Urgent - ethics around pain med for 93 yr old

I have found the number of people against giving opioids to their relatives is larger than the number against taking them themselves.

When you personally are in enough pain 99.9% of people take the drugs regardless of their worries.

It is much easier to pontificate well meaningly about someone else.

Please advocate for her - I've worked in a nursing home and residents were always administered extra pain relief 30 minutes before they were handled. It's fucking cruel not to.

Is there a back story where he could want her to be in pain? Sorry to ask but these things happen....

I don’t think causing addiction is really a concern in someone who is dying.
There’s letting the body do its thing and then there is dying in pain and suffering. Which in this day and age is completely unnecessary

Totally agree with you yesmen. Please get the support of GP or Macmillan nurses to speak to your brother.

Absolutely go for the morphine. Control her pain.

What is unethical and extremely cruel is knowing that she's in pain but not doing as much as possible to relieve it.

I work in palliative care. I wouldn’t expect an appropriate dose of morphine to hasten someone’s death. If she’s in constant pain she needs and deserves medical review. Are the district nurses involved too - she needs a nursing care review if she’s got pressure sores. I would see not getting her appropriate care ie review by medics as neglect.

I think there are a few options before morphine but she can’t be left constantly in pain.

Your mother should be on a hospital bed. If not, ask GP to refer you to occupational health. If you can’t have a morphine syringe then you need district nurses and palliative care team on speed dial so they can come and give injections. My mother was refused morphine as they said there was a contra-indication in her blood but fortunately she didn’t need it. MiL was in a nursing home and we insisted on morphine. It can depress the breathing and hasten death but who wants to live longer in pain?

Ask GP for referral to the Community Specialist Palliative Care team.

I've seen loads of patients like your mum. Usually the answer is patches for pain all the time, a compromise on turning regime and extra pain relief before care or turning. However every one needs an individual assessment.

As above your mum's opinion is most important here.

I'm sorry I know this isn't very sympathetic but your post has literally made me feel ill. Imagining myself vulnerable and in excruciating pain and my family withholding relief.

What is yout DB's reasoning around 'she has a right to the process'? I understand that it's not beneficial to take away someone's opportunity to work through a process when they will come out of the other side having gained something (better understanding, new skills etc) but what exactly is he thinking your mother will benefit from this when the end result will be the same regardless.

Is his approach really with your DM's interest at heart or is he not willing to let go for his own reasons (has he accepted that she is going or is he expecting a recovery of sorts)? If the latter, as pps have suggested, maybe medical or care staff can talk to him.

I know your brother is coming from a place of love, but I can't help thinking that he has this one a bit the wrong way round.

What does he mean "she has a right to the process" as that seems an odd thing to say to me? She has a right to be as pain free and as comfortable as possible. He has no right to push her to go through severe pain just because it is his idea of the process.

Can your mum express her own wishes? If so then what does she have to say? What does she say to both of you? If she wants to use the pain killers then that should really be that and no further discussion about "process" from your brother even though, to be completely fair, he is probably just dreading losing her (as I'm sure you both are).

From a medical point of view controlling the pain is likely to be the main thing that they can do, and for a 93 year old it is likely to be palliative care that is required.

My Dad went through hell with pressure sores.

Why would he actively want his mother in pain? Obviously she needs better pain relief. Ethically she needs better pain relief. Maybe it will speed up the ‘process’ maybe it won’t. But she deserves her last days/weeks/months to be comfortable not suffering. No one would want to live in agony

Pain relief should be paramount
What kind of life is she having if it's a life full of constant pain.

Can they not try some lower doses to find out the right pain relief level for her?

I would also contact 111. She needs to have her pain relief properly managed. Over 20 years ago now my Mum was in hospital for her last few weeks of life - her pain was managed but things were getting more difficult. I spoke to the Dr who said if he upped her morphine any higher he knew it would kill her and although we knew she would die within a couple of hours/days it was a step over which, ethically, he couldn't cross - you are a long way from that point in what you are asking. Really hope you can get this sorted.

Sorry if I missed this bit...
What does your mum think? Does she have capacity?

If so then she can make the choice.

If it was my choice to make then I'd be 100% going for better pain relief. However this types of things can weigh really heavily on a family and cause splits so the more direction from her the better so you aren't left holding any blame

Absolutely this. Thank you @TraitorsGate

She has a right to the process???

Christ, I’ve heard it all now - who does he think he is, Mother Theresa??

Morphine all the way.

Your brother comes from a place of love but is causing your mum to suffer more than she has to.

Get the palliative team and gp on board.

@yesmen , I have stood in those shoes and it s absolutely all about her comfort now. It’s hard when a well meaning person doesn’t agree with you but you must move from what’s best for your mum. 🙏🏻

I am so sorry you are in this position - been there, and it is so difficult. Fortunately DB and I agreed that morphine was the way forward for DM, as it would relieve her discomfort, and was what the GP recommended. If you have a good relationship normally with your DB, could you explain that although you understand it may hasten your DM's death, it will make that time so much more comfortable for her. Would the medics talk to him?

Thinking of you.

It’s unethical to leave her in pain

Get on to 111 immediately, you can’t wait until Monday, sounds like she needs to be on a syringe driver now

she has a right to the process.

What? What does your DM want? Unless there’s a history of your DM insisting she wouldn’t want end of life pain relief then your DB is massively out of order.

Is your mother able to express her wishes? If so I'd talk to her. If not I'd agree with you it's about quality not quantity of life and being as comfortable as possible.