Fear of meds

I can relate; so frustrating. I had a patient who was dying of pancreatic cancer and had a family member who called, screaming and ranting, saying he was a pharmacist and didn't want his relative to have any opioid pain medications, and tried to force us to take him off fentanyl and switch to toradol of all things. There was some sort of power of attorney involved, even though the patient seemed a&o. Anyway, the ethics team got involved. Poor patient was diagnosed extremely late and likely had days to weeks left. These situations frustrate me beyond belief. 😩

It is important to remember that no power of attorney has the ability to deny pain medicine and comfort measures to a patient, even if they have full authority to make all medical decisions on that patient's behalf. Every state expressly excludes the authority to withhold pain medication and comfort measures from the authority of a POA. If a health care provider believes that a POA is not making decisions in the best interest of the patient, they are obligated to seek assistance from APS.

Of course, in most situations, it is more effective to educate the family. But I can recall several situations where we had to get APS involved. I agree, they are very sad and difficult.

We have all probably had patients with similar circumstances. I am direct with the family. I don't sugar coat diddly when they have those sort of attitudes. I ask them questions...like; do you think your dying husband is going to go out and rob gas stations to keep himself flush with Morphine? Do you thik it is bad for someone to be "addicted" to insulin or digoxin? Are you so afraid of "addiction" that you would rather that your husband suffer physically and emotionally while he dies just to keep you comfortable? Is your fear of addiction more important than your dying husbands comfort in his last days? I don't ask them with a "mean" or angry tone...just direct and firm. It is shocking for family members to be questioned in that way and most don't appreciate it. In my experience, however, it frequently results in a change of plan on the part of the family member.

If the patient is able to indicate THEIR wishes I follow their lead. When the patient caregiver is not willing to provide the medications for comfort that the patient desires to have then we make other arrangements, perhaps a continuous infusion. I have reported caregivers to APS when they are directly causing the pain and suffering of a hospice patient who has indicated other preferences.