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.

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.

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?

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

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.

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

Thank you very much everyone.

A few answers.

DM is in a hospital bed at home with compression etc. She cannot really advocate for herself or express her wishes.

We have caregivers come in three times a day.

nursing care will start on Mo day.

DB is a good man who has bad information. He is a big advocate for natural care and letting the body do its thing. He is genuinely afraid of killing her or causing an addiction.

Maybe he jus does not want her to die. Maybe he is finding that hard.

Thank you everyone. I will have another chat.

Absolutely go for the morphine. Control her pain.

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

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

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 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.

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

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.

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.

Thank you.

I feel that this would be the most sensible thing at this time.

The professionals have discussed and instructed.

He hears things differently.

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

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.

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.

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.

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.

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

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.

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

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.