Potentially upsetting question about death.

It's true that the elderly can lose the ability to eat and drink, but my point is that the State can and will force the issue - there's little to chose between someone in that condition, and someone who has been denied drink in a care home, as the post mortem will not be able to tell the difference. This saves money but the family will be unawares, or if 'awards' they'll be made out to be a trouble maker.

I've written down in my advanced directive that I want to die in a hospice or a nursing home, or in hospital if that can't be achieved. My top aim is to avoid ds having to nurse me at home. My cousin is still traumatised years after nursing her husband at home until his death. They asked him where he wanted to be but they didn't ask her what she felt about it.

I've come to the conclusion we're an odd family because to us, DNR should be the norm and you should have to make a special case to have resuscitation tbh. I really don't think medical teams should have to do it. I genuinely don't understand why anyone wants resuscitation of a stopped heart for a relative or for themselves. It is a brutal procedure that hardly ever works unless you are in hospital and even then the outcome isn't great. It's lucky i guess that I'm not involved with the decision except for myself and my dm, and I know her wishes.

The not eating and drinking thing is more the body isn’t getting the messages from the brain they loose the ability to eat and the body can’t process the food
palliative care can run you through this

once it got to that point trying to feed them will kill them they will aspirate and food it ends up in there lungs they'll chest infection

I was talked into a DNR in 2014 for Mum who was in Epsom General Hospital after nursing home neglect. Her BP had gone down to 40/20. The idea was if she had cardiac arrest it might be cruel to resuscitate her and the doctor seemed sincere but I was there all night to oversee her recovery and argue her case at the time. BTW no accountability for the nursing home in question - that's just how Surrey County Council likes it! - and the day before one of the consultants had argued Mum could return to the care home asap, they're all lovely aren't they? Mum had aspiration pneumonia.

Three years later - and I'd have settled for that at the time tbf - in Kingston hospital with the awful then manager of Galsworthy House secretly plotting - I agreed to DNR for Mum thinking that we were there every day and could keep tabs on it. The look of relief on that cow of a manager's face should have told me something, and Mum was dead that autumn.

So it depends whom you're dealing with.

One family I knew had their elderly mum in for respite in a care home, she was DNR but the paperwork wasn't there so when she had a fatal heart attack the paramedics were forced to resuscitate her. (This one instance shows the total disparity between paramedics and the rest of the medical profession - they will be conscientious to a fault but other care home residents under some consultants or care home managers or Safeguarding heads will be allowed to die with no comeback at all.) She was a zombie in pain for the next 24 hours and the daughter had to get the hospital chaplain to urge the doctors to 'see to it' i.e. finish her off or put her out of her misery. There's no suggestion on anyone's part that this was the wrong thing to do. It also is highly unlikely it will be in her medical notes.

A general observation about DNRs (Do Not Resucitate) is that I think as a someone's child the first time you have any interaction with or thoughts of DNR (which often happens for the first time following an emergency admission) your whole body and mind is screaming against the very idea because you want your parent to be with you forever and stay alive.

For many people, it takes a bit of time, distance, calm thinking and outside of an emergency to realise that in a lot of cases resucitating someone elderly near end of life or with a terminal illness would be cruel. It can take a lot to mentally make that jump to acceptance.

Thank you for this thread it is very worthwhile.

Will come back to this thread another time but @PermanentTemporary is very good on this. Sums up the chief difference though - in my experience with my late elderly mum with Parkinson's in a care home, no nudging was needed to kill her off and I felt that Surrey were trying to bump her off via dehydration. Despite her being up for life very much so, and us wanting her to live. Seems you're up against the British State which is frankly nuts, whatever you want, they won't deliver, it's the only way they can feel in control, which is the main thing.

I mean, it was like a game of chess where you were the knight in The Seventh Seal duelling with Death, who would show up in different guises. You felt like these parents who have kids in care settings which are trying to take away their life support, all tricks and tactics and smears will be utilised by the Trust.

My Dad has just moved from a hospice to a nursing home for palliative care (liver cancer). He filled a RESPECT form in and that expresses that he doesn't want to be given resuscitation, or any form of antibiotics to treat infection and that he doesn't want hospital admission under any circumstances. Luckily he filled this is fairly early on.

He's now barely drinking or eating, is sleeping more and is gently fading although we're having issues with the home reacting to med changes that are needed. It's heart breaking to watch someone go through a slow and draining end of life... but it's also a natural process and in some people, can take a really long time.

My mum had dementia. Went into hospital late 2021 having had a stroke and we thought she would die then. After a couple of days she rallied, and I had a meeting with her consultant who said she should be sent home with a Peace Plan, which is a document that says she shouldn't have any more hospital admissions and should instead be kept comfortable until her death. I agreed and she was returned home with carers and the district nurses visiting every day to dress her ulcerated legs. From then on she just faded away over a period of 3 months. At the end she was like a little bird taking sips of warm tea. On the last day I think she probably had a stroke and became unresponsive and died a few hours later. It was a peaceful end.

What i feel about the Rahm article is that it's not that he wants to die at 75, quite the opposite. He's just saying that he wants the maximum quality of life and not to bugger up his later years with medical treatment, particularly the full strength USA high tech version . I feel the same. I think it can be difficult to understand what losing mental capacity and real frailty actually look like, when you've barely been ill a day in your life. My mum was on no medication at all when she had her stroke at 86 and in my view had never really understood how powerless and impaired she might become, while still being kept alive.

I’m reading Being Mortal right now and find it extremely engaging. We are not good at dealing with the inevitable in western society.

One can make an Advance Decision while one still has capacity. It covers several scenarios, is legally valid and gets put on your medical record. I recently looked into this for a relative, and found this website beta.compassionindying.org.uk/

Like setting up POA, I guess making an Advance Decision is something we all should do...

Wonder if he'll go through with it though? My Mum had spent years going through how she didn't want us running round after her, would go into a home when she needed to, no need for us to worry about anything...

Now she's in her late 70s and becoming very demanding!

They don’t stop screening for Brest cancer at 75 because they’re happy for nature to take its course. It’s more that the benefit isn’t there for the patient. There is over diagnosis after 70 (or 75 for those who have previously had breast cancer).

@lazymum99 I pretty much exactly agree with that article but it definitely will be interesting to see if he and also I change our minds as age 75 approaches (age 60 for me).

When we entered into end of life care for DH the palliative care consultant at the hospital said if DH had picked up an infection that he would still be treated with oral antibiotics as a comfort measure but he wouldn't be admitted and treated with IVs.

The oncologist who will refuse all medical treatment after 75 (even for cancer)

www.thetimes.co.uk/article/48336a68-8d1c-11ed-b24e-c1aaebfbdb8d?shareToken=6cf980ba4912bd3b1515b6745e043b5e

interesting article here about non intervention. Not sure if there is a pay wall for this though

Sorry if that sounded a bit snippy, but I wouldn't be bothering hard working NHS staff if I didn't think it needed doing. I have huge respect for the NHS and have had good experiences in the past.

That's not really the point. The problem was that my siblings were told she was dying of septicemia which they had given her antibiotics for, but she didn't have that at all. Her death was caused by a massive bleed which the hospital either hadn't diagnosed or didn't disclose. Even if nothing can be done relatives deserve to know the truth. We would all have been fine if they had said it was untreatable. Lots of things are in very old age. We aren't unreasonable.

My mum also had camera investigations two weeks before she died due to suspected bowel cancer, which she didn't have. They didn't see the advanced ulcers that she had? Didn't connect this with her death? I think some kind of explanation would help in this case.

Whilst I understand your anger, a gastrointestinal bleed is a catastrophic event that is practically untreatable. My own FIL died of one. He collapsed at home, was admitted to hospital, and died within 2 hours. It was only the post mortem that found the bleed. Th hospital did what they could, but even if they had known he’d had a bleed when he was admitted he most likely would have died.
You could write to PALS to ask for his medical records and then arrange to speak to his hospital doctor to help you understand what happened.

Thanks for this thread OP.
It's very important to discuss these things.

Your MIL most likely does have a DNR in place - most people in her situation do. But giving antibiotics isnt resuscitation. A DNR involves using CPR if a person’s heart or breathing has stopped. Family dont have to give consent to this; its a medical decision. Of course one would expect the decision to be shared with family members though.