Does Morphine Hasten Death? Pain Relief and Dying

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

gk

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

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

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

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

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

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