How can we trust our palliative care team?


I have been reading this thread in the forum:
and it seems that many people believe that the medications palliative care teams or hospice hastened the death of their loved ones when they were unwell.
I personally thought that at first that my mum died from the morphine pump, she died two days after starting on the medication.
My mum didn't sleep properly for a month and she was very agitated and had lots of pain taking so many tablets including opioid tablets Tapentadol and she kept complaining about pain. The palliative care team finally came to assess her pain. I just wanted them to know if she was in real pain or she was just exaggerating. How could she still have pain with all the tablets she was taking? He then proceeded to explore her, my mum was screaming with pain and the doctor asked her a few questions and he instructed the nurse to place the pump with the medication on my mum. He then explained they are using the pump with the equivalent of what she was taking already and if she felt comfortable with the dose she will be given the medication in tablet form . I was happy with that and I trusted them 100%. The second day she was very sleepy and I called the palliative care team to ask if it was normal and they said to just keep her awake, otherwise she would not sleep at night time, but they never showed any concern. She died in the evening.
I made an appointment with the palliative care doctor because of my doubts with the medication and he explained that my mum had other important health issues such as heart disease and kidney problems, and that is why she died. He said that the medication they gave her was to control the pain and it is normal at first that they appear very tired and sleepy, so that wouldn't have been a cause for concern. He was very thorough with the explanations and when I left his office I felt a lot better because I couldn't stop thinking that the medication was the cause of her death.
Then I read that thread in the forum and my doubts returned. Surely if their intention was to hasten people's death something would have been done about it by now, they couldn't go around speeding up the dying process.
What do you think?

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I think that maybe the reason that some people feel that Hospice hastened the death of someone they knew is that many people want until they are at death's door to call Hospice in. I also know people who outlived their Hospice stay and other people, not even in Hospice, who had a rapid decline and passed away within forty eight hours. The doctors that I've talked to with Hospice or Palliative Care, say that pain control is a delicate thing because elderly people are so sensitive to it, and finding pain medicine that will not cause them to fall or cause hallucinations and mental problems is very difficult. It's hard to predict what effect it has on someone who already has multiple health problems. Usually they start out on a mild dose, but with extreme pain, they may have felt that they didn't have that option.
The difficult thing with palliative care is to figure out what is necessary and will enhance their life, compared with what may cause more distress and really not do any good. There's no pat answers and you have to do the best that you can, and make sure that the doctor understands when you feel a treatment would be beneficial for their comfort level.
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Hospice is a big time money-maker. There's absolutely no reason to hasten one's life under hospice care. So many emotions go into play when it come to end of life care. It's hard on everyone, including the doctors and nurses managing the patient's care. It's perfectly normal to question the what ifs. However, if you're mother was still alive today and under hospice care, what would her quality of life be? Suffering from whatever condition really takes a toll on the patient. I only speak for myself: I don't want to drag out my mother's suffering. It's simply not fair to her. I don't believe she should have to suffer to the point her body is worn-out. Enough's enough - for her. Again, I'm speaking only for myself: It's cruel and inhumane for me to see my mother in a prolonged state of pain. It's just not worth it.
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I've seen the thread you're referring to along with other threads questioning hospice and the use of morphine. I've never read the main thread on the subject as largely I think it's driven by misconceptions and individuals struggling with their own grief.

Both my parents had hospice care. My father started with palliative care but was moved to hospice care after a couple of weeks - a combined total of about two months. My mom was on hospice care slightly over six months and had been examined and approved for additional care past the usual six months when she passed.

So - I've more or less seen the long and short of it where hospice care is involved. With my dad I did think the hospice team was a little heavy handed with the morphine and Ativan but when it came down to it, it was family and our hired caregivers who gave daddy the drugs so we could have cut back any time we might have wanted to. The problem was that without the drugs my dad would get very anxious - struggling to breath and as excruciating as that was for me to see, it must have been a thousand times worse for my dad - so yes, we gave my dad all the morphine and Ativan he needed to be comfortable. My mothers experience with the end of life process was much more gentle and the drugs were used more sparingly.

In both cases I was - in the end and after - grateful for hospice and the care they gave both my parents - and the concern they showed my brother and me. I do not, in any way believe hospice shortened my parents lives. In addition - I tend to be a bit of an over thinker - I have considered my parents hospice care in a logical, black and white way - just so I could rest easy with the choices I made for my parents. Bottom line - cutting through all the emotional crap that can cloud the issue - it makes no logical sense for hospice to hasten death. Hospice is paid for treating patients while they are still alive.
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star68, I am sorry to hear about your mom. By definition, palliative care is for people with serious, persistent diseases. Palliative care does not cure, it comforts. It sounds to me, your mom may have been more appropriate for hospice care rather than palliative care but that call isn't clear cut and there is no one out there who can tell you when someone will die. Palliative care is a very important facet of end of life care and does not hasten the dying process.
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The thread you quote is very inappropriate, imo. It bothers me that it unnecessarily distresses people.

Please accept my condolences on the loss of your mother. It sounds like you obtained her help for her pain through her dying process.
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I don't think they speed up the death process.
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