Withdrawing medical interventions

[idontknow202]

Hi,

My Nanny is currently poorly in hospital with several infections being treated and has very advanced dementia.
During a spell of very lucid interaction she very very clearly told me she wanted to stop being falsely being kept alive that she was very tired and wants to go home to be allowed to die.
We haven't been told she is likely to die while in the hospital they're keen to treat her infections.
Can I do anything to support her to be allowed a say in her treatment plans?
We're very very close and always have been. I know she is ready to be left to go on her terms. I feel so sad I can't help her. She has a dnr but I don't think any of her other wishes are recorded

Ask to speak to the consultant responsible for her treatment, and tell them exactly what you have said here. Very difficult and sad for you.

Her NOk needs to have that conversation.

Speak to the medics - they need to know. From all I’ve ever heard, it’s often the relatives who are so keen for someone to be kept going in such cases, rather than the medics, so they might well agree that it’d be the kindest thing.

If she has an infection, then antibiotics will make her more comfortable. Withdrawing this treatment would be cruel! A DNR will most likely be in place anyway - it means that should she, say, have a heart attack, they won’t resuscitate.

The best thing you can do is pass on to the consultant what she has said. As she has a DNR in place, that would at least suggest to them that what you're saying doesn't go completely against her previous thoughts so they will hopefully give some credence to what you say.
Re the cruelty point made above, there are many drugs that can be given for different types of pain, distress and/or agitation irrespective of whether antibiotics are given.
Best wishes to you - it's a horrible situation.

I work in this feild a little. What you need to discuss with the rest of family and her drs is an advanced care plan. in different areas they are called different things ( respect form, pace form).
If she is lucid she can say to Dr's that she has a certain ceiling of care e.g my next infection I don't want any treatment or I only want to be treated at home for an infection but I would want to be admitted if it was reversible e.g broken leg ( or not).

If she doesn't have mental capacity you and family should say that you don't feel that ongoing treatment and repeated admissions to hospital are in her best interests. Dr will either agree or not and discuss with you and then record this descion. You can also discuss this with gp if at home so gp doesn't send her back to hospital.

You might also be able to contact your local hospice for support as a family as well.

She can still have treatment to be comfortable at home or other place of care
xxx

An aunt of mine in her late 80s, with fairly advanced dementia was refusing food and drink after the umpteenth UTI - she’d always been prone to them so of course dementia-related incontinence made them that much more likely.

The care home staff asked me whether I (the only relative contactable at the time) wanted her taken to hospital for IV fluids/ABs, or left where she was, with palliative care, but where she would otherwise die.

It was a horrible decision - I could only ask the GP what he’d do if it were his much-loved aunt. He said that especially since it was only going to happen again, probably quite soon, and since hospital is a terrible place for anyone with dementia (when they can’t understand what is going on or why) he’d leave her where she was, where they’d keep her comfortable.

I sat with her a lot during her last days - she was sleeping nearly all the time and did not seem to be in any discomfort. Staff continued to offer drinks and e,g, yoghurt, but she’d close her mouth and turn her head away. Her mouth was kept moist with little sponges.

She drifted away quite peacefully after about a week. Although it was a horrible decision at the time, I never once regretted it afterwards - I was quite sure that it was what her former self would have wanted.

Thank you for all your advice. I shall speak to the hospital consultant, she's sadly still in hospital with now another different infection which they are treating. She is refusing all food offered but is drinking so I guess that will keep her going longer than not drinking either.
Her children would not support her not being treated they would fight very hard for her to kept going.
I will see what the doctor says thank you.