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Tgalbraith Asked June 2017

Did my father-in-law lose his right to refuse the morphine with hospice?

My father-in-law just passed away on the 17th of June 2017. He went in to detox from alcohol and was sent to the hospital. After tests they said his cancer had came back and had spread from lungs to liver it now was stage 4 also he had a tumor in his sternum. He chose hospice and went home with that. Now mind you he didn't leave the hospital with them implanting a tumor. Doctor said he had 6mo to a yr. We were all called to come see him and told he is ill given brief information. Upon going his "wife" tells us that hospice said that morphine should be given for comfort and to aid in his breathing to help him not to cough so the tumor doesn't explode killing him. But, that once the morphine is started he'll most likely pass within 48hrs. He was alert and had told my husband he was waiting on a call from the doctor to see if the tumor could be removed. His "wife" however had his phone and wouldn't let him have access to it. She wasn't feeding him anything except ensure and adavan and morphine in the last 2days of the 4 he was on hospice. Anytime he'd wake up, she'd be in there giving him morphine even though he said he wasn't in pain and didn't want it. She told him it was couch medicine to manipulate the situation. Everytime he'd wake she would say, do you know who I am, your kids are here did you know that, do you know where you are? He'd say have you lost your mind? Why do you keep asking me this stuff? Finally nearing the end of the 2nd day he was very tired but far from out of it mind wise. Around 8pm his step daughter administered morphine to him and said he'd sleep the rest of the night. She left to go out to the movies. His "wife" who stayed under the influence of alcohol was acting funny all day. Upon hospice coming around 3pm and taking supplies from the home (which was odd) as they were delivered that day. Can't tell me she didn't smell the alcohol and notice the wifes lack of focus. Yet did not report it. Around 9:15-9:30pm my father inlaw asked for cough medicine and his "wife" tried giving him MORE morphine. He pulled his head away saying no I don't want that now damn it, what is that? I said I wanted cough medicine. She said just open your mouth, lift up your tongue. She was attempting to force it in his mouth. My husband said, he said NO. Finally she said, its just cough medicine. He said, well I just don't want anymore of that damn morphine. And he took it. We said our goodbyes told him we would be back in a few weeks. He said he'd work on eating and getting strength and he'd be there. Said he loved us. We left Tennessee drove back to illinois and no sooner than we got unpacked and settled in, we got a call he was dead. I find it hard to believe he had 6mo to a 1yr one min and upon taking anxiety meds and morphine and us being told it was for his lungs and would most likely kill him within 48hrs because he was "that bad". We saw him, I am telling you, something isn't right . He may not of lived 6mo but he should NOT of died when he did. With hospice did he lose his right to refuse the morphine? Was it meant to kill him? And if it was meant to "help him" why did it not start from day 1 of hospice as his cond. Was no different from day 1 to day end except maybe sleepy due to the morphine. I feel like it was meant to be an involuntary human euthanization. And we called the police after he died and they would do nothing saying hospice was involved it was a planned death. My father-in-law took hospice thinking it was a nurse who would come help at home. His wife told police he was out of his mind, so did hospice. The whole family can say otherwise as can others who visited. Only those who stand to be in trouble say otherwise. The moment he passed the stepdaughter asked me over the phone when will we beable to come help clean out the house of personal belongings such as pictures etc. They are wanting everything out. Then said well, not a big rush per say but..HE JUST DIED his body was right in front of her SERIOUSLY? We believe there was foul play involved. Most are saying and its getting frustrating and its not the point, "he was going to die eventually". My husband makes a good point. Since someone wants to play God, everyone will die SOMEDAY so why not just lethally inject whom ever because everyone will die SOMEDAY. We want answers period and accountability. Anyone can have paperwork "in order". Just like crooked cops there are nurses willing to do the same for reasons only they know. My father inlaws wife and daughter stood to gain from his death. He said himself, I'm worth more dead than alive. And he joked at one point and said to sell the morphine. She replied, "this batch was made up special just for you Jim for this, theres only enough to go to the cause for the full effect". WHAT?? Its all just, it sounds like the intent was there yet nobody seems to care because be had hospice and was gonna die anyway so we are to just get over it.

Countrymouse Jun 2017
I'm very sorry for your loss, and for your understandable anxieties about what might have happened.

I'm sure there will be a system for requesting a review of your FIL's care under hospice; and although I don't know I would expect the hospice provider to be able to tell you what it is. If you want to do that, approach them courteously and without levelling accusations: the point is to find out exactly what happened, and ensure that your husband and his family received a satisfactory explanation of what treatment was given and what the medical/nursing/palliative care reasons for it were. If you are convinced, however, that the system is engaged in a conspiratorial cover-up, then perhaps you could seek legal advice on asking for an independent post-mortem.

There is one important point that based on your post I think you may have overlooked; and that is to do with your FIL's state of mind. This isn't a matter of shrugging and saying what the heck the poor old boy was on his last legs anyway: I happen to oppose euthanasia myself, and agree with you about respecting the wishes of a terminal patient.

But you say your FIL was talkative, upbeat, looking forward. I am very glad that he spent his last days pain-free and feeling positive - that's what the drugs are for, to relieve suffering. Better that, than your husband having to witness the dreadful pain and terror of respiratory distress, liver failure and - possibly? - further fall-out from the previous problems with alcohol withdrawal.

What I'm saying is, that there are questions to be asked about how ill your FIL was exactly, and what the immediate cause of his death was. Those are fair and reasonable questions, and I hope the answers will bring your husband and his family peace of mind.

But I don't think you can form any reliable conclusions based on FIL's mood or anything he himself said, both because he was extremely ill (secondary cancer and tumours in one place can often mean tumours in another - you can't rule out brain involvement, for example) and also because he was essentially as high as a kite. In a good way, that is - a way that protected him from suffering.

By the way, my ex-husband - who will be with us for many decades to come, God willing - has to take morphine regularly because of a chronic neurological condition that forced his early retirement. On the occasions when I need to ring him, I can always tell if he's had his medication within the last hour - he was never before the chattiest of men, but while it's kicking in you can't get a word in edgeways. Perfectly lucid, just incredibly garrulous.

You are also placing a great emphasis on the one doctor who said/mentioned/betted/estimated when pressed to do so: "six months to a year." Well, that period just happens to coincide with hospice's admission criteria, doesn't it? - so what was the context of this statement being made, a prognosis of your FIL's illness or an explanation of hospice care? And who was this doctor? And who was he talking to at the time? Your husband's worries over this provide a very good illustration of why most doctors flatly refuse to answer families' questions about how long their loved ones have to live - for fear that their best guess will later be treated as gospel, set in stone.

For you yourself, think carefully about how you can best support your husband. There are many factors at play here: bereavement, of course; but there is also hostility to your late FIL's partner and her daughter; disapproval of their lifestyle and behaviour; and bewilderment over the apparent suddenness of FIL's death, leading to anxieties over what may have occurred.

Well. What is going to be the best outcome for your husband when you look back on this? He needs time to process what has happened, and I'm not suggesting you should contradict or oppose him. But surely coming to terms, in time and with support, with the medical realities of your FIL's illness and death is going to do your husband more good than getting embroiled in accusations of murder and conspiracy.

Countrymouse Jun 2017
What do you suppose caused the leg edema and cellulitis? These are often symptoms of end stage heart and/or kidney failure. I'm puzzled by the apparent contradiction of his having health issues which you accept drastically limited his life expectancy but then saying that his "vitals" were all excellent. What vitals?

And nothing you could do - well, if you didn't understand why your SIL was chasing up further doses of medication you could have asked her to explain, could you not?

In any case I'm sorry for your loss of your brother. I just can't see how presuming that your brother's "wife", as you put it, must have undergone a radical transformation into a mercenary she-devil is either the most plausible explanation or of any comfort to you at all.

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jeannegibbs Jun 2017
I'm so sorry for what you and your husband have gone through.

Who is this "wife"? Were they legally married?

As the others have said, the comfort kit does not contain enough morphine to be lethal. And it can be given for other reasons than pain -- for example, to aid breathing.

An oncologist said my father had 3 to 5 days to live. Dad died on day 3. A hospitalist expected my mom to die within the week. She lived two more years. Hospice thought my husband had a few months left. He died after 5 weeks. NO ONE can say with certainty when someone will die. When pushed, medical professionals will give a general prognosis which represents about how long most people with those particular conditions would last.

It is not against the law to drink while your husband or partner is dying.

It is so good that the family was called in when they were, and did not wait for "6 months." Having seen my best friend's husband die of cancer, I think I would prefer for it to happen quickly rather than be drawn out. Not that we really have choices, of course, but if it happened quickly, I think I'd be glad.

Your father died of stage 4 cancer (with perhaps some other co-morbidities). Hospice did not cause his death, nor were his partner or her daughter the cause of his death.

I'm sure his death was extremely sad for you, especially since you had seen him that day. Try not to make it worse for yourself by imagining implausible scenarios. Be gentle with yourself.

Wittm1 Jun 2017
In my case I removed my mother from rehab because I had become convinced her body was giving out and wanted to be let go. Rehab felt they could still work with her and she would see improvement. I took her home as I wanted to follow what I believe her body was telling us, not what others wanted to believe.

I asked the hospice nurse what she thought my mother's longevity would be, and she tried not to answer. So I asked if she had, had a patient with very similar medical issues and in my mother's current condition. She currently had a patient that mirrored my mother's situation. She had been caring for her for well over a year.

I prepared to have my mother possibly with me for as long as two more years. In spite of the rehab professionals and the hospice nurse indications, Momma was gone in three weeks. The hospice nurse said she was "stunned" by the swiftness of my mother's passing. I gave Momma her meds, including the morphine and I did not give more than was prescribed.

Please, your family is suffering enough. There is so much that is unknown here that could explain both his upbeat mood (relief provided by the drugs) and his passing more quickly than anticipated. When we suffer such a loss we look for explanations - reasons that bad things happen. That can color our perception of everything. But sometimes there is no where to place blame.

Caregiving 24/7 is very stressful and an emotional experience. Have you tried opening your heart, pushing the anger and suspicion aside, and putting yourself in the wife's shoes? Can you find reasonable explanations for the things she did or said? Here is an example; someone could say about you; "they visited, saw her forcing drugs upon him and just left him there, defenseless. They sure didn't care about him." That is what someone saw, so it must be true, right? But it is absolutely WRONG. So try to look at things from her perspective and see if there are reasonable explanations. Previous posts have outlined a number of reasons certain things done or said could be explained as completely innocent.

You are all suffering, so before you escalate the suffering consider all possibilities. Make sure there is no other explanation for how things were handled. If you see no other plausible scenario than wrong doing, start looking into things by contacting the hospice. Be non-accusatory and non-confrontational.

BritChris Jun 2017
My husband passed away on May 1 this year. He was under hospice care for 5 1/2 months and used liquid morphine to control pain for the last two months. He had Parkinson's disease and Lewy Body Dementia. The hospice supplied me with enough morphine but there was never pressure to increase the dosage. I could have ended it faster for him and I think hospice would have said nothing. Yet I had to live with myself. My stepson indicated to me that he thought I should give his father a huge dose of morphine but he wasn't the one controlling it. It's a very difficult scenario and I think it plays out differently for each person. I was the caregiver and my stepsons took no part in my husband's care. Same stepson wanted me to put his father in a nursing home too. Until you are the caregiver you do not know how you would react. I knew my husband wanted an early death but I was unable to grant that wish as I couldn't live with it afterwards. Your FIL could refuse morphine any time and hospice would not force it. There is some thinking that pain med should be taken in a timely way whether you feel you need it or not so that the pain does not become overwhelming and harder to control. It is conceivable that the "wife" was operating under that premise.

jeannegibbs Jun 2017
I'm reading a very interesting book right now, by a doctor. In a study that compared doctor's life expectancy prognosis with actual time the patients lived found that 67% overestimated the time their patients had left. The average estimate was 530% too high. In other words, an estimate of 24 weeks on average turned out to be under 5 weeks. Just something to keep in mind.

The morning my husband died, on hospice, he was quite lucid. In fact, he had been more coherent than usual for a week or so. He wasn't eating much. Hospice advised me to provide food if he wanted it. That morning he ate his favorite breakfast. Someone visiting him that day might have been shocked to hear he died that night.

What the doctor predicts and how the patient behaves isn't always a good indication of when they are ready to die.

Midkid58 Jun 2017
I already piped in here, but I do want to add that my FIL was lucid, eating and talking to us the night before he died. We went home from the hospital making plans to move him to a rehab center while we looked for more permanent care.
Within 12 hours we were called back to the hospital and he passed within the hour. He was not on Hospice. He was under his dr's care.

My SIL and DIL are both drs. I am often surprised by how LITTLE they actually know. Going to school for 16 years just gets you very well educated--it doesn't make you able to tell the future.

Also, your father was an alcoholic also, right? Sounds like he and MIL had problems. I am very sorry your FIL passed under such circumstances, but it sounds like your MIL was overwhelmed and perhaps under-trained. Drinking to ease her "stress" would have been her "normal" go to under this difficult time. I'd go kind of easy on her. Just grieve and try to be gracious to the "steps" in the family. In the long run, keeping relationships calm is far better than a brawl at the funeral.

mar126 Jun 2017
Your husband should call the hospice organization and ask to speak to the social worker or chaplain who was assigned to your FIL's case. Hospice should provide counseling for family members and I think they could provide your husband with more information.

Veronica91 Jun 2017
This is a big case of "would " have "should " have, "could" have.
Nothing can be changed now. FIL is dead and he passed in reasonable comfort being cared for by professionals.
In a hospital only hospital nurses can administer drugs and have to follow dr's prescriptions to the letter. FIL had every right to refuse any or all treatment.
Dr's are notoriously bad at predicting length of life. which is partly because they see the loss of a patient as a reflection on their treatment, lack of experiencing closely the stages of dying. An experienced hospice nurse is better able to predict the time a patient has left. It is a matter of experience and intuition and the patient's own willpower. Some people waiting for an important event such as the birth of a grand child or the arrival of a loved one seem able to make themselves live for that event.
Don't blame FIL's partner for being inebriated, both of them were alcoholics and that was the only way she could cope.
As for wanting Fil's belongings out of the house this is another way some people cope. it is not always the best way but however it is done it is never easy. You do not know and can't know the inside workings of this relationship so FIL's death may have been a huge burden lifted for the partner and her daughter,so cut them some slack. Get it over with then you don't need to deal with them again.
I am sorry you have lost a member of your family but whatever his hopes and wishes were he was terminally ill and facing an unpleasant death

MaryKathleen Jun 2017
My heart goes out to you and your family. He was in extremely poor health, an Alcoholic, with metastasized cancer all over his body. If it was in his sternum it probably was in other bones. That can be extremely painful.

I have found in my 83 years that doctor's can't predict how long a person will live. I always cut the time they say in at least half. If they say 6 months, I mentally think 3 at most.

My daddy wanted to die at home, so they stayed at my house, me taking care of him in the daytime and mom at night. My mother wanted all his stuff out of the house before she went back to it. That was how she coped with his death. When you think about it, why put it off. Get his stuff out of the house before it just disappears. Who owns the house? Perhaps his wife and daughter can't afford it anymore and they have to move.

I strongly urge you to get some grief counseling. Hospice can provide that. Call them.

My poor daddy died by inches, it took a long time. I just lost a very good friend the same way. I am so happy your loved one went quick and didn't just go inch at a time like my Daddy and Vinnie did.

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