Urgent - ethics around pain med for 93 yr old

You need an urgent palliative care review and your brother needs a bluntly honest talking to by professionals who deal with this type of horror. The absolute best thing you can do now is keep advocating for your mum. Who has LPA? If your mum cannot make her own decisions then all actions need to be in her best interest. Ultimately your brother can't stop your mum being given what she needs in her best interests, but life will be hugely easier for all if he is on side.
Sending you hugs, OP

@yesmen p.s. do also discuss the turning regime with the nurse,sometimes 2 hourly turns become in themselves inappropriate as the balance/ benefit of reducing pressure versus increased shearing and pain from the turn can shift .

Dr don’t prescribed drugs to help along the process of dying (this is a huge other debate). Your Mum is in a lot of pain and she should have pain relief for that.

Is your brother struggling with the thought that your Mum will die? To be blunt he shouldn’t be your priority now.

Look, any opiod can depress breathing, which was hasten the end of life. But is it ok to leave her in agony because you dont want to take the chance? I had this debate about my own mother, in the end the district nurses came in and gave her shots which was a relief.

Sorry, I have edited this when I read more of the thread. This sounds more like your DB not wanting to deal with the fact she is dying than anything else. My mums partner was the same.

Your brother sounds difficult. Have the medics suggested morphine? If so, surely he doesn't have a right to refuse on her behalf.
Somehow he needs to get the message that normal doses of morphine don't kill people. And doctors do not prescribe drugs to patients that will kill them! If one of them could explain to him in more detail how the dosing works?

As an ex hospice worker, I would challenge him as to why being in extreme pain whenever carers need to do basic care, is in any way spiritually beneficial or part of the process? People at the end of their lives deserve to be cared for ,have their symptoms managed and allowed to appreciate the time they have left with their loved ones. If he still doubts why morphine can be necessary, ask him to hold a match to his finger then regularly press on the burn and see how he likes it.

It sounds to me like your DH is wanting to deny his mum the pain relief she needs during the unpleasant final stage of her life because that will postpone for him facing the inevitable grief of her passing. Dying happens for us all but no one would choose hanging on for a few months of pain if the alternative was a shorter period without the pain. He is being selfish.

This. Please call the urgent out of hours doctor today. No one should be in so much pain unless they choose it for themselves such as a pregnant woman wanting a natural birth.

Morphine.

Unfortunately hearing things differently is not uncommon with the bunch of people who are in to natural stuff.

It's OK watching someone say they want to experience pain as part of their spiritual journey (and even these give up when it hurts enough) but not to do it for a relative.

If your DM shared your DB's world view it might be arguable this is what she wanted but it's sounds as if this all him.

As a professional I would be prepared to make a safeguarding referral for this if DB was blocking her access to appropriate treatment but this would depend on how much you want to fall out with your brother as it is the nuclear option.

Even if the nurse is coming on Monday and they request pain killers you'd still have to wait for the prescription to be arranged and delivered, that leaves her 3 days in pain on one paracetamol every 4 hours. Who prescribed the panadol? It doesn't seem much for someone in obvious pain

Addiction isn't really the main concern for a 93 year old who is on end of life care. Her comfort is.

Her body being allowed to "do its own thing" will achieve nothing other than to keep her in unnecessary and severe pain.

Get the GP out urgently to review her pain relief.
Let the GP, who is an expert in prescribing medication, make the decision what treatment your mother needs to control her pain. You and your DB can be there to hear what the GP recommends

We had a similar situation, my sibling threw all my parents morphine away before going to a carehome, been on it for a while so went days without anything waiting for a new prescription. Scared about adduction at 91 and crippled with pain.

Causing an addiction at 93 years old. Is he rather dim?
Who the fuck cares if at her age she becomes addicted?
Not like shes going to be out robbing houses to feed the addiction.
Ffs

She needs good palliative care. It won’t kill her. It’s inhumane not to give someone who is at the end of their life proper pain relief.
please be strong here and advocate for your mum.

Sorry, but tough. This is NOT about him- not at all. Medical staff should explain this to him and if he refuses to 'hear'- he should be excluded.
I am so so sorry yesmen, but your mother's comfort and freedom from pain is all that matters, NOT your db.

What have they discussed and instructed, is she prescribed pain relief but he's refusing to let her have it, if so that needs addressing, he cannot refuse.

Can you both agree that she needs "better pain relief as prescribed by a professional" and take it from there.

She's 93, I think concerns about shortening her life or addiction are misplaced but that is just my opinion as I don't have access to the research data to prove it. Your brother most likely doesn't either. If we were letting the body do its thing she would most likely have died years ago from an infection not treated by antibiotics. He's allowed to make his own choices but not to impose them on others. Did she see a doctor during her lifetime? Take medication as prescribed? If so that would indicate that her viewpoint differs from that of her son and it's fair to overrule him.

She deserves to be comfy, that has to be the priority at any point but certainly at this point.

morphine patches may be an option for the steady pain relief side of things? But I agree with others talk to her care team and get something in place

I'm sorry you're in thos position, OP.

She cant express herself now. But you know her, can you work through what you think she probably would have said when she was able to decide? Did she take pain relief at other times in her life? Did she ever discuss quality of life issues? Most people would opt for effective pain relief, particularly as its actually very unlikely to cause her demise. I dont imagine there are many who would opt to be fully aware of the pain of her bedsores.

Would DB listen to medical professional working with DM? It may well be that if he has no right to refuse treatment on her behalf, although that would be a hugely difficult situation.
My DF had morphine patches, occasionally topped up with paracetamol or oramorph when needed.

Age, pain, frailty, not wanting to eat or drink because of pain will shorten her lifemore than anything else , addiction is not an issue now, who has power of attorney. The nurses need to get a doctors review ASAP, it myst be frustrating that the care around pain relief and palliative care isn't already in place.

Hopefully when the nursing care starts they will prioritise her pain and help your brother to see her comfort is priority.