I have written many articles on morphine yet I repeatedly get this question. What that tells me is how big the fear is, and how lacking the knowledge, around the use of morphine.
Here are my thoughts on the use of morphine at the end of life. First and foremost dying in itself is not painful. Disease causes pain. If the disease history of the dying person is one of experiencing pain, than we must treat that pain with whatever it takes and however much it takes to keep the person comfortable until their very last breath.
There are diseases that do not cause pain. If the person's disease history is one of no pain then there is no reason to give them morphine just because they are dying. UNLESS breathing is an issue, not the normal puffing and start and stop breathing that occurs weeks and days before death, but severe labored breathing. Then a small, small, amount of morphine will often ease the difficulty in breathing. We must remember that taking in oxygen by breathing is one of the ways the body lives. If it is preparing to die then breathing and air intake will be effected. That is part of the NORMAL dying process.
I had a friend who drank an entire bottle of liquid morphine in a suicide attempt. He had no previous use of the drug, so its full effect acted on his body. He slept a long time but did not die. A different person (body size, age) might have died. But my friend didn’t . This tells me our bodies can take a lot of morphine and not stop breathing.
I will ask the obvious question here: If, when someone is in the dying process (days, hours or weeks before death), the morphine dosage were to make them die, is that really a consideration? Yes, I think it is. No caregiver wants to live with the knowledge that the medication they administered made their patient die (I think this is the center of caregivers fear of narcotic administration).
In the days to hours before death a person’s body is shutting down. Nothing works right. Circulation is slowing down (mottling, very low 60/40 blood pressure). It is circulation that makes medications work. Medications taken by mouth, skin, or rectum take a long time to be absorbed into the blood stream. Even longer if the circulation is compromised which it is when a person is dying. If you give a narcotic other than through an IV (let’s hope most people are not getting IV’s in the days to hours or a week before their death from disease) it is going to take a VERY long time for this medication to work.
If you give morphine to someone who is in the dying process hours before death and they die shortly after you administer the medication they most probably did not die from the drug. They would have died with or without the narcotic.
All of the above said, I am going to give you something to think about. The key to a gentle death is to relax. All we have to do to slip out of our body is to relax. Fear, pain, and unfinished business are what make our “labor” to leave this world longer. If someone is very agitated (fearful) and/or has a disease history of pain then giving them medications that can reduce those occurrences can be very beneficial to allowing the person to relax and have a gentle passing from this world to the next.
Something More About "Dangers of Morphine for the Dying?"...
Hospices and Palliative Care Centers are using my dvd, NEW RULES for End of Life Care to educate families on how and why morphine may be used with a loved one why is dying. It is so common for nurses to hear families say, "I don't want Mom to get addicted", and not allow use of this helpful tool. NEW RULES... can help to make this conversation so much easier.
20 comments
Anna Shaneyfelt
I have tortured myself for over 3 years now over my Mom’s death from Non-alcoholic Cyrhosis of the Liver. I was her medical POA and each time the nurses came in and asked if they should hold the morphine or go ahead, I stupidly said go ahead. I give out liquid morphine to my patients in the hospital as a Med Aide but I failed to see the bigger picture and do the math for equation of ml per mg, or whatever the liquid morphine equates to. I fear I killed my mom. The fall out was tremendous as she passed on my nephew’s birthday and he couldn’t recover. 2 years later he ended his life. I feel I killed my mom and my nephew. If I had held some of that damn morphine she may have lived a few more days and then Mike may have survived. I’m tortured with guilt. I wish I could know for certain that I didn’t hasten her death.
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BK Books replied:
Oh Anna, you are carrying so much. You want answers that you will never get. There are just too many unknowns. BUT here is what I do know. You did the best you could under extremely challenging, heart felt times. I find it hard to believe your mother would want you feeling this way over a “few days”. Whether it was morphine or her disease process she was no longer suffering. About your nephew. I don’t know his story but it seems there was more to his death than because his aunt died on his birthday. You might write both of them letters and put all your thoughts, recriminations, and tears on paper. Burn the letters and scatter the ashes to the wind. Let how well you live your life going forward be the gift of love you give them. Blessings! Barbara
I have tortured myself for over 3 years now over my Mom’s death from Non-alcoholic Cyrhosis of the Liver. I was her medical POA and each time the nurses came in and asked if they should hold the morphine or go ahead, I stupidly said go ahead. I give out liquid morphine to my patients in the hospital as a Med Aide but I failed to see the bigger picture and do the math for equation of ml per mg, or whatever the liquid morphine equates to. I fear I killed my mom. The fall out was tremendous as she passed on my nephew’s birthday and he couldn’t recover. 2 years later he ended his life. I feel I killed my mom and my nephew. If I had held some of that damn morphine she may have lived a few more days and then Mike may have survived. I’m tortured with guilt. I wish I could know for certain that I didn’t hasten her death.
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BK Books replied:
Oh Anna, you are carrying so much. You want answers that you will never get. There are just too many unknowns. BUT here is what I do know. You did the best you could under extremely challenging, heart felt times. I find it hard to believe your mother would want you feeling this way over a “few days”. Whether it was morphine or her disease process she was no longer suffering. About your nephew. I don’t know his story but it seems there was more to his death than because his aunt died on his birthday. You might write both of them letters and put all your thoughts, recriminations, and tears on paper. Burn the letters and scatter the ashes to the wind. Let how well you live your life going forward be the gift of love you give them. Blessings! Barbara
Becky
My son had cancer as soon as I got him home on a Friday evening they started poke morphine down him I didn’t even get a last I love you mom they started giving him two whole droppers full I had to have 24 hour care cause I have health problems I heard a nurse say only have nine days I felt like they overdose my baby they could at least let me talk to my boy before they kill him
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BK Books replied:
Oh Becky, I am so sorry you did not have the opportunity to say goodbye to your son. You might write him a letter and put all that you would have said to him, had you had the opportunity, on paper, all your thoughts, all your tears and then burn the letter and scatter the ashes to the wind. Let how well you live your life now be the tribute of your love for him. Blessings! Barbara
My son had cancer as soon as I got him home on a Friday evening they started poke morphine down him I didn’t even get a last I love you mom they started giving him two whole droppers full I had to have 24 hour care cause I have health problems I heard a nurse say only have nine days I felt like they overdose my baby they could at least let me talk to my boy before they kill him
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BK Books replied:
Oh Becky, I am so sorry you did not have the opportunity to say goodbye to your son. You might write him a letter and put all that you would have said to him, had you had the opportunity, on paper, all your thoughts, all your tears and then burn the letter and scatter the ashes to the wind. Let how well you live your life now be the tribute of your love for him. Blessings! Barbara
barbara
Oh Jane, what a time you both have had; so much has happens, so quickly, and in the midst of a pandemic. I can’t give you medical advice but I can understand why the doctors think your husband must be in pain. He has been through so much and has so much wrong with his body. They want him to be comfortable. I understand that. What I don’t understand is why is no one listening to your husband? If he says he is not uncomfortable, is not in pain, why insist he take pain medication? If your husband doesn’t want to take the medicine, and he is clear of mind and thinking, then I think you honor his wishes. Talk with the hospice about this. Maybe a compromise is have the medications in the house, get a dosage amount to give him if and when he requests it.
I am keeping you in my thoughts. Blessings to you both. Barbara
Oh Jane, what a time you both have had; so much has happens, so quickly, and in the midst of a pandemic. I can’t give you medical advice but I can understand why the doctors think your husband must be in pain. He has been through so much and has so much wrong with his body. They want him to be comfortable. I understand that. What I don’t understand is why is no one listening to your husband? If he says he is not uncomfortable, is not in pain, why insist he take pain medication? If your husband doesn’t want to take the medicine, and he is clear of mind and thinking, then I think you honor his wishes. Talk with the hospice about this. Maybe a compromise is have the medications in the house, get a dosage amount to give him if and when he requests it.
I am keeping you in my thoughts. Blessings to you both. Barbara
Jane Fannin
Hello,
I new here and have a question. My husband is a veteran, 82 now, diagnosed with Penile Cancer, Lymphatic Cancer and in a very short while I must say, it spread!! Omg, my husband went in for an Angioplasty, seemed to have recovered nicely. The Dr want to do a Venogram/Collegen Plug, not healed. Then a Stent, in upper thigh, went in behind knee. Seemed it all was going to be ok, but, at a follow up appt, we had a shock given to us!
Dr said, uh, “I SEE CANCER”! Well, what a surprise! Wouldn’t he have seen ALL THAT, during ALL the Imaging?? After all those surgeries, why say this then, when he had all the proof already? In this case, did surgeries spread the CANCER?
So many questions now! We are beside ourselves. He recently had to be admitted to hosptial, 6 days, now home on Hospice. And Morphine and Lorasapam. He says he isn’t in pain. But could he be, with all that Cancer? He doesn’t talk much on any one issue to me. Has a throat obstruction too. So eating and drinking, HARD to do for him. Scares me.
He went through those surgeries, found out he had cancer, on hospice now, ALL IN over 3 Months! The Va, staggered his Appt, with this COVID, took months to get to the Dr., then long time to get first surgery suggested. Vascular Dr suggested these operation’s. But should he have? I mean, with Cancer, should he have? My brain is frazzled over all this, just haven’t caught up with this Info, now a DEATH, very near! What can you suggest on Meds?
Hello,
I new here and have a question. My husband is a veteran, 82 now, diagnosed with Penile Cancer, Lymphatic Cancer and in a very short while I must say, it spread!! Omg, my husband went in for an Angioplasty, seemed to have recovered nicely. The Dr want to do a Venogram/Collegen Plug, not healed. Then a Stent, in upper thigh, went in behind knee. Seemed it all was going to be ok, but, at a follow up appt, we had a shock given to us!
Dr said, uh, “I SEE CANCER”! Well, what a surprise! Wouldn’t he have seen ALL THAT, during ALL the Imaging?? After all those surgeries, why say this then, when he had all the proof already? In this case, did surgeries spread the CANCER?
So many questions now! We are beside ourselves. He recently had to be admitted to hosptial, 6 days, now home on Hospice. And Morphine and Lorasapam. He says he isn’t in pain. But could he be, with all that Cancer? He doesn’t talk much on any one issue to me. Has a throat obstruction too. So eating and drinking, HARD to do for him. Scares me.
He went through those surgeries, found out he had cancer, on hospice now, ALL IN over 3 Months! The Va, staggered his Appt, with this COVID, took months to get to the Dr., then long time to get first surgery suggested. Vascular Dr suggested these operation’s. But should he have? I mean, with Cancer, should he have? My brain is frazzled over all this, just haven’t caught up with this Info, now a DEATH, very near! What can you suggest on Meds?
Barbara
Hi Gaby, in response to your challenge with your physician, your pain, and morphine. This country’s opioid crisis has had a serious affect on those people that are using narcotics in a serious, appropriate way. Many, not all, physicians are “running scared” about prescribing narcotics. It appears your physician is one of those people. Because Kaiser is your medical provider you have limited choices of getting another physician but you might try going up the chain of command explaining your situation to this physician’s boss. I would think you can request, even demand, a different physician. If I have read your letter correctly your pain is controlled by the CBD. It is the shortness of breath that you are asking the morphine for. It doesn’t take very much morphine to ease the breathing difficulty. I would think that is a medical help and a legitimate reason to prescribe.
Blessings! Barbara
Hi Gaby, in response to your challenge with your physician, your pain, and morphine. This country’s opioid crisis has had a serious affect on those people that are using narcotics in a serious, appropriate way. Many, not all, physicians are “running scared” about prescribing narcotics. It appears your physician is one of those people. Because Kaiser is your medical provider you have limited choices of getting another physician but you might try going up the chain of command explaining your situation to this physician’s boss. I would think you can request, even demand, a different physician. If I have read your letter correctly your pain is controlled by the CBD. It is the shortness of breath that you are asking the morphine for. It doesn’t take very much morphine to ease the breathing difficulty. I would think that is a medical help and a legitimate reason to prescribe.
Blessings! Barbara
Gaby Weddle
Barbara
Hi Corrina, your question “Is it dangerous to give morphine every hour?” is one I can’t answer. Pain management, particularly pain management at end of life is so individualized I would have to have more information about your cousin’s medical history. What I can say is our goal in working with end of life pain is to keep the person comfortable. If pain was an issue in the disease (and a lot of cancers, including the kind your cousin had, produce pain) then we address that pain with medication right up until the moment of death. I hope this information puts your mind at ease. You might want to talk with the hospice nurse and ask her your questions. Even though your cousin has died you can still call hospice and ask your questions. My blessings are with you. Barbara
Hi Corrina, your question “Is it dangerous to give morphine every hour?” is one I can’t answer. Pain management, particularly pain management at end of life is so individualized I would have to have more information about your cousin’s medical history. What I can say is our goal in working with end of life pain is to keep the person comfortable. If pain was an issue in the disease (and a lot of cancers, including the kind your cousin had, produce pain) then we address that pain with medication right up until the moment of death. I hope this information puts your mind at ease. You might want to talk with the hospice nurse and ask her your questions. Even though your cousin has died you can still call hospice and ask your questions. My blessings are with you. Barbara
Corrina Slade
My Cousin passed away yesterday at 12:30 a.m ..i was there with her and left at 9:30 p.m before she passed …i arrive there at her house at 6 that evening the whole time i was there she was administered morphine every hour on the hour by her daughter following the Hospice nurse directions…it really didn’t sit right with me but those were the directions from the hospice nurse….my question is….is it dangerous to give morphine every hour??? Oh by the way..she was fighting cancer..she was diagnosed 3 wks ago..lesions in the brain and found mass on her lung n liver…
My Cousin passed away yesterday at 12:30 a.m ..i was there with her and left at 9:30 p.m before she passed …i arrive there at her house at 6 that evening the whole time i was there she was administered morphine every hour on the hour by her daughter following the Hospice nurse directions…it really didn’t sit right with me but those were the directions from the hospice nurse….my question is….is it dangerous to give morphine every hour??? Oh by the way..she was fighting cancer..she was diagnosed 3 wks ago..lesions in the brain and found mass on her lung n liver…
Barbara
Hi Marta, when a person is not experiencing pain I see no reason to give them a narcotic or any kind of medication as a pain reliever. If there is breathing difficulties a small amount of morphine may ease the breathing but that doesn’t seem to be the issue here. The family can certainly tell the hospice nurse they are not comfortable with the use of morphine, at this time. We need to remember any agency, physician or healthcare professional works for the family and patient. Their opinion matters. We just want to make sure the opinion comes from knowledge and not fear and/or ignorance. Blessings! Barbara
Hi Marta, when a person is not experiencing pain I see no reason to give them a narcotic or any kind of medication as a pain reliever. If there is breathing difficulties a small amount of morphine may ease the breathing but that doesn’t seem to be the issue here. The family can certainly tell the hospice nurse they are not comfortable with the use of morphine, at this time. We need to remember any agency, physician or healthcare professional works for the family and patient. Their opinion matters. We just want to make sure the opinion comes from knowledge and not fear and/or ignorance. Blessings! Barbara
Marta
I am taking care of a patient in her last days/weeks of Alzheimer’s. She is not in pain, she is comfortable and her vital signs are steady, she has no issues with breathing. She still eats and drinks and eliminates pretty much regularly. Family decided to put her on hospice just few days ago. Hospice nurse instantly suggested giving her morphine. I do not see a need for it just yet. Does family have to agree to administering morphine immediately or can they wait till their mom actually would benefit from it to help her with peaceful passing?
I am taking care of a patient in her last days/weeks of Alzheimer’s. She is not in pain, she is comfortable and her vital signs are steady, she has no issues with breathing. She still eats and drinks and eliminates pretty much regularly. Family decided to put her on hospice just few days ago. Hospice nurse instantly suggested giving her morphine. I do not see a need for it just yet. Does family have to agree to administering morphine immediately or can they wait till their mom actually would benefit from it to help her with peaceful passing?
Patricia
Very informative information above.my husband has non treatable cholangiocarcinoma ,due to too many other health issues.He hasn’t shown any systems yet ,I plan an appointment with a hospice nurse to come to the house and speak with us and your prior information for me to read is very helpful.I have ordered 4 booklets from you and eagerly awaiting their arrival! My husband is almost 89 and though he doesn’t speak of the disease he has shown remarkable strength !!
Very informative information above.my husband has non treatable cholangiocarcinoma ,due to too many other health issues.He hasn’t shown any systems yet ,I plan an appointment with a hospice nurse to come to the house and speak with us and your prior information for me to read is very helpful.I have ordered 4 booklets from you and eagerly awaiting their arrival! My husband is almost 89 and though he doesn’t speak of the disease he has shown remarkable strength !!
Barbara Karnes
Hi Mary, I do not have enough medical information to comment on the morphine and its affects on your husbands body and breathing. I do know it is unsettling to watch death approach and the helplessness that accompanies those moments can stay with us for quite awhile.
My blessings are with you. Barbara
Hi Mary, I do not have enough medical information to comment on the morphine and its affects on your husbands body and breathing. I do know it is unsettling to watch death approach and the helplessness that accompanies those moments can stay with us for quite awhile.
My blessings are with you. Barbara
Mary Cantrell
But what is a small dose to you? My husband was on his last breath yes I had hospice but she gave him a full syringe full of morphine when he started labor breathing about 45 min later Agen a full dose full syringe full. Now what’s up with that? He didn’t look relaxed?!!
But what is a small dose to you? My husband was on his last breath yes I had hospice but she gave him a full syringe full of morphine when he started labor breathing about 45 min later Agen a full dose full syringe full. Now what’s up with that? He didn’t look relaxed?!!
Patti Zeimet-Jones
Thank goodness for Morphine. Watching someone suffer from air hunger is frightening. A small dose of morphine settles this down quite nicely.
President Northeast Oklahoma Hospice and Palliative Nurses Association.
Thank goodness for Morphine. Watching someone suffer from air hunger is frightening. A small dose of morphine settles this down quite nicely.
President Northeast Oklahoma Hospice and Palliative Nurses Association.
Nancy
My husband has been on hospice care going on eight months. My brother moved in with us 5 yrs ago and now helps me with my husband. He fell at a rehab facility and had been bedridden since, he had a subdural hematoma (stroke), he isn’t in pain and I am very thankful. I have read your books, watched your dvd.. and read all your emails. I can talk about death to him today but he may not remember the conversation tomorrow. Thank you for your posts.
Blessings,
Nancy
My husband has been on hospice care going on eight months. My brother moved in with us 5 yrs ago and now helps me with my husband. He fell at a rehab facility and had been bedridden since, he had a subdural hematoma (stroke), he isn’t in pain and I am very thankful. I have read your books, watched your dvd.. and read all your emails. I can talk about death to him today but he may not remember the conversation tomorrow. Thank you for your posts.
Blessings,
Nancy
Barbara Karnes
Hi Janna, Make sure now while you are healthy that your physician has in your medical record that you are allergic to Morphine. There are allergic bracelets that you can get (at drug stores?) to wear. Also put it in your Advanced Directive and POLST. Blessings! Barbara
Hi Janna, Make sure now while you are healthy that your physician has in your medical record that you are allergic to Morphine. There are allergic bracelets that you can get (at drug stores?) to wear. Also put it in your Advanced Directive and POLST. Blessings! Barbara
Janna Karsjens
I placed my husband on hospice/palliative care three days before his death. He had been in the nursing home for 2 months prior, supposedly for rehabilitative therapy after suffering a 2nd stroke. Unfortunately, he would get agitated every time he ran a fever. As his cognitive abilities decreased, the agitation increased. The palliative care nurse(s) recommended use of morphine to keep him relaxed and I’m very glad they did, because not only did it relax him, but it also helped me relax knowing that he was in no pain and was not suffering.
My biggest concern, should I ever be placed in hospice/palliative care, is that the nurses and doctors pay attention to noted medication allergies. I am allergic to morphine; I break out in a nasty itchy rash and become agitated, not calm. I would hope they would choose another medication to help me relax.
I placed my husband on hospice/palliative care three days before his death. He had been in the nursing home for 2 months prior, supposedly for rehabilitative therapy after suffering a 2nd stroke. Unfortunately, he would get agitated every time he ran a fever. As his cognitive abilities decreased, the agitation increased. The palliative care nurse(s) recommended use of morphine to keep him relaxed and I’m very glad they did, because not only did it relax him, but it also helped me relax knowing that he was in no pain and was not suffering.
My biggest concern, should I ever be placed in hospice/palliative care, is that the nurses and doctors pay attention to noted medication allergies. I am allergic to morphine; I break out in a nasty itchy rash and become agitated, not calm. I would hope they would choose another medication to help me relax.
Patti Urban
As an end of life doula, I also agree that a small dose of morphine can have a good effect on someone who is experiencing labored breathing. It really does make a difference.
As an end of life doula, I also agree that a small dose of morphine can have a good effect on someone who is experiencing labored breathing. It really does make a difference.
Melissa
My husband had COPD and he took morphine on a regular basis for a year before he passed. His last dose of morphine was just moments before he passed. His last request was that we not let him suffocate. He went peacefully.
My husband had COPD and he took morphine on a regular basis for a year before he passed. His last dose of morphine was just moments before he passed. His last request was that we not let him suffocate. He went peacefully.
Maureen Asper
As a palliative care nurse, I can’t agree more with the use of morphine with terminal patients. Used properly morphine allows the patient to relax and will also address pain and shortness of breath effectively. A little bit can make a huge difference between a peaceful death compared to the last moments of life filled with anxiety and fear. It is also the drug of choice when shortness of breath becomes burdensome. It is a God-send for those suffering from COPD. Please don’t be afraid to try a small dose if your doctor suggests it.
As a palliative care nurse, I can’t agree more with the use of morphine with terminal patients. Used properly morphine allows the patient to relax and will also address pain and shortness of breath effectively. A little bit can make a huge difference between a peaceful death compared to the last moments of life filled with anxiety and fear. It is also the drug of choice when shortness of breath becomes burdensome. It is a God-send for those suffering from COPD. Please don’t be afraid to try a small dose if your doctor suggests it.