Date
November 16 2015
Written By
Barbara Karnes, RN
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Does Morphine Hasten Death?

Does Morphine Hasten Death?


Comments

barbara - September 13 2020

Dear GK, about your blog comment question of did the Valium given cause death? I don’t have enough medical history to know if your father’s death was the result of stopping his medications and/or  taking Valium. What I can say is when I deem a person weeks from death I stop all medications except pain meds. When death is eminent why prolong the labor of dying. When restlessness and agitation is severe enough to put the person in danger of hurting themselves then Valium is very appropriate. It doesn’t hasten death but keeps the person out of harms way of falling out of bed, or otherwise hurting themselves. When we enter the dying process, months before death, our personality doesn’t change, it intensifies. If we were controlling and irritable in living then as we approach death we will be more controlling, more angry, more irritable. Those changes have nothing to do with us, the family.Hindsight, looking back over what we might have done, gets us nowhere. How well we live our life now is the job of us the living. Remember no one sets out to do a bad job. We always to the best we can with what we have to work with in the moment. My blessings are with you. Barbara

barbara - September 13 2020

Dear Trudy, I have read your comment on my blog about morphine killing. Your description of your husband’s last hours are certainly disturbing. I don’t know your husband’s medical history to have an opinion of why or what was occurring. What I do know is 26 years is too long to carry the guilt. We always do the best we can in any given situation. None of us set out to make mistakes or do a bad job.I want you to sit down and write your husband a letter. Writing is important, don’t just think, write, what is in your heart. Write what you have carried all these years, the guilt, the sadness, the fear you felt, the lack of knowledge you had, the helplessness you felt. Write what you wish you had done, what you would do if you had a “do over”. Let all the tears, the anger, all the feelings and thoughts you have carried all these years out and down on paper. Then burn the letter, go outside and throw the ashes to the wind. Watch the ashes fly away and with the ashes all the thoughts and anguish you have carried for so long.It is time you live in the present. It is time you let how well you live your life be the gift you give your husband. Blessings! Barbara

barbara - September 13 2020

Mary, I am so sorry to hear of your horrible hospice experience.  I hope you spoke to the hospice administrator explaining your beliefs. You can also report the hospice to medicare. Taking action will not change what has happened but it may prevent someone else having the same experience. My blessings are with you and your daughter. Barbara

Mary Brady - September 13 2020

I am not a perponent of morphine, I personally have seen it abused by hospice three out of three times, I have witnessed a death. They flat out killed the person within a few hours of their arrival. I begged my daughter when her husband was at the end of his life, not to allow hospice into her home. She listened to her doctor, hospice was ordered by her doctor, and her husband was literally killed within 4 hours of hospices arrival. Now with that being said, the unbelievable guilt my daughter feels for the rest of her life, because she was exhausted from caring for a patient with cancer and was to exhausted to think for herself. She allowed her doctor to make that decision for her and her husband. When she recovered from her exhaustion, and began to think for herself, the guilt set in because she realized what had happened. That was three years ago and she has become a recluse, and the guilt of what hospice did eats at her. She blames herself because she did not have the strength to say no to the doctor who ordered it. He told her it would just keep him comfortable.

Trudy - September 13 2020

My husband passed 26 years ago. It still haunts me. He was on home hospice. He had slipped into a comatose state briefly. Then he rallied and was alert, communicating, in fact he asked to sit outside to see the sunset. Hospice was with us 24/7 the final 3 days. He was conscious but in terrible pain. He received every form of morphine that existed constantly. I don’t understand. The hospice workers (2) held his shoulders down, while he called out and pushed extra crushed morphine and liquid morphine down his throat. I was there. It appeared he was fighting them, not wanting the extra drugs. He was already on push IV morphine and a patch. This continued for an hour. Until he quit breathing.
I carry that horrific struggle every day. He choked on the drugs. I didn’t tell them to stop.
I feel like I killed him.

gk - September 13 2020

Well, reading through the comments I see I am not alone in reliving the traumatic last days/months of a loved ones death.
My father was in hospice for 6 months and was often angry, agitated and depressed during that time. There was an unexpected death in our family during his time under hospice care and it broke my already anxious father. My father was always a proud and independent man and was resistant to any help even in his waning years. Looking back, he was much more confused and disorientated during his years than any of us realised. It was difficult to separate his character (strong willed, intelligent) from his illness (senilty) and we pretty much treated him as we’ve always treated him. We gave him space and argued with him without realise he really didn’t remember blocks of time.
In any case, after the unexpected death of another family member he was self medicating while drinking and asked hospice for valium. They gave it because he was obviously in a great deal of grief and pain.
It seems that once valium started, it was almost instantaeneously rapid downhill deterioration of his health. He fell a lot, slept a lot, was confused more until one hard fall in the middle of the night and then bedbound and not really concious for another 10 days. Do you think valium could have contributed to his death? We also stopped all his heart medications at that time, could that have contributed? Rationally I know, does it matter that much if he went slightly earlier if he were suffering so.
Anyway, I’m not being coherent. I guess once I start dwelling it all comes out again.
But thank you for all that you do. And this quote of yours means so much to me, “Family dynamics are very challenging in the best of times. The approaching death of someone we care about (or don’t care about) brings out the best or the worse in these fragile relationships.”
It helps me to understand why my relationship with my father was so fraught right until the end. I bitterly regret the way we related the last two years of his life. He was SO ANGRY at me for moving him into my home and blamed me for his woes. I wish I had been more patient and understanding. I so wanted those last years to be gentle. But they were not.

barbara - September 11 2020

Hi Kim, Family dynamics are very challenging in the best of times. The approaching death of someone we care about (or don’t care about) brings out the best or the worse in these fragile relationships. I am sorry your mother had the difficult ending to her life. So often the last year of our old age life is one of medical issues, falls, helplessness, confusion. I also appreciate the frustration you must have felt in being excluded in the decision making regarding her end of life care. The question now is how do you live forward with these feelings? You might write your mother a letter. Put all your thoughts about your life with her and about how her life ended on paper. Let the tears, frustration, sorrow out and down on paper. Write from your heart everything you want to say to her. then burn the letter and scatter the ashes to the wind.
Being an end of life doula is a great goal but I would recommend you wait at least a year. Right now you are too fresh in your grief for your mother. Every interaction with someone who is dying will rub the wound of your own grief. Use this year as a study year. Prepare yourself with end of life knowledge, with communication techniques, maybe one of the end of life doula courses. Blessings! Barbara

Joye Coker - September 11 2020

A friend shared your post.My late husband had Lung cancer and Pulmonary fibrosis..To make a long story short he was on liquid morphine and a couple of pills..His last days he was in a coma like state which was a blessing..He was no longer struggling to breath..Before that the morphine seemed to help him deal with this..I might have given him more morphine than needed but Ihave no regrets and hope my family will do the same if I am in that condition

kim - September 11 2020

My 93 year old mother passed in a horrible way on June 28, 2018. She fell three times within 6 months of her death due to negligent group home and rehab staff! She had dementia, but not severely. In her last fall- the one that sentenced her to inevitable death- she was unattended in bathroom and fell, hitting her head, knocking out front teeth and cracking her skull. Morphine was given, of course. But several weeks later, when it was clear she was deteriorating, morphine was still on her treatment even though she did not need it. Tylenol worked just fine. So, how do you feel about the fact that she was given morphine and Atavan as she died??!! I objected, but sister had POA. Why do families crack up so often around the death of a family member, especially a parent. It is a sacred time, in my opinion. My mother was robbed of the end of life she asked me for. I still grieve. Family still fractured. Your experience and insight would be much appreciated. I’m a retired clinical social worker thinking about becoming a Death Doula or similar. Thank you for your wonderful info.

barbara - July 24 2020

Renee, I am so sorry to hear of your experience with hospice and your mother’s death. I do not know all the medical circumstances of your mother’s approaching death however, I can say it should never be the intension of a hospice or any other medical facility to hasten death by any means. I suggest that you talk with the hospice manager or director about your concerns. If you don’t, they will never know about what happened and your dissatisfaction, let alone the anguish you are carrying. A big part of hospice care for the family is telling the family, educating the family, about end of life and more importantly explaining why they are doing what they are doing. I wonder if the nurse had taken the time to explain why she was administering morphine your anguish could have been avoided. My blessings are with you. Barbara

Barbara - March 25 2019

Hi Keef, your morphine history is unusual. I doubt many people could be sustained with that amount for that length of time. You said that amount manages your pain, does it affect your mental capabilities? You said it has affected your body in a negative way. The question that comes to my mind is by reducing the physical pain, even though it affected your physical body negatively, have you been able to have some quality in your living that you otherwise would not have had? If the answer is yes, then isn’t that our goal in medicine (to provide the best quality of living). As I write that statement I realize “quality” doesn’t always enter into the equation even though I want it to. Thank you for sharing your unusual situation. My thoughts for you are that you will find joy, peace of mind and fulfillment while living with your physical challenge. Blessings! Barbara

Barbara - March 25 2019

Hi Lisa, The Final Act of Living is a book with the information I give in workshops and in the DVDs. I did the book for the very reason you are asking. We learn in different ways, hearing or seeing to name just two. I am like you I learn more from reading. I hope you find the book helpful. Blessings! Barbara

Keef y - March 25 2019

I have been on morphine every day for 15 years. At one point I was prescribed over 300mgs to be taken evenly twice every day. The pain clinic consultant was appalled at my GP for exceeding the recommended per day dosage set down by the medical body that controls opiates in the UK. The maximum dosage is a maximum of 200mgs per day. Since then I have reduced down to 120mgs per day, the pain is more noticeable.
I was hospitalised in May 2017 for10 days due to chest pains. I was mortified when a doctor (with NO bedside manner) told me I had non -alcoholic liver cirrhosis, fungal infection in my lungs as well as enlarged lymph glands and a couple more hypertensions
So far, since then ( now we are in March 2019 ) there has been no response to any medication. I believe that long term, taking morphine and other ‘toxic’ medication does without doubt does injure my body.

Lisa Covell - March 25 2019

Is there any of your books I could read instead of listening to DVD? I’m hard if hearing and I don’t understand words on TV.

Lisa Shimkus - March 11 2019

I’m so grateful to have found this site. My 96 year old Dad passed away 5 weeks ago after a 9-month battle with advanced prostate cancer. I was with him while my sister (who he lived with was on vacation). He declined so rapidly that I’m feeling as though something I did caused it. From the day I got there he seemed to get progressively worse each day. He went from walking a few steps to complete bed rest within days. He suddenly stopped eating and by the 7th day he was so agitated and uncomfortable that hospice decided we should increase his morphine dosage. Two days later he was gone. My sister made it home hours before he passed. It all happened so fast that we barely had time to comprehend what was happening, we all thought he had months left. I’m grateful that his suffering ended quickly but I still feel responsiblilty because it happened on my watch. I’m very glad I was there to say goodbye but the grief is overwhelming.

Barbara - February 10 2019

Hi Brittany, from your description of your grandmother’s illness her body had entered the dying process. Her body was shutting down, unable to combat the disease that she had lived with for so many years. It sounds like she was given morphine to ease her transition from this world to the next. Not knowing your grandmother’s medical history I cannot say if the morphine was appropriate or not. What I can say is it did not kill her. She was dying whether she had morphine or not and she was dying now, not later. I know that may sound harsh but at the point she was given the morphine her circulation was not able to work in the normal way, plus it was her blood that was not healthy which makes circulation and distribution of the medicine less timely and effective. For your question would she have still been alert if she hadn’t been given the morphine before she died? Dying is not like it is in the movies— we say something important and then take our last breath. In the hours to even days before death a person is generally non responsive (non responsive to their environment). They may be talking, even moving about, but not making sense and movements are aimless. They are not alert as we think of alert. That is how people die and from what you have told me your grandmother died well. Nothing bad or pathological was happening. She died the way people die and she did it well. It is very sad when someone we love dies but from what you have described her death was not bad. It was relatively quick without a great deal of suffering. Having someone we love die is devastating, a loss we have to learn to live with. Let go of how she died, it was not pathological, and savor the time you had with her. We have limited control over the time that we die. Your grandmother died with only you there. That was her gift to you. She choose to have you there to support her as she left. She could have died when you left the room. What trust she had in you. You might write her a letter. Put all of your thoughts and feelings about her and your relationship on paper—the good and the challenging— and then burn the letter and throw the ashes to the wind. My blessings are with you. Barbara

Brittany - February 10 2019

My grandmother had lupus for 20+ yrs. Her platelets and redblood cells got very low and ten blood transfusions and plasmapheris did nothing. They said she had a blood infection and her body was basically killing the red blood cells. In a few weeks she could no longer walk on her own or use her hands. Her final day they gave her morphine and took off her oxygen mask. Before the morphine she was alert and talking to us but after she was completely checked out and then unresponsive. Would she have stayed alert without the morphine? Would she have still be alive? I was the only one in the room with her when she took her last breath and my heart breaks over wether we made the right decision. She passed yesterday morning.

Barbara - January 12 2019

Hi Robin, I am so sorry to hear of the experience you had with your father’s last weeks of life. I do not have enough information to comment on your father’s illness, its relationship with morphine, and how it lead to his death. What I can say is when a person is in their 80’s and above, any physical condition and the resulting set backs can lead to death. Non life threatening situations in a 60 or 70 year old can quickly become life threatening and end in death with an 80 or 90 year old. The older the body the less resilience it seems to have in healing. Blessings! Barbara

Robin Doak - January 12 2019

My dad passed away recently from “end stage” dementia while at my home on hospice. Prior to his hospitalization, he was living at an ALF in memory care, eating a regular diet, no oxygen, high energy, walking at moderate cognitive level on November 6. He was 83.

On the afternoon of November 6, he was taken to the ER for a-fib rvr. From that point on, my dad never walked again or stood without assistance, and demonstrated extrapyramidal effects while in the hospital for 2 1/2 weeks. My dad declined so fast at the hands of the doctors as they never addressed the extrapyramidal effects despite my repeated reports of new symptoms; I was dismissed and ignored. His decline forced me to change him from full code to DNR.

On hospice at my home, he improved, sat up edge of bed, wanted to stand, fed himself at times, and talked to me. He had some difficult nights and the hospice nurse convinced me he was in pain and ordered morphine which he was given in very low doses. He was also provided anti-psychotic medications, and developed a severe UTI with antibiotic ordered.

My dad declined which I thought was from the UTI, knowing that can cause severe confusion. He was unable to swallow within days of receiving the morphine, resulting in no food or water. Due to other meds, I didn’t connect the symptoms to morphine.

My dad had been improving, and I actually saw an opportunity for my dad to graduate from hospice. My dad was gone 31 days after entering the hospital, and after 9 days on morphine. He most likely lived longer due to the minimal dosages I gave him, but I never understood how he declined to being bedridden in a week. I’ve always felt I missed something, and now I know! It wasn’t his time, even hospice was surprised how strong willed and physically fit he was despite his a-fib and dementia. If it weren’t for dementia, he’d lived to be 100 I’m sure.

I miss him terribly, and I regret not reading more on morphine and its effects, as I believe he would still be here!

Barbara - January 03 2019

Hi Kim, would you have had more time with your father had you not given him the Morphine and Ativan that hospice had prescribed for him? I don’t know. I don’t have enough medical information to make any kind of assessment. What I can say is your father was on Hospice which tells me his physician believed he had a limited time to live and in prescribing Morphine for air hunger and Ativan for restlessness they were looking to keep him as comfortable as possible during the labor to leave his body. No matter the use of either drug it is not to shorten life but to make it more comfortable—-which is the goal of all hospice workers. “What if I hadn’t given it to him?” He still would have died. Maybe it would have taken him longer (days, weeks) but during that time he would have withdrawn more and more, gone within, slept more. become confused, possibly agitated. We all experience the labor of dying. Some of us can do it more quickly than others. Have you read my booklet Gone From My Sight? It will give you an understanding of the dying process. My guess is you will find your father’s journey in the booklet. You may find some comfort there. My wish for you is to find comfort in the love and relationship you had with your father through out his life. The memory of his last days is a burden you don’t need to carry any longer. Blessings! Barbara

Barbara - January 03 2019

Hi Cynthia, from what I gather you are concerned that your sister died quickly after being given Morphine. You were not told that death was near so it was unexpected. Why was she breathing “very fast”? In the hours to minutes before death the body is in “labor”. Nothing works right. Breathing is generally fast and difficult, often with congestion. Then, as death gets even closer, the breath slows down to often 6 or 8 times a minutes. Just think of a little chick working to get out of it’s shell. We work to get out of our bodies. Did the morphine affect the time of her death? No, I do not believe it did. How do I know for sure? Your sister was given the morphine at 8:00 and at 8:05 her breathing slowed and then stopped at 8:09. A person with a normal functioning body, when given medicine by mouth or rectum, must wait 30 to 45 minutes for the medicine to take effect, to get into the blood stream and begin working. When the body is shutting down the circulation of the blood is slowed down (that is why the hands, feet, arms and legs are bluish colored and cold) and will not get the medicine throughout the body in a timely manner. Even if the morphine was given as an injection it did not have time to make her die. She was working to release from her body, probably all day if not several days, and succeeded at 8:09. I am sorry the nurses did not perceive what was occurring and give you the opportunity to say goodbye. Have you read my booklet Gone From My Sight? I think it will give you an understanding of what occurred as your sister was dying. Two years is a long time to carry this concern with you. I hope you have found some understanding in my response and are now able to put this to rest. Hold on to the good memories with your sister, let go of the rest. From what you have told me nothing bad happened that day, sad, very sad that your sister died but nothing pathological or bad happened. Blessings! Barbara

Barbara - January 03 2019

Dear Tilly, This poor gentleman! My concern is that he has dementia and mental health issues so why is the medical team working with him not bypassing his medical wishes and giving him the appropriate care he needs. Does he have a designated medical spokes person (here in the US is called a Medical Durable Power of Attorney). You are right if he continues on this path of limited medical attention he will become septic and die. Your challenge is to give him the best possible care within the limits everyone has put on you. My thoughts and blessings are with both of you. Barbara

Kim - January 03 2019

My dad passed away in February from congestive heart failure. He was on hospice care in my home. I’ve been going over and over his last days of life and thinking that I may have caused his death by giving him morphine and Ativan. I administered all of his medication. It was almost like as soon as we called in hospice and started the morphine and Ativan he began dying. He stopped communicating after 2-3 days on hospice care and died 2 days after. I was told the morphine was for “air hunger” and the Ativan was for agitation. What if I hadn’t given it to him? Would I have had more time with him? I am heartbroken still and it’s 11 months later.

cynthia shipley - January 03 2019

My sister battled Lupus for most of her adult life. She died two years ago. Something keeps nagging me since then. On the day she died, I arrived at the nursing home (in a hospital) at 9:30 AM she was breathing very fast. She wasn’t breathing that way when I went home the evening before at 10:30 PM. She was not responsive and hadn’t been for days. She was on Ativan and Morphine. Her husband is a respiratory therapist. It was strange that he was there as he never came until 8:00 PM, stayed 15 minutes and left every day. I asked why she was breathing so fast and he offered no answer. I thought morphine was supposed to slow a person’s breathing. She continued to breath at a fast rate of speed until 8 PM. At that time they gave her more morphine and at 8:05 PM her breathing slowed to normal. She stopped breathing a 8:09 PM. The nurses gave me very little information whenever I talked to them, although I was her health care provider. I asked that they let me know when she was near death. I wanted to be with her as much as I could. I babysat my two grandchildren and tried to split my time between my sister and my grandchildren. I had to beg her husband to visit her. That was when she was still lucid. She agreed to change her health care provider to me. I found out later that he had been having an affair. He knew all the nurses. They never told me anything as to how close she might be to death. I can’t understand why she was breathing so fast. Can you shed any light on this?

Tilly - January 03 2019

Ive been currently looking after a patient for 7 yrs with dementia, and sicotic mental health, he recently got an auto immune disorder, his body is full of sores which are infected as the dressings are green, i am a carer and have been for 30yrs, hes in a lot of pain so is now on oramorph every 4 hrs, the wounds and the smell is erendous but won’t give him any antibiotics after finding 2 bugs from his sores, he refuses for anyone to go near him to change i know he isnt gonna come out from this as i know he will end up with sepsis which will kill him, its heartbreaking seeing him like this

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