Withholding pain medication from a terminal patient

[PossiblyDreaming]

My aunt has stomach cancer which has spread to her lymph nodes. Despite radiotherapy and chemotherapy over the last 10 months she’s now decided she doesn’t want any more and is trying to cope at home for as long as possible.

I’ve visited her today and she couldn’t move and was moaning/ whimpering almost constantly from the pain. She had been prescribed Oramorph and paracetamol but the Oramorph was all gone and she kept vomiting up the paracetamol. When she’s not in pain she is still very mobile - still swimming in the sea most days, doing her own shopping etc. It’s just the pain that is stopping her. I asked her why she hadn’t asked for more Oramorph and she claimed that the doctor was concerned about her becoming addicted. She has folders of notes on her dining room table in case she needs help urgently she can show them and, sure enough there was a note there from Friday stating that additional paracetamol had been prescribed, Oramorph had been requested but declined due to increasing dependence. Arranged a meeting with a pain management clinic for later next week.

Aibu to think that is completely unacceptable? She is dying. She knows she is dying. She has refused treatment in an attempt to make her last few months as enjoyable as possible and instead she is curled up in the foetal position sobbing because she is in so much pain.

She’s fiercely independent and won’t let me intervene but does anyone know if there is someone else she could speak to who could prescribe her something? Would turning up at A and E be a complete waste of time? She’d be happy for me to drive her places and put her in touch with people but she won’t let me speak to her doctor directly or attend an appointment with her. She’s a very private woman, she always has been but I’m the person that is probably closest to her and I don’t know what to do. I went to the pharmacy and they gave me some dispersable Solpadeine Max which was the strongest thing they could give me over the counter and which they thought she might be able to keep down. I’ve been messaging her and she said that helped a bit but she always says that and unless I’m physically there I don’t know what I can do.

Any advice?

Sounds like she needs to be on longer acting morphine tablets with the Oromorph for breakthrough pain. i would ask for referral to a community palliative care nurse if she doesn't already have one.

Arrange a consult with palliative care home; quality of life is critical in these painful months.

I feel so mad about this. That poor woman. They have all kinds of wonderful medication they could use to help her feel better. We don't let our pets suffer so why should humans.

I'm a chronic pain sufferer and have been on strong pain pills for many years. The meds allow me to have a life besides sitting in my comfy chair surrounded by ice packs. Thanks to the war on drugs here in the US there is the constant threat they are going to stop giving them to me and they help me so much. Here they are worried about overdosing or addiction, but even after all these years I'm not addicted. I know this because when I'm a high dose of steroids I don't need, let alone crave the opiates.

My husband was told when he had Oramorph for mesothlioma that he wouldnt get addicted because it concentrated on the pain !

While she needs palliative care and get in touch with a hospice. I have never known a Gp to completely stop medication like that for someone who is terminally ill and would in no doubt be in extreme pain if left with none and they have haven't thought of the side effects from stopping completely. Is she still under a consultant? If so I would contact them and explain. They can then write to her Gp.

[quote PossiblyDreaming]@Elsiebear90 as far as I saw on her notes it looks just like that one request was declined. She said she had been being prescribed a bottle a week but she used the last one up more quickly as she was in pain and that’s why she wouldn’t give another. It makes sense if a GP isn’t allowed to prescribe above a certain amount, thank you.[/quote]
Even so they still shouldn't of left her with no medication at all apart from paracetemol which wouldn't touch the pain.

cks.nice.org.uk/topics/palliative-cancer-care-pain/management/end-of-life-care/

My Dad was under the care of the hospice at home during his last month or so.
I don't know whether it is the same in all areas but Marie Curie organised his care from when he was discharged from hospital.
It might be worth giving them a ring - I'm sure they would he able to give you advice.

I feel so mad about this. That poor woman. They have all kinds of wonderful medication they could use to help her feel better. We don't let our pets suffer so why should humans.
With the greatest of respect (honestly), we only have one side of the story. I lived with my dad when he was terminally ill and we spent time with fil under the same circumstances. Both would not have been able to deal with pain medication, doctors nurses etc without someone helping everyone figure out what was going on which was understandable as they were in pain. We had to watch things like pain meds like a hawk and then things had to be upped or down according to side effects that included getting extremely confused or feeling sick, bowel issues etc. Nothing related to palliative care is easy and there's a big difference between a person who's willing to go with a doctor's recommendations and a person who wants to go a different way. Nobody here knows what was turned down in terms of help or medication. Sorry you're all going through this op and best wishes for your aunt and would agree that the hospice is amazing, my dad met and spoke to people there and even did art etc on day visits. The doctors, nurses and helpers were amazing on both the medical and social side, I will never ever be able to thank them enough