best she could and allowed him to end his life with a loved one by his side in a familiar place. I’m sure he’d have loved to get well and live another 10 or 20 years in decent health but that was never an option. Given the option of dying now at home with his sister or dying a little while later in a hospital or care home then seems based on what you’ve said in your OP he’d have picked the former.

He was receiving palliative care, why are you talking about how he might have lived? Maybe for a couple more weeks so he could suffer some more, but surely you wouldn't want that for him? He was an adult who made a decision regarding his end of life care (the same decision many people in that position would make) and your aunt respected his wishes. Preserving life, regardless of the quality of life, is not in the best interests of the patient. It sounds like your aunt did a great job looking after him, it must have been very hard for her.

68 is certainly not elderly and I don't see what your aunt's age has to do with the caring situation.
My 95 yr old aunt was sent to hospital from her respite nursing home. She lay in an ambulance for 12 hours, unable to communicate with anyone as she'd previously had a stroke. Throughout the time she was in the ambulance we were in the a&e waiting room but couldn't go to her. She then lay in a corridor for days. She required specialist feeding, didn't get it and basically asphyxiated on her food.
Hospital is not necessarily the best place for anyone with a terminal diagnosis.

Did he have pain relief? Did she give it to him?

Yes if he’s a stroke he should’ve had immediate medical attention.

It’s a bit late in the day now to question all of this. Unless you think a crime has occurred… seems unlikely.

Sorry for your loss, but I would leave it now, it’ll just cause upset.

If I was dying and knew it, I would rather be at home than have to go into hospital and be alone most of the time. I hate going into hospital it’s a horrible place to be but I love my bed and home so I know exactly what I would pick

I’m really unsure what you were expecting to happen had the paramedics been called? He could of lived but how long? A week? A month? Possibly they could of given him more effective pain relief if he was distressed.

My colleagues mum died recently and she is feeling really traumatised by the whole thing. The palliative care team were unreachable for many hours, she was in a care home so not unsupported but it was highly distressing for her mum and her.

I think you need to balance up patient wishes/ likely outcomes tbh. There’s little point dragging out a life with lots of medical interventions when someone is dying. Yes some people will want to be in hospital and have them do everything possible which is their choice. Others will prefer to accept the inevitable and slip
off at home. These decisions were made between him and his doctors.

Your uncle who was dying wished to die at home. Your aunt honoured that.

Your other aunt was also present and if she felt this was the wrong decision and your uncle was needlessly suffering she could have phoned 999 at any time.

Just out of interest how involved were you in the day to day care of your terminally ill uncle? Did you accompany him when he did go to the hospital? Did you spend days at their home caring for him? Caring for a terminally ill loved-one is emotionally gruelling, physically tiring and often involves making difficult decisions in less than ideal circumstances, as well as having to give up on aspects of one's own life (often including self-care) Unless you were as actively involved in this as your aunt was, you really aren't in a position to criticise the decisions - in line with your uncle's wishes- that she made.

She sounds eccentric but it seems she cared for him according to her own sincere convictions, and if the family was happy with that while he was alive I don't think any good will come of picking at it now.

I’m 68, not elderly. I cared for my DH, whose health was failing. He died as he wanted to - hospitals, unless it’s a specialist end-of-life ward, aren’t the best places to be.

DH died, pain free, with me by his side.

Leave your aunt alone now - she’s grieving.

She did the right thing. He was very end stage. But being in hospital, he might have clawed back a few days - but what for? Miserable days in hospital?

I agree with PP 68 is not elderly. My partner is 68 and his mother is still alive and my aunt who is 81 still works full time.