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.

Even if the nurse is coming on Monday and they request pain killers you'd still have to wait for the prescription to be arranged and delivered, that leaves her 3 days in pain on one paracetamol every 4 hours. Who prescribed the panadol? It doesn't seem much for someone in obvious pain

Unfortunately hearing things differently is not uncommon with the bunch of people who are in to natural stuff.

It's OK watching someone say they want to experience pain as part of their spiritual journey (and even these give up when it hurts enough) but not to do it for a relative.

If your DM shared your DB's world view it might be arguable this is what she wanted but it's sounds as if this all him.

As a professional I would be prepared to make a safeguarding referral for this if DB was blocking her access to appropriate treatment but this would depend on how much you want to fall out with your brother as it is the nuclear option.

Morphine.

This. Please call the urgent out of hours doctor today. No one should be in so much pain unless they choose it for themselves such as a pregnant woman wanting a natural birth.

It sounds to me like your DH is wanting to deny his mum the pain relief she needs during the unpleasant final stage of her life because that will postpone for him facing the inevitable grief of her passing. Dying happens for us all but no one would choose hanging on for a few months of pain if the alternative was a shorter period without the pain. He is being selfish.

As an ex hospice worker, I would challenge him as to why being in extreme pain whenever carers need to do basic care, is in any way spiritually beneficial or part of the process? People at the end of their lives deserve to be cared for ,have their symptoms managed and allowed to appreciate the time they have left with their loved ones. If he still doubts why morphine can be necessary, ask him to hold a match to his finger then regularly press on the burn and see how he likes it.

Your brother sounds difficult. Have the medics suggested morphine? If so, surely he doesn't have a right to refuse on her behalf.
Somehow he needs to get the message that normal doses of morphine don't kill people. And doctors do not prescribe drugs to patients that will kill them! If one of them could explain to him in more detail how the dosing works?

Look, any opiod can depress breathing, which was hasten the end of life. But is it ok to leave her in agony because you dont want to take the chance? I had this debate about my own mother, in the end the district nurses came in and gave her shots which was a relief.

Sorry, I have edited this when I read more of the thread. This sounds more like your DB not wanting to deal with the fact she is dying than anything else. My mums partner was the same.

Dr don’t prescribed drugs to help along the process of dying (this is a huge other debate). Your Mum is in a lot of pain and she should have pain relief for that.

Is your brother struggling with the thought that your Mum will die? To be blunt he shouldn’t be your priority now.

@yesmen p.s. do also discuss the turning regime with the nurse,sometimes 2 hourly turns become in themselves inappropriate as the balance/ benefit of reducing pressure versus increased shearing and pain from the turn can shift .

You need an urgent palliative care review and your brother needs a bluntly honest talking to by professionals who deal with this type of horror. The absolute best thing you can do now is keep advocating for your mum. Who has LPA? If your mum cannot make her own decisions then all actions need to be in her best interest. Ultimately your brother can't stop your mum being given what she needs in her best interests, but life will be hugely easier for all if he is on side.
Sending you hugs, OP

What's unethical is allowing your dm to be in pain when there are options.

Point this out. Tell him he is being unethical and inhumane

I know this.

As I said before he is a good person with very bad information.

He is here every day helping to turn her, to change her, give fluids etc. He has really stepped up.

it is just this hurdle of Big Pharma etc. I try to agree for “general life” but end of life is different.

We have agreed to disagree and a doctor is on the way.

I really think it is this.

He does not want to face it.

Sounds like brother doesn't want to allow Mum either to live or die in dignity and comfort, just to fulfil his own beliefs.

How does he KNOW that Mum wants a spiritual journey of pain? Honestly people like him make me so mad. Full of airy fairy shite and meanwhile the person they profess to love is suffering unnecessarily. Awful stuff. Get the professionals involved asap on this one. Please.

I'm speaking as a former carer for my mother RIP, who was in pain and was not communicating or eating etc. That happened quite suddenly in her journey. Within 24 hours the palliative care team had her on morphine and various other things, and you know what? She was a delight from then on, eating, talking, laughing with us - all because she was pain free and so comfortable. Now there were bad days too, but I often wonder what the bad days would have been like without the palliative care regimen.

UES! I do feel it is way to extreme at this point.

I think they are trying to prevent new ones developing but she is too far gone for this intense regime. It distresses her beyond measure and she is just starting to settle when we start again.

I think everyone needs to accept the limits of this situation.

Having said that - any and all district nurses, hospital nurses, care givers and anyone else reading this that has ever shown an act of kindness to the ill - thank you from the bottom of my heart.

Do you think she would be better off in a care home? I really wouldn't want to be on my own all the time except for a few medical visits if I was that age and in such a lot of pain.

Well done @yesmen for getting a doctor to come. I hope the doctor can reassure both of you about appropriate pain relief and care at this stage of your mum's life.

Thank you for that. I will recount it to him.

Her comfort is paramount. Why should she be made to suffer unnecessary agony because your DB thinks it is 'the process'?

I would say morphine every time.

She is not alone. We are here 24/7.

she is never alone.

You are kinder than me, I was going to say break his leg with a hammer, let him walk on it without ever getting it fixed. Ask him if it hurts, does he want pain relief now.

On a lighter note, our family (mum's children and grandkids) would often joke with Granny/Mum about her morphine, and jokingly asked if she had any left over that we'd love some too! How she laughed.

I don't want anyone to think that my mother's journey was problem or symptom free, it wasn't, but it was made much more bearable so that she could enjoy us and things around her for the last leg of her journey.

Like OP, I wish all who are in similar situations all the best, and as peaceful and pain free a passage for loved ones as possible.

Sounds like brother doesn't want to allow Mum either to live or die in dignity and comfort, just to fulfil his own beliefs.

Or it may just be that he is feeling panicky about the end of her life and not thinking straight. He would not be the first or last person to go into denial. Not condoning it - I believe when a loved one is ill you have to put your big girl pants on and deal with it - but I do think I understand it.

Hey OP
I'm a specialist palliative care pharmacist and I work in a hospice.
It is a common misconception, but opiods do not hasten death, they need to be titrated closely to a patients pain needs but as long as that is done there is zero danger in their usage, your brother is allowed to hold whatever misguided belief he wishes to, but to deny another human being pain relief is unethical and immoral. He does not get to decide what's in your mums best interest.
It is really really important you find out what your mums wishes are, if she asks for pain relief then she needs to get it, you must advocate for her. To leave a poor human being in that situation with only paracetamol is disgusting.
Please do not allow this, you must stand up to your brother,
I wish you all the best, you have a difficult journey ahead of you.