Hi Paul,
I work in hospice so I have seen many people make the same choice that your mom has in refusing treatment. It sounds like she has been active, driving, getting out, going to her church, and doing the things that are important to her over the last 9 months. That's the good news, she's had a relatively good quality of life during this.

However, it's not an all or nothing situation. Most of our patients who have refused treatment for the cancer, still accept treatment to control pain and other symptoms. Is there anyone she would talk to about why she is putting those 2 separate issues together?

Some drugs will prevent her from driving and some won't, it's a matter of finding the right dose and the right medication for her. She's very tiny so that needs to be considered in those decisions. There is prescription strength aleve (naproxen) that comes in liquid form if that's easier for her to swallow and it's stronger than the over the counter motrin. Has she had a bad experience with pain medication in the past? What is she really afraid of?

It's not unusual for parents to not want to discuss things with their adult children even when one is a doctor. Apparently we never grow up. I have the same issue with my 83 year old mother who tells me all her symptoms but never accepts any of my suggestions to resolve them.

Would she talk to a chaplain, her minister or a social worker about her feelings? Who does she trust at this point? I think you need to find out what your mom thinks is going to happen at this point and go from there. Does she understand that the cancer is progressing?

Family conferences can also be useful - with a neutral objective person to facilitate - to come to a resolution. She has the right to refuse any and all treatment, but the flip side of that is that pain will increase, her ability to eat will deteriorate, and those are quality of life issues too. Also she has a family who obviously love her and your feelings need to be expressed and considered. Have you told her how hard it is to watch her be in pain when she could take medication to alleviate that?

As for the driving, that's the hardest thing for independent people to give up. The issue there is not only her own safety if she is driving with the distraction of pain but everyone else on the road. Are there people who are able and willing to drive her to the places she wants to go? Does she live near near all of you?

Many people express their fears through pat answers like everyone is a drug pusher. She knows they aren't but it sounds good and shuts down the conversation. Is she on a hospice program? There are several good programs in the Philadelphia area that I'll be happy to tell you about in a private email.

I'm sorry that you are all going through this and let us know how she is doing.
Regards JoAnne