End of Life Care

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AlyssaEimers's picture
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End of Life Care

So I have a very good friend who's mother is dying of cancer. She (my friend) has been very adamant that she is not to have any pain medicine or to be put on hospice. That hospice will kill her faster.

Debate question - Would you want pain medicine at the end, or would you want to live as long as possible no matte what?

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I'm not understanding. Are you thinking pain medication reduces the amount of time a person lives? Why does she think that hospice would kill her faster, because of her own feelings, etc?

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I have the same question as Beertje.

Doesn't the mother have an advanced medical directive? I know that I never want my children making this decision for me, which is why DH and I have clear and concise living wills and AMA's outlining our specific wishes. As to not putting her in hospice, ultimately the Mothers insurance will stop paying for the hospital, which may sway your friends opinion.

I think that failing to allow pain medicine is downright inhumane of your friend.

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I'm completely confused. The daughter doesn't want the dying mother to have pain meds??? Why? Does she think staff at the hospice will "kill" her by providing pain control? Have they stopped actively trying to "cure" the cancer?

I previously worked in palliative care. This person (and probably the mother as well) need a lot of education about palliative care processes and goals (ie. quality of life in the last days). Palliative care can be provided in hospice, hospital, or at home. The daughter really should be hooked up with counsel regarding the looming loss of her mother. The mom most definitely needs to get the paperwork (advanced directives, DNR status) organized.

Good palliative care gives a person a pain free death. This means pain meds! Some forms of cancer are excruciatingly painful... What kind does the mother have?

I will say though that this sort of mentality is super common. People think they'll become "addicted" to the narcotics. That people need food and IV fluids late into the palliative stage. It is all part of struggling to let go. A massive part of palliative nursing is education.

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Cancer is a very painful death. Having no pain medicine will definitely kill her faster because she will want to be out of her misery. I think that as long as the pain can be managed I would like to stick around as long as possible but once it gets to the point that it's not worth it just let me go. I would prefer to be put on hospice and spend my last days at home if I had the choice.

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I think withholding pain meds is straight up cruel and uninformed.

I hope a social worker gets involved in her care, bc the daughter is just being mean and ignorant IMO.

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Those two ideas don't really go well together. If she wants her mother to live longer, she needs to let her have pain medicine. I can't imagine wanting my parents (even the one that makes me bonkers) to be in pain for their last days here on Earth.

We have Advanced directives too. I had mine done during the kidney donation because if anything happened it would have put my Mom in some seriously uncomfortable positions making decisions that she wouldn't have been in the right frame of mind to make. I cannot imagine asking my child (even as an adult) to make those decisions for his parent.

Both me and dh want pain medicine but no extraordinary measures. If there is a slim chance we could come back from whatever is allowing someone else to make decisions for us but it would take a fortune to wait it out or the resources could be used for another person who has a much better chance, I can't imagine having to make someone else make that decision.

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I would want to be in my own home as long as possible with pain meds for sure. I think Hospice is a wonderful program, and have seen it at work with various family members, much better than any care facility they had or others were in. Simply because HOME is a comforting place.

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Why does your friend think being on Hospice will kill her faster? It sounds like she got some wrong information from somewhere.

The debate question makes it sound like she thinks pain medication will kill you faster because of how it's worded (since the choice is either, "be on pain meds" --OR-- "live longer"). Maybe you didn't intend for it to sound that way?

I would want to be on pain medication if it was necessary. Even the Bible says, ".... use a little wine for your stomach's sake and your frequent infirmities." (See 1 Timothy 5:23)

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I have been super confused as well. I have never heard of being against pain medicine or hospice. I think she is clouded by her grief and not thinking straight? I wanted to see if it was a prevalent belief. I am very much hoping that someone from the hospital will talk to her, but she has her mind firmly made up that pain medicine will make her die faster.

A little back story, Her mother has breast cancer that has spread through her body. They gave her one dose of Chemo. She went to the hospital asking for pain medicine because under her arm was all swollen. It ended up being an infection. Her white blood count is .1. She is in kidney failure and is also having heart problems. She has been in and out of wakefullness and has been sleeping all of the time. Somehow my friend thinks it is the pain medicine that causing her to sleep and go down hill so fast? I am sure if it was my mother I would not necessarily make smart decisions either though.

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Hospice is not just for the patient, it's for the whole family. People can survive a long time on hospice, even be taken off it (i have a resident right now that was on hospice).

She needs and deserves to put on pain med's. Pain causes stress. Pain and Stress hinder ANY healing process the body is trying to do. Not giving her the pain med's is going to kill her quicker.

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"AlyssaEimers" wrote:

I am sure if it was my mother I would not necessarily make smart decisions either though.

Exactly why it should not be your decision to make. If anyone reading this thread has kids and does not have a will and all the rest (power of attorney, living will/medical directive etc) they are flat out irresponsible. I know that I harp on this, but it really bugs me how many people don't take care of business.

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"boilermaker" wrote:

I think withholding pain meds is straight up cruel and uninformed.

I hope a social worker gets involved in her care, bc the daughter is just being mean and ignorant IMO.

Ditto this. I would be calling them myself ASAP! What a horrible thing to do to her mother, and I'm surprised that the hospital staff would allow that to happen in the first place. Sad

To answer the debate question, my answer is both. I don't want to live in pain, and I want to live as long as possible without pain. ITA with the PP who said people die faster without pain meds, that's because the stress of being in pain shuts down the body faster. That's why it's so important for c-section moms to take their meds on the clock, you simply can't heal well when you're in pain. If I'm dying, I want it to be as peaceful as possible, and if it involves cancer, that means lots of pain meds so I might actually enjoy my last days with the people I love instead of wishing for a quick end to the misery. Sad

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"Spacers" wrote:

Ditto this. I would be calling them myself ASAP! What a horrible thing to do to her mother, and I'm surprised that the hospital staff would allow that to happen in the first place. Sad

I can only speak for myself as a nurse, but I wouldn't. If the mother is at all able to communicate at this time, I would do whatever she wants, regardless of how her family feels.

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I spoke to her more last night and realized I misunderstood the situation. She just does not want her to have morphine, but is ok with any other pain medicines like Tylonal with Codeine. I still do not understand the thought process though.

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"AlyssaEimers" wrote:

I spoke to her more last night and realized I misunderstood the situation. She just does not want her to have morphine, but is ok with any other pain medicines like Tylonal with Codeine. I still do not understand the thought process though.

That is no better, imo. Tylenol and codeine will do squat for cancer pain. Also, as her mom deteriorates she likely won't be able to swallow oral pills. She will need something that can be given subcutaneously. Morphine and dilaudid are both great drugs.

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I just got off the phone with her. For now, her mother is aware enough to make her own decisions so she is on morphine now. It is a huge source of strife between them though. I just can not fathom the situation though. She is 100% convinced that morphine will kill her mother.

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She is grieving, but she needs to realize it is the cancer will kill her mother, not the pain medications that are keeping her comfortable.

I would encourage her to go and speak to her mother's doctor. Maybe if she knew all that was going on and the pain her mom is in, she would be more understanding. If your area has a hospice or palliative care group, they are a great support to families.

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She is very anti hospice. It goes back to a bad experience that she had with her Grandfather. She is stuck on the idea that hospice/morphine killed him. At this point, she knows how I feel and there is nothing else that I can do besides just listen to her. It does bother me a lot though.

(ps. I noticed you are close to your crowns.)

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"AlyssaEimers" wrote:

She is very anti hospice. It goes back to a bad experience that she had with her Grandfather. She is stuck on the idea that hospice/morphine killed him. At this point, she knows how I feel and there is nothing else that I can do besides just listen to her. It does bother me a lot though.

(ps. I noticed you are close to your crowns.)

Did her grandfather have an allergic reaction from or OD on morphine that she would be so adamant?

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"kris_w" wrote:

I can only speak for myself as a nurse, but I wouldn't. If the mother is at all able to communicate at this time, I would do whatever she wants, regardless of how her family feels.

It seems the mother is able to communicate right now, and I hope the hospital has gotten her wishes for the future documented so that this daughter and her insane hangups about morphine don't get in the way when she can no longer communicate.

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"Spacers" wrote:

It seems the mother is able to communicate right now, and I hope the hospital has gotten her wishes for the future documented so that this daughter and her insane hangups about morphine don't get in the way when she can no longer communicate.

Yep!And I suspect the daughter will change her tune if she sees what sort of pain her mother could/would be in without the meds... Especially down the road. Sometimes it isn't too bad. Sometimes it is downright horrible. Sad

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"Beertje" wrote:

Did her grandfather have an allergic reaction from or OD on morphine that she would be so adamant?

He OD on the morphine.

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What makes them think he OD'd vs. the natural course of death? Was that officially what happened or her take on the situation? I ask because most palliative patients I have seen can tolerate extremely high doses of analgesic (amounts that would kill you and I). There are times however when a person's pain is so severe that in order to relieve the pain the patient needs to be heavily sedated ("snowed"). I do NOT mean euthanasia - I am 100% against that, but I am 100% for providing people with a good, comfortable death... And analgesics are definitely a necessary part of that.

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I really am not sure. I did not know her then.

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"wlillie" wrote:

Those two ideas don't really go well together. If she wants her mother to live longer, she needs to let her have pain medicine. I can't imagine wanting my parents (even the one that makes me bonkers) to be in pain for their last days here on Earth.

This.

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"kris_w" wrote:

What makes them think he OD'd vs. the natural course of death? Was that officially what happened or her take on the situation? I ask because most palliative patients I have seen can tolerate extremely high doses of analgesic (amounts that would kill you and I). There are times however when a person's pain is so severe that in order to relieve the pain the patient needs to be heavily sedated ("snowed"). I do NOT mean euthanasia - I am 100% against that, but I am 100% for providing people with a good, comfortable death... And analgesics are definitely a necessary part of that.

I would question him OD'ing too. If he was on a drip there is no way he should have been able to OD.

And HUGE ditto on the amount of pain med's they can give someone. My husband had his lower right leg amputated 2 yrs ago and they had him on fentanyl patch (up to 10 times stronger then morphine), demoral (controlled), and also i think vic's.