I actually had to make this exact decision for a parent in almost the exact same situation. It's really hard when the parent has comorbidities that cause suffering like a UTI.

First time they had a UTI that went septic, I did IV antibiotics. Made that choice because it seemed at the time that it would cause less suffering.

Second time, I did not. Basically, the previous hospital stay for sepsis caused their condition to deteriorate and I decided no more hospitals, etc. I wanted a calm, supported passing. To do IV antibiotics again, I would have had to take them off hospice (oral was fine on hospice at my discretion).

Well, it didn't exactly go that way.

I had to push very hard to get the pain meds where they needed to be. Parent had a high tolerance to opioids. I familiarized myself with signs of pain in nonverbal patients. I had to basically sit there for the full time it took them to pass (4 days) making sure meds were administered at the first sign of a grimace (this was in a memory care place -- they were asleep/nonverbal). This was with a top rated memory care/top rated hospice.

I just want to say, these answers aren't easy. They are hard. Sometimes you make the wrong ones because you are doing the best you can. The parent may have made a boilerplate advanced directive and never talked to you about it or what they truly wanted. Of course, no CPR is clear cut. But other stuff is more of a gray area. It's really hard. Take care of yourself! I flip flopped on a lot of stuff, because this decision is one of the hardest you will make!

Thank you for the additional information and experiences with antibiotics. This is all good to know.

OP

It depends on what they antibiotics are for - sometimes they provide relief from pain or fever or prevent difficulty breathing. Think of them as giving comfort not as disobeying wishes.

Hospice DOES give antibiotics to prevent suffering. They prescribed Mom antibiotics several times for UTI's.

Anonymous wrote:Similar situation, they chose "DNR" but I do think they said antibiotics were fine but probably didn't understand the nuance of that.

They were thinking they caught something at the AL but were otherwise fine. But in the case of OP as long as it's not painful I think it's fine to respect. Is pneumonia painful?

A woman I know was sitting with her husband in the living room when he passed from pneumonia, and neither she nor the nurse realized for a few minutes-- it was really peaceful

Similar situation, they chose "DNR" but I do think they said antibiotics were fine but probably didn't understand the nuance of that.

They were thinking they caught something at the AL but were otherwise fine. But in the case of OP as long as it's not painful I think it's fine to respect. Is pneumonia painful?

Honestly, I think it's fine to ignore the "no antibiotics" rule if you want to and can.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm a social worker in a nursing home and I do advance directives daily. When discussing palliative care, families often choose no antibiotics because they have also chosen no labs, which can be painful. If we can't do labs to find out what infection is present, we can't give antibiotics for it.

You can give antibiotics. This isn't true.

Our facility cannot. The doctors will not prescribe antibiotics without documentation, so they know which antibiotic to give. Maybe other facilities in other states are more lax.

So it sounds like the doctors will prescribe with documentation? If so, that means they can get antibiotics.

Yes. As I said in my original post, sometimes families choose no antibiotics because they have also chosen no labs.

Anonymous wrote:Thank you so much, everyone.

I appreciate your answers, understanding, advice, and sympathy.

🙏

I’ll add that a friend whose dad died of Alzheimer’s said they’d I’d give antibiotics because they felt it was kinder and less painful. She is a doctor so I guess she based this choice on her experience with patients.

This drove home the point that an advanced directive can not take everything into consideration, so we may have to deduce what is best based on the info we have at the time.

The reason it's called an "advance" directive, not an "advanced" directive, is that your loved one is letting you know IN ADVANCE what they do and don't want. Unless there's a miracle cure for whatever a patient is getting abx for, that hasn't changed.

Thank you so much, everyone.

I appreciate your answers, understanding, advice, and sympathy.

🙏

I’ll add that a friend whose dad died of Alzheimer’s said they’d I’d give antibiotics because they felt it was kinder and less painful. She is a doctor so I guess she based this choice on her experience with patients.

This drove home the point that an advanced directive can not take everything into consideration, so we may have to deduce what is best based on the info we have at the time.