Urgent - ethics around pain med for 93 yr old

Does DB actually care for her? Its all very clear cut in the abstract but it’s awful to watch someone you love suffering.
I don’t believe in assisted dying but I do believe in people being able to live whatever is left of their life without pain, even if the pain relief may shorten it.

Your brother does not have the right to inflict pain on his mother, which is basically what he is doing. If he does not like big pharma, explain to him that morphine is basically poppies!

What can he be thinking? It is sad that he cannot come to terms with the end of her life; but that does not give him the right to inflict pain on her. It is his problem and he has to deal with it without causing her misery.

She might be better with a pain patch or syringe driver tbh, is she eating and drinking much?

Who is dressing the pressure ulcers? Have the community nurses assessed her? Is she on an air mattress?

If the community nurses believe your db is withholding analgesia that would be a safeguarding concern (quite rightly.)

Pressure ulcers are extremely painful and to have one on both hips is not great.

You can ask the community nurses about lateral turning systems (TOTOs in our area) thee see t might be useful to gently move your mum. You can also ask for a referral to tissue viability re the pressure ulcers.

I bet.

Op I'm sorry your mum is going through this. Can you talk to the doctor about stronger pain relief? Does she have a special air mattress for her bed?? The doctor may recommend a visit from the council who can help with the necessary equipment so she is comfortable. 💐

She needs a morphine syringe driver - I insisted on this for my grandmother and the nurse told me that they are not allowed to give her morphine until she is visibly in pain - I told her very clearly that she was lying and I spoke to the consultant who set the right treatment going very quickly.

So - your brother thinks it might kill her! Well, of course it might - does he really think that she is going to recover, to suddenly have no bed sores, to suddenly be well? Whilst he is getting his head round this, the poor woman is suffering.

My late OH had PD that had advanced rapidly and he was physically totally incapacitated and mad as a hatter - he thought people were trying to kill him. His life was utter misery. When he got an infection they were about to blue light him to hospital for drips, and antibiotics and terror on an unfamiliar place. Thankfully I had PofA for his health and welfare and (after consultation with my DDs) I refused to allow this. An end-of-life care pack arrived and he was kept peaceful and sedated until he slipped away.

You need to get a medic on your side to explain reality to your brother.

I know what you mean, but the brother is being obtuse and is not listening to reason. This was not a sudden event.

For some reason women seem to be far more practical than men when it comes to life altering decisions like this. Not saying women don't care or are hard as nails either BTW.

She's got a right not to be in pain. I'm relying on my children to protect me from pain in that kind of situation.

Thank goodness the doctor is on their way, let's hope they will prescribe something for her. It needs to be sorted out as soon as possible and if I were the doctor and the relative put up barriers and refused pain relief I would be seeking an urgent hospital or carehome admission as you can't stop your brother being there.

Exactly this.
Your "D" B is being an absolute dick. Your .other had made it to the ripe old age of 93. She is now bed bound and stuck with painful bed sores. They are bound to be painful all.of the time, and as you say especially.on movement.
She should of course be afforded every possible type of pain relief and comfort available to her. She deserves it.
A process indeed. Imagine I said that to every family member of every palliative care patient that I have looked after in the past. I don't think I would still be working now that's for sure.
Your DM should be afforded the comfort and dignity she deserves, and you should be doing everything you can to work with the healthcare professionals to make that happen. They have a duty of care, and you will feel so much relief on your DM behalf to get the help she needs.
I'm sorry you are in this position OP. Its truly awful to observe things like this and have another person be so dismissive of it.
Sending you and your DM hugs and sending you strength to help deal with the situation.

Hey OP
I'm a specialist palliative care pharmacist and I work in a hospice.
It is a common misconception, but opiods do not hasten death, they need to be titrated closely to a patients pain needs but as long as that is done there is zero danger in their usage, your brother is allowed to hold whatever misguided belief he wishes to, but to deny another human being pain relief is unethical and immoral. He does not get to decide what's in your mums best interest.
It is really really important you find out what your mums wishes are, if she asks for pain relief then she needs to get it, you must advocate for her. To leave a poor human being in that situation with only paracetamol is disgusting.
Please do not allow this, you must stand up to your brother,
I wish you all the best, you have a difficult journey ahead of you.

Sounds like brother doesn't want to allow Mum either to live or die in dignity and comfort, just to fulfil his own beliefs.

Or it may just be that he is feeling panicky about the end of her life and not thinking straight. He would not be the first or last person to go into denial. Not condoning it - I believe when a loved one is ill you have to put your big girl pants on and deal with it - but I do think I understand it.

On a lighter note, our family (mum's children and grandkids) would often joke with Granny/Mum about her morphine, and jokingly asked if she had any left over that we'd love some too! How she laughed.

I don't want anyone to think that my mother's journey was problem or symptom free, it wasn't, but it was made much more bearable so that she could enjoy us and things around her for the last leg of her journey.

Like OP, I wish all who are in similar situations all the best, and as peaceful and pain free a passage for loved ones as possible.

You are kinder than me, I was going to say break his leg with a hammer, let him walk on it without ever getting it fixed. Ask him if it hurts, does he want pain relief now.

Her comfort is paramount. Why should she be made to suffer unnecessary agony because your DB thinks it is 'the process'?

I would say morphine every time.

Well done @yesmen for getting a doctor to come. I hope the doctor can reassure both of you about appropriate pain relief and care at this stage of your mum's life.

Do you think she would be better off in a care home? I really wouldn't want to be on my own all the time except for a few medical visits if I was that age and in such a lot of pain.

Sounds like brother doesn't want to allow Mum either to live or die in dignity and comfort, just to fulfil his own beliefs.

How does he KNOW that Mum wants a spiritual journey of pain? Honestly people like him make me so mad. Full of airy fairy shite and meanwhile the person they profess to love is suffering unnecessarily. Awful stuff. Get the professionals involved asap on this one. Please.

I'm speaking as a former carer for my mother RIP, who was in pain and was not communicating or eating etc. That happened quite suddenly in her journey. Within 24 hours the palliative care team had her on morphine and various other things, and you know what? She was a delight from then on, eating, talking, laughing with us - all because she was pain free and so comfortable. Now there were bad days too, but I often wonder what the bad days would have been like without the palliative care regimen.

What's unethical is allowing your dm to be in pain when there are options.

Point this out. Tell him he is being unethical and inhumane