Dear Barbara, How do you approach families who refuse to allow us to administer morphine when their loved one is in excruciating pain at end of life? No amount of education seems to help.

Fear, lack of knowledge, lack of being able to really hear and understand the knowledge being given, lack of trust, living in a country where opioids (identified under the word morphine) have become a national epidemic of their own, all contribute to people’s responses.

Our job as end of life workers is to get beyond the misinformation and the fear. That won’t be done in five minutes and maybe not even in five visits. The patient may die before you make any headway BUT you have to try.

Ideally, the trust between patient, family, and nurse is established at the first visit. Working in end of life we don’t have time for the “normal” social tools. Our tools for establishing trust on the first visit include direct eye contact when speaking, sitting, or standing close, physical touch, teaching openly and honestly, and that means addressing the “goblins” in the room. 

No looking at your laptop, no asking questions from the laptop, no typing on your laptop. The quickest way to break any connection you may have with a listener is to be distracted by a computer. By the way, all our people building trust tools were and often still are jeopardized by covid.

Soooooo, education, our biggest, sturdiest tool, begins on day one.  Start by saying, “Taking care of someone at end of life is different than taking care of someone who is going to get better,” and then begin teaching nutrition, fluids, energy levels changes, social interaction and pain management. This teaching is 90% of the work we do. It lays the groundwork for all our further instructions and recommendations.

All this said, you know the old saying, "You can lead a horse to water but you can't make him drink?" Well, we can teach, guide, and support but we can't make a person, or persons, do something even if it is the wise thing to do. 

One of the hardest parts of our work is to continue to support the patient and family as they live and, in many cases, die with the choices they have made.

When no matter how much information we have given, when we have used every tool in our tool kit to provide pain relief and all has been to no avail and rejected, our job is to continue to be supportive and gentle in the care of these human beings. 

Something More... about Refusing Morphine For a Dying Loved One 

When families are provided my booklet, PAIN AT END OF LIFE What You Need to Know About End of Life Comfort and Pain Management  and can sit with their nurse/social worker/volunteer/chaplain to read the book, outcomes are quite positive. Showing families NEW RULES for End of Life Care will also be beneficial in helping them understand the different way that narcotics are used for someone who won't be getting better.