Ailing mother in law/end of life decisions

I hope I don't come across wrongly here, my heart does go out to you and your close family.
If it was my family.... I think we'd have a gentle family meeting, are there enough close family to have a balanced discussion. FIL wants to hope with full optimism.
Perhaps if everyone could get their emotions and views discussed with calm and understanding and hear how each other feel.

Perhaps this has already been done.
Has anyone said to FIL that MIL is not as strong as he thinks.

Last year my mother was in a situation where her quality of life was very poor. She was 98 and had had a good and active life until everything seemed to deteriorate in the previous two years. She had always been very independent but finally had to succumb to going into a care home after a hospital stay after having a stroke. She went down hill from that point and in the end her doctor rang me and asked me if I would consider putting her on the 'Liverpool Pathway' which is end of life care. We did that and I somehow felt relived that she wouldn't be in pain for very much longer. She died two days later being cared for by lovely staff at the home. We felt that we did the very best possible for her and that it was the way she would have chosen for herself. I am sure you will come to the right decision for your MiL. I wish you well. I know it isn't an easy decision.

As your MIL seems to know her own mind, Kate, I'm not sure that the family can make decisions on her behalf, especially with regard to DNR, even though they obviously have her best interests at heart.

Poor lady. I think if she wants to hang on to life as long as possible, then that is her decision and no-one else should try to make it for her.

to you all.

She doesn't have a DNR in place...staff are starting to gently mention that perhaps she has to look at making some decisions but she won't hear of it.

If DNAR is being suggested, I would leave that to the hospital staff to deal with and not volunteer to raise this with your MiL yourselves; it's not surprising really is it that she doesn't want to entertain the idea - that tends to come when someone has simply had enough and maybe she's not at that point. To 'encourage' her to go along with it may leave you with the feeling 'did we do the right thing'.

I think your family should sit and chat privately with qualified medical people who will be able to fully inform you of what is happening and what choices are available - this may also help your FiL accept that his wife's condition is quite bad. Does the hospital have a patient counsellor you could speak to?

It must be a very difficult situation and I do hope that you can all reach a decision that is comfortable for everyone concerned.

The decision rests with your MiL and her physicians.

The hospital staff will tell your FiL and your MiL exactly what the situation is. We've just been through this with a much younger (65) family member. Both she and her husband thought she could be 'cured' and would return home.

They were both shocked when they were told that only palliative care was possible, but in the week from this diagnosis to her death, both eventually accepted the verdict, hard through it was.

I would echo letting the hospital staff do the talking - any input you had could end in recriminations after.

What a horrid situation for you all to be in

Katek, it must be so very hard for you to be watching this, whilst knowing in your heart of hearts that this dear old lady is fading fast. I think you can really only let the medical experts take charge...and back them up when they make suggestions as best you can. This is a horrid situation for you and I really sympathise. This over medicalization of what is, in effect, dying which is a purely natural and inevitable event is causing so many problems and dilemmas for the surviving relatives.
I think we all need to work a little harder at educating each other that at some time, and we all hope its later and after a full and delightful life, we will have to say goodbye.

I am sorry I have no real advise for you, I just know exactly what you are going through and send you my sympathies and best wishes.

This is a very poignant thread for me today. My dear son in law who lives in New Zealand discovered just a few weeks ago that his mother had cancer. He flew home and having had frank discussions with family members and medical staff it was agreed by everyone that because the cancer was so advanced that only the symptoms would be treated. (My son in law is a very experienced nurse.) He returned to NZ two weeks ago after having made arrangements for his mother's pain relief and for cancer care nurses to help his father take care of her and then he booked flights to come home this Friday hoping that he and my daughter would be in time to see her to say a last goodbye. Sadly I've just learned that his mother died at about 9 o'clock this morning. I'm sure their journey home will be overwhelmingly sad, but at least my daughter and son in law have the comfort of knowing that she had time to plan her funeral.

I think it's helpful for these decisions to be discussed well in advance of them needing to be acted upon. Katek I suspect it's too late now to do anything other than leave it in the hands of the 'principal players' - your mother and father in law.

Poor lady, how sad. I wouldn't want to live like that. And what a difficult decision for the family. Every sympathy.

I think jing is right- life is sweet and we want to hang on and to hang on to our loved ones but we don't want them to suffer. All you can do is talk together, love each other and be kind to each other. I'm sorry for this sad time you are having. When her time is right, it will come and until then I hope she is kept comfortable.

Many thoughtful words by other posters and I have to agree, the medical staff will talk to your MIL and FIL and you can only support them with this.

My thoughts are with you Katek.

Katek

My best wishes to you and your family Katek. Make sure you get the support you can from those involved with your MIL's care. It's a very difficult time for families as it's sometimes hard to know if you are making the right decisions.

Thank you all so much for your wise and comforting words. Things have taken a downturn this evening...MIL has been moved to high dependency unit and doc has suggested that she stops even the partial dialysis she's been receiving. She won't hear of it and medics are still actively treating her. It's dreadful....she's now convinced that she's going to die this instant, and that there's no point in phoning the family as we wouldn't get there in time. This hasn't happened of course but her passing is indeed very imminent. Meanwhile FIL is still talking about getting her home at weekend and making plans. All we can do now is wait.

Thank you for taking the time to reply to me. x

What a painful situation for you, Katek. I know from my own recent experiences that whatever end of life plans have been put in place they sometimes go haywire. All the family can do is try to be there for her and support one another. Your FIL sounds like he's going to need a lot of support.

The end will come and it will be sad but it will also be a relief that her suffering has ended.

Katek....I do sort of understand a little of the way your FIL is thinking. When my Mum was in a hospice and in her last few days, part of me could not accept that she was dying. It was almost an emotional blind spot.....of course deep down I knew she was not coming home, I just could not fully accept what was really happening.

His denial is probably a self preservation act and all you can do is listen to him, be with him and when the inevitable happens help him grieve and hopefully he will eventually accept that she has been through enough and is now at peace.

All the best.

Katek it is such a sad time for all- you just have to be there when the time comes. As somebody mentioned, your F in L will need a lot of support as he is not accepting the true situation.

Such a distressing situation for you Katek this is truly one of the great challenges of life. I am so grateful for your words Sherish. I was struggling today, even though my mother died on the Liverpool Pathway three years ago. But your words are so calming and reassuring I feel comforted with the decision I took that day. Thank you to all who post. You never know what good you may do. And to Katek, thinking of you.

The Liverpool Care Pathway has been withdrawn due to misuse in some hospitals. It was a very good tool and while I was nursing in a dementia unit we often used it. While your MiL has mental capacity, she is the one who has to make the decision about a DNR. It is a very difficult decision for some people. Life is precious and very difficult to let go of. I feel very sorry for all your family at this difficult time.

We have been called to a case review tomorrow afternoon. MIL is refusing food, drink, dialysis and medication and hospital has asked my FIL to sign over her care to them. I don't know if this indicates that despite her mental acuity they feel she is psychologically unwell and no longer making appropriate decisions, as surely my FIL cannot sign over her care as long as she's in full possession of her faculties?? Am I making sense?? They are still prepared to treat her and GD (who is a district nurse) feels she is committing suicide whilst simultaneously saying she's not ready to die. I'm very confused. Part of the problem for us is also that we live 150 miles away and are having difficulty determining when it's appropriate to go down.

My mother refused food and drink towards the end, Katek. I think it was partly because she had given up but partly because she was finding it painful to swallow.

Good luck with the case review tomorrow. Hopefully you will be able to have all your questions answered so you can all be in agreement over your MIL's end of life care.

Good luck tomorrow, Katek. My husband refused to eat and drink towards the end of his life. It's actually very brave of them. She appears to be saying she has had enough. He was told by the GP that if he changed his mind all he had to do was ask, but he never did.
It's actually the only choice they can have towards the end of their lives. She has taken control.

I agree. I hope your FIL can understand that it's his wife's choice, KateK and I know he'll have so much support from the family. Such a hard time for you all.