Can we ask for interventions to be withdrawn

[Debbie Ann C]

Mum is currently in hospital having broken her hip. She was in hospital 4 months ago with the other hip. Since then she has deteriorated rapidly and is reliant on care staff to anticipate all her needs. she spends her days (and nights) in a constant agitated, confused and depressed state. she has no quality of life left… We have completed an Advance care plan requesting no invasive treatment or admission 5 hospital unless a fracture is suspected hic hit was so we have little choice. She has had the operation and is now on drip, oxygen & antibiotics for a chest infection. This, I guess is keeping her alive… this next bit is hard to ask but i know there are many of you who have /are in similar situations. Can we withdraw this intervention? And would this enable mum to pass away as she has wanted to do for a very long time,
Thank you for your understanding

 

[Chaplin]

I’m sorry you find yourselves in this situation. I think you need to have a very honest discussion with her doctors. That’s what we did when mum was last admitted to hospital after numerous falls in her care home. The hospital finally admitted they would only do observations on mum which could be done in her nursing home, by the nursing staff.
When she had one bad fall and hit her head again, one of the staff called a Paramedic to check her over who wanted her to go to hospital. They phoned me and asked my opinion and I explained previous conversations at the hospital. Thankfully they left mum where she was. They said they might of scanned her head for a bleed but due to her frailty would unlikely treat anything found!
I do understand the doctors position and after all their role is to make people better, but, sometimes it’s kinder to let people slip away peacefully which is what finally happened to my mum just before Christmas.
Ask the doctors what the plan is if there is no improvement from the antibiotics. Explain your mum’s wishes, you have to advocate for her.

 

[Kevinl]

You can be asked or agree to stopping medical intervention, get a DNR (do not resuitate ) but the medical profession has to go with wheres theres life theres hope.
K

 

[Dirge]

I managed to get the GP to withdraw certain interventions for my mother by quoting the Mental Health Act etc just to show that I had fully researched the decision that had been taken. That being said the medical profession has the final say so I don't think I'd suggested anything that wasn't already under consideration.

 

[Chizz]

Hi @Debbie Ann C
The Dr's first objective is try and preserve life, then to "do no harm" but they will note what the nearest relatives want or request, but without an Advance Directive (living Will) that covers the circumstances as they arise or without a LPoA H&W, it is ultimately the Dr's decision supposedly in the best interests of the patient.

When my FiL was in hospital with sepsis following a burst stomach ulcer, in his mid 80's, the Dr said he didn't think he was strong enough for a long operation, the anaesthetic dosage required, but would do what they could. FiL survived the operation, but in intensive care it became clear he would probably not regain consciousness, and, thankfully for his 3 daughters, he was allowed to drift away peacefully unconscious - it took a matter of a few hours.

Similarly, when my mum, in her mid 80's, was in hospital after a bad fall, she decided that she'd had enough. She was a widow, in pain, with several co-morbities. She couldn't see a pleasant future for herself at all. She said she wasn't going to eat anything - she told the nurses, the dr and all the family. The dr agreed not to force feed her via tubes, but said he was obliged to keep up her liquids. Mum just kept pulling out the tubes from her cannula. After some days of this, the dr agreed he'd just administer and monitor her pain killers, morphine, etc. Her EoL surprisingly lasted about 2 weeks or just over. It was v painful for us to witness, but should she have been forced to live (if you call that living)?

In both cases it became a question. as with all old patients, value for effort versus outcomes. Saved the system a lot of time trouble money manpower etc.

Best wishes. Argue for what you think would be best in your mum's interest bearing in mind she can't decided herself.

 

[Palerider]

Mum is currently in hospital having broken her hip. She was in hospital 4 months ago with the other hip. Since then she has deteriorated rapidly and is reliant on care staff to anticipate all her needs. she spends her days (and nights) in a constant agitated, confused and depressed state. she has no quality of life left… We have completed an Advance care plan requesting no invasive treatment or admission 5 hospital unless a fracture is suspected hic hit was so we have little choice. She has had the operation and is now on drip, oxygen & antibiotics for a chest infection. This, I guess is keeping her alive… this next bit is hard to ask but i know there are many of you who have /are in similar situations. Can we withdraw this intervention? And would this enable mum to pass away as she has wanted to do for a very long time,
Thank you for your understanding

I've read your comments and also the rest of this thread. I think from my own experience it seems your mum is on the maximum treatment (ceiling of care) they would give anyway given the stage she is at. I don't think stopping antibiotics would be in her best interests purely from the extra burden an infection may cause her but equally it sounds that your thoughts / viewpoints are valid ones given your mums situation as it is now. I have gone through a similar approach with my mum. I think you do have to be present and verbal with the overseeing medical / surgical team in how far they should go and it is worth discussing current and future possibilities which includes future treatment / interventions.

At Christmas my mum was admitted after a fall, luckily I was able to speak to the consultant directly in the A&E department at the time due to a new approach by the hospital. I asked the consultant if my mum did have a significant head injury would he given my mums condition do anything about it -the answer was no, it would not be in her best interests as she is now. There comes a point when even medical / surgical teams have to be realistic and see the person in their own context rather than that of the hospital context, if you see what I mean -sometimes we carers have to prompt the professionals to think more laterally.

 

[Debbie Ann C]

Thank you everyone for sharing your thoughts, it is so much appreciated. This morning the drs advised with our agreement that the best cause of action now was palliative care only and have withdrawn all drips, monitoring and antibiotics. Mum has been left to rest in peace I guess it now up t9 her what happens next.

 

[Chaplin]

That sounds like a sensible approach for your mum. Take the next few days to remind her of how loved she is and tell her all those important things you need her to hear.

I’m sure they will keep her comfortable so be kind to yourself too, sadly none of us know how long this next phase will take so get plenty of rest.

I hope she has a peaceful passing. Take care,

 

[Chizz]

That sounds like a sensible approach for your mum. Take the next few days to remind her of how loved she is and tell her all those important things you need her to hear.

I’m sure they will keep her comfortable so be kind to yourself too, sadly none of us know how long this next phase will take so get plenty of rest.

I hope she has a peaceful passing. Take care,

Well put @Chaplin

Glad @Debbie Ann C that a sensible and humane approach has been taken, Wishing you strength in the coming days.

 

[Lawson58]

Hi @Debbie Ann C
The Dr's first objective is try and preserve life, then to "do no harm" but they will note what the nearest relatives want or request, but without an Advance Directive (living Will) that covers the circumstances as they arise or without a LPoA H&W, it is ultimately the Dr's decision supposedly in the best interests of the patient.

When my FiL was in hospital with sepsis following a burst stomach ulcer, in his mid 80's, the Dr said he didn't think he was strong enough for a long operation, the anaesthetic dosage required, but would do what they could. FiL survived the operation, but in intensive care it became clear he would probably not regain consciousness, and, thankfully for his 3 daughters, he was allowed to drift away peacefully unconscious - it took a matter of a few hours.

Similarly, when my mum, in her mid 80's, was in hospital after a bad fall, she decided that she'd had enough. She was a widow, in pain, with several co-morbities. She couldn't see a pleasant future for herself at all. She said she wasn't going to eat anything - she told the nurses, the dr and all the family. The dr agreed not to force feed her via tubes, but said he was obliged to keep up her liquids. Mum just kept pulling out the tubes from her cannula. After some days of this, the dr agreed he'd just administer and monitor her pain killers, morphine, etc. Her EoL surprisingly lasted about 2 weeks or just over. It was v painful for us to witness, but should she have been forced to live (if you call that living)?

In both cases it became a question. as with all old patients, value for effort versus outcomes. Saved the system a lot of time trouble money manpower etc.

Best wishes. Argue for what you think would be best in your mum's interest bearing in mind she can't decided herself.

And this should be a timely reminder for us all to get those Advanced Care Directives in place, not just for ourselves but for our families who are going to be faced with dilemmas like that of @Debbie Ann C.

It all sounds a scary thing to do but it isn’t. Just be brave, take the plunge and do it.

 

[Hartwick]

Mum is currently in hospital having broken her hip. She was in hospital 4 months ago with the other hip. Since then she has deteriorated rapidly and is reliant on care staff to anticipate all her needs. she spends her days (and nights) in a constant agitated, confused and depressed state. she has no quality of life left… We have completed an Advance care plan requesting no invasive treatment or admission 5 hospital unless a fracture is suspected hic hit was so we have little choice. She has had the operation and is now on drip, oxygen & antibiotics for a chest infection. This, I guess is keeping her alive… this next bit is hard to ask but i know there are many of you who have /are in similar situations. Can we withdraw this intervention? And would this enable mum to pass away as she has wanted to do for a very long time,
Thank you for your understanding

I perfectly understand mum has vascular dementia and I know compared to the person she was to now it’s like she’s passed away but is still here if that makes sense she always use to say don’t let me get like that help me go to sleep so I wish she would close her eyes there’s no quality of life. Until you are in this situation people shouldn’t judge. Take care .