Urgent - ethics around pain med for 93 yr old

[yesmen]

Hi. Urgent help needed if anybody is around.

Mum is 93 and in her own home.

She is immobile, needing to be turned every two hours. she has two massive bedsore - one on each hip.

She is in pain all the time and a volcano of pain when we turn her.

At the moment she gets 5 mls of panadol liquid every four hours. In my opinion it is touching her pain.

I want to insist on morphine prescription. DB does not. He thinks it is unethical and may kill her.

I say it is about her comfort now.

He says it will hurry up the process and she has a right to the process.

Thoughts from anybody at all are gratefully read.

I agree with you @yesmen . It's palliative care. Do you have any nurses or doctors visiting?
Sorry that you are having to cope with this.

What a tough situation. I doubt it would speed anything up, but I would insist on stronger pain relief. She’s 93, and in agony. I agree with you that she deserves something stronger. I would chat with the drs involved to see what could be offered, and try to get them to explain to DB the important of proper pain relief.

I'm no expert but I'd agree with you, treating the most urgent feature is the priority, so pain medication. I don't know anything about nursing or care for elderly but I'd want my Mum pain free rather than in agony but unable to enjoy anything about the day.

I'd go for stronger. She's in obvious pain.

Dying is a process, yes.
But pain can be controlled and managed, of which she also has every right to.

Some morphine liquid given 20 mins before turning could really help. Likewise Buprenorphine patches or similar could be helpful. Speak to the GP or palliative team. It's totally unethical for someone to be in pain like this in their last months.

I would agree with you. She's 93, it's about her comfort. Could she not have something like Oramorph a couple of times a day?

Could the doctor have a conversation with your brother? Your mother needs to be comfortable. There's no point in her life being made hell by pain. She could go downhill from that just as fast.

Are the palliative team or nurses involved in her care. Is she on a pressure mattress so that she may not need turning so often. Her comfort and pain control is the priority, oramorph is very good, she needs a medical visit, being in pain stops you wanting to do anything, there's no need for her to be left in agony. Your brother is scared but she's 93, has pressure sores and will be miserable. Does anyone have health poa. Is mum able to express herself, if asked I'm sure she would prefer to be as pain free as possible.

I'd say she needs a syringe driver with morphine. It's not really about 'helping her along' but about her being as pain free and as comfortable as possible. Would your brother speak to a Dr with you about it?

Ethically you can't leave someone in pain or deny them analgesia

I would talk to GP and go for morphine.
At her age it can costs a few days of life but not kill her.
Talk to GP how to take care of her the last days of life. Medication plan is a must and knowledge of how the days/nights can be. Can you get a nurse to visit Helping with the care then reaching terminal?

It wouldn’t necessarily need to be morphine, there are other options to help keep her comfortable.
It is unethical (and cruel) to leave her in that much pain. Contact 111 for advice, don’t leave her until the GP surgery opens tomorrow.

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.

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.

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

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.

@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. 🙏🏻

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.

She has a right to the process???

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

Absolutely this. Thank you @TraitorsGate

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

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.

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?

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

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.

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.