Page 4 | Urgent - ethics around pain med for 93 yr old

yesmen · 2024-04-27T13:19:38+00:00

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.

nats2010 · 27/04/2024 17:19

Winterjoy · 27/04/2024 15:01

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.

Exactly this.
Your "D" B is being an absolute dick. Your .other had made it to the ripe old age of 93. She is now bed bound and stuck with painful bed sores. They are bound to be painful all.of the time, and as you say especially.on movement.
She should of course be afforded every possible type of pain relief and comfort available to her. She deserves it.
A process indeed. Imagine I said that to every family member of every palliative care patient that I have looked after in the past. I don't think I would still be working now that's for sure.
Your DM should be afforded the comfort and dignity she deserves, and you should be doing everything you can to work with the healthcare professionals to make that happen. They have a duty of care, and you will feel so much relief on your DM behalf to get the help she needs.
I'm sorry you are in this position OP. Its truly awful to observe things like this and have another person be so dismissive of it.
Sending you and your DM hugs and sending you strength to help deal with the situation.

TraitorsGate · 27/04/2024 17:21

Thank goodness the doctor is on their way, let's hope they will prescribe something for her. It needs to be sorted out as soon as possible and if I were the doctor and the relative put up barriers and refused pain relief I would be seeking an urgent hospital or carehome admission as you can't stop your brother being there.

LiterallyOnFire · 27/04/2024 17:27

She's got a right not to be in pain. I'm relying on my children to protect me from pain in that kind of situation.

quizzys · 27/04/2024 17:28

Atethehalloweenchocs · 27/04/2024 17:12

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.

I know what you mean, but the brother is being obtuse and is not listening to reason. This was not a sudden event.

For some reason women seem to be far more practical than men when it comes to life altering decisions like this. Not saying women don't care or are hard as nails either BTW.

Mischance · 27/04/2024 17:31

She needs a morphine syringe driver - I insisted on this for my grandmother and the nurse told me that they are not allowed to give her morphine until she is visibly in pain - I told her very clearly that she was lying and I spoke to the consultant who set the right treatment going very quickly.

So - your brother thinks it might kill her! Well, of course it might - does he really think that she is going to recover, to suddenly have no bed sores, to suddenly be well? Whilst he is getting his head round this, the poor woman is suffering.

My late OH had PD that had advanced rapidly and he was physically totally incapacitated and mad as a hatter - he thought people were trying to kill him. His life was utter misery. When he got an infection they were about to blue light him to hospital for drips, and antibiotics and terror on an unfamiliar place. Thankfully I had PofA for his health and welfare and (after consultation with my DDs) I refused to allow this. An end-of-life care pack arrived and he was kept peaceful and sedated until he slipped away.

You need to get a medic on your side to explain reality to your brother.

shellyleppard · 27/04/2024 17:31

Op I'm sorry your mum is going through this. Can you talk to the doctor about stronger pain relief? Does she have a special air mattress for her bed?? The doctor may recommend a visit from the council who can help with the necessary equipment so she is comfortable. 💐

LiterallyOnFire · 27/04/2024 17:34

AnnaMagnani · 27/04/2024 15:15

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.

I bet.

Girliefriendlikespuppies · 27/04/2024 17:35

She might be better with a pain patch or syringe driver tbh, is she eating and drinking much?

Who is dressing the pressure ulcers? Have the community nurses assessed her? Is she on an air mattress?

If the community nurses believe your db is withholding analgesia that would be a safeguarding concern (quite rightly.)

Pressure ulcers are extremely painful and to have one on both hips is not great.

You can ask the community nurses about lateral turning systems (TOTOs in our area) thee see t might be useful to gently move your mum. You can also ask for a referral to tissue viability re the pressure ulcers.

Original poster

yesmen · 27/04/2024 17:37

Atethehalloweenchocs · 27/04/2024 17:12

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.

exactly this.

OP posts:

Mischance · 27/04/2024 17:37

Your brother does not have the right to inflict pain on his mother, which is basically what he is doing. If he does not like big pharma, explain to him that morphine is basically poppies!

What can he be thinking? It is sad that he cannot come to terms with the end of her life; but that does not give him the right to inflict pain on her. It is his problem and he has to deal with it without causing her misery.

Mistredd · 27/04/2024 17:39

Does DB actually care for her? Its all very clear cut in the abstract but it’s awful to watch someone you love suffering.
I don’t believe in assisted dying but I do believe in people being able to live whatever is left of their life without pain, even if the pain relief may shorten it.

Jujubeez · 27/04/2024 17:40

Gymmum82 · 27/04/2024 15:10

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

It's not an uncommon concern, unfortunately. But it's not a real risk obviously.

Please get your mum pain relief. It'll make it easier for her.

Original poster

yesmen · 27/04/2024 17:40

Mischance · 27/04/2024 17:31

She needs a morphine syringe driver - I insisted on this for my grandmother and the nurse told me that they are not allowed to give her morphine until she is visibly in pain - I told her very clearly that she was lying and I spoke to the consultant who set the right treatment going very quickly.

So - your brother thinks it might kill her! Well, of course it might - does he really think that she is going to recover, to suddenly have no bed sores, to suddenly be well? Whilst he is getting his head round this, the poor woman is suffering.

My late OH had PD that had advanced rapidly and he was physically totally incapacitated and mad as a hatter - he thought people were trying to kill him. His life was utter misery. When he got an infection they were about to blue light him to hospital for drips, and antibiotics and terror on an unfamiliar place. Thankfully I had PofA for his health and welfare and (after consultation with my DDs) I refused to allow this. An end-of-life care pack arrived and he was kept peaceful and sedated until he slipped away.

You need to get a medic on your side to explain reality to your brother.

I am sorry for your loss but glad for you that you were able to manage it for him.

OP posts:

Ponderingwindow · 27/04/2024 17:44

I believe I would want the pain relief, even if it suppressed my breathing.

Original poster

yesmen · 27/04/2024 17:45

Thank you everyone. The doctor came and is taking care of pain management.

DB is on board.

He does not want her to die.

He is heartbroken.

I won’t post anything more as I have to attend to things here but thank you all so much.

OP posts:

Mrsjayy · 27/04/2024 17:46

JaneIves · 27/04/2024 14:24

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.

100% this, she deserves to be pain free as much as possible. These medicines are monitored and regulated contact the gp or if she's really bad phone the out of hours.

MrsElijahMikaelson1 · 27/04/2024 17:47

Get her the oramorph prescribed-poor old lady. Let her be at peace and pain free. My in laws and done living directives exactly around this so no one will be questioning what’s to be done to look after them if needed. Also have LPA done and respect forms

Mrsjayy · 27/04/2024 17:47

yesmen · 27/04/2024 17:45

Thank you everyone. The doctor came and is taking care of pain management.

DB is on board.

He does not want her to die.

He is heartbroken.

I won’t post anything more as I have to attend to things here but thank you all so much.

I'm glad you managed to get someone today .take care

LiterallyOnFire · 27/04/2024 17:47

yesmen · 27/04/2024 17:45

Thank you everyone. The doctor came and is taking care of pain management.

DB is on board.

He does not want her to die.

He is heartbroken.

I won’t post anything more as I have to attend to things here but thank you all so much.

All the best OP

Topseyt123 · 27/04/2024 17:49

yesmen · 27/04/2024 17:45

Thank you everyone. The doctor came and is taking care of pain management.

DB is on board.

He does not want her to die.

He is heartbroken.

I won’t post anything more as I have to attend to things here but thank you all so much.

That is the best outcome you could hope for under the circumstances.

I'm not going to criticise your brother any further as he is clearly struggling too, and has come on board.

You are all in my thoughts.

Icepinkeskimo · 27/04/2024 17:52

I didn’t want to read and run OP, I read through the thread there has been a lot of good advice given here.
I am an absolute advocate of when a patient is in severe pain then imo it should be administered ensuring that they can be pain free and thus rest. Your mother is presenting severe pain and discomfort and the priority for me would be to ensure that the pain relief is stepped up immediately. I understand your brothers concern regarding OUD however these are secondary to the pain.
I am advising you contact your health care team urgently (there should be someone alway available in these cases).
No patient should be subjected to this excruciating level of pain, that is non negotiable in a patient in such circumstances.

oakleaffy · 27/04/2024 17:58

Bedsores come from a variety of causes
the CAUSE needs addressing.
Has she a hospital air bed?
She will be in desperate pain bless her

Morphine won’t help the open wound being touched by the mattress- it’s down to suboptimal care that she has developed bedsores-
Sort the CAUSE
Morphine will make her desperately constipated- which has it’s own problems.
Morphine feels calming though
She deserves that, at least.

TraitorsGate · 27/04/2024 18:06

All the very best to you all at this difficult time

Atethehalloweenchocs · 27/04/2024 18:08

All the best to you and your entire family OP. And wishing your lovely mother a peaceful night.

MontyDonsBlueScarf · 27/04/2024 18:21

AnnaMagnani · 27/04/2024 15:03

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.

Definitely this. The palliative care team are the specialists in pain control and are also very experienced in explaining things to family. You could sell it to DB as getting the specialists in as you appreciate his concerns.