Does Morphine Hasten Death?

Dear Barbara, I have a man that regrets giving his father morphine for pain at the end. His father had cancer all over. What would you say to him to make him understand that he did not kill his father? After his father passed a family member made a comment that he gave morphine until his father died.

The use of Morphine is one of the most misunderstood practices I encounter with families and end of life issues. Our society is so drug conscious we tend to equate any use as misuse.

First, let’s understand end of life pain. Dying is not painful, disease causes pain. If pain has not been an issue in the person’s disease history then just because death is approaching does not mean the person is in pain. We do not need to use a narcotic for comfort. Ibuprofen is my drug of choice.

If pain has been an issue during the disease process then we certainly want to continue to provide adequate pain management until the last breath is taken. Just because a person is non-responsive (which most people are before death) does not mean that pain is not there. We also need to know that whatever was causing the pain is not removed by the narcotic. The narcotic just covers up the pain. We must keep the cover on. In end of life pain management we also need to know that the use of narcotics over time tends to require increasing the amount of the narcotic.

I am trying to put a lot of detailed information into a few words, but end of life pain management is really an all day or more workshop.

Now let’s address the major concern---hastening death with the administration of morphine (or any narcotic). When a person is days to hours before death their body is shutting down. Nothing works right. Circulation, the blood flowing through the body, is slower and less effective (this is what the bluish color to the hands and feet shows). When you give any medication at that time it does not get absorbed and become effective in the same way it would in a body that’s functioning normally. This is why giving pain medicine to someone who is actively dying is rarely the cause of death.

This father had “cancer all over”. I believe that means he had the potential for pain, lots of pain, in his disease progression. Morphine given continually is a must to keep this man relaxed and relatively comfortable. The morphine did not kill him, it allowed him to leave this world more gently than if he were suffering physically.

Now let's explore a controversial thought. What if the morphine had killed his father? He had a terminal illness. In fact his father was actually in the dying process. There was no reversing what was physically happening. Death was coming. What if hours of life (a few hours) could be extended by withholding the pain medicine? The result would be physical pain causing agitation and extreme discomfort even though the body is non-responsive. By continuing to give the morphine the last hours could be relaxed and relatively comfortable. Either way the person, as death approaches, is non-responsive. The misconception is that by withholding the narcotic the person would be alert and interactive. That is not the case. Either way the person will be non-responsive. It is just that in one scenario the person is hurting and the other they are not. What would you want?

Something more about Does Morphine Hasten Death?...

There are so many questions and concerns about narcotics. In my booklet, Pain At End of Life, I address the issue of narcotics and how they are used in end of life care.

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52 comments

barbara

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

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

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

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

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.

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