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 show. 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. My film NEW RULES for End of Life Care will also help educate families (and staff) on the use of narcotics with the dying.
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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.
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?
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
Oh Laura, I am so sorry you had such a stressful time with your mother’s passing. It is so difficult to watch someone die, particularly when you don’t know what to do. From what you have told me you did a wonderful job of caring for and being with your mom during her dying days. What you have described, although scary to watch, is how people die. Your mom actually did a good job of getting out of her body. Just think of a little chick working to get out of it’s shell, that is what your mom was doing, working to get out of her body. And it takes work—some more than others. It sounds like all the medicines she was receiving allowed her to relax and make the work of releasing a bit easier. Laura, know that despite appearances your mother could hear you and knew you were with her, supporting her during her final act of living. My blessings are with you, your family, and your blessed new baby. Barbara
Hello. My mom had stage 4 metastatic breast cancer that was all over. Her bones, lungs, lymph nodes, breast, and liver. She was amazing and lived all on her own in the 8 days before she passed, with a weekly visit from hospice and daily visits from me and my newborn. It was so hard. She suddenly couldn’t breathe well and went to the hospital, and just seemed to go into a coma. It was so strange. She was in and out of it. She woke up having stomach pain (the liver tumor) and they told her it was time to go home to hospice. When we moved her she wasn’t even coherent. She got to her final home and it was 7 days until she passed. She only woke once and was very agitated and uncomfortable, she was very very VERY thin and her bottom had a bone pressing on the bed so she needed to be moved. I kept moving her but no position helped. Finally I crushed up her xanax bc she had taken that so long and hadn’t had it, and used a syringe to put it in her mouth. She calmed down and fell back asleep and never came to again after that. She was also on morphine through all this, a full syringe every hour. She seemed like she was in a coma, she was also getting Ativan after that every 2 hours. It was sooo much medicine for her tiny 85lb body, plus she hadn’t eaten in like 5 days. Her eyes were open. She just seemed gone. I sat by her the whole 7 days while my husband and his family cared for our newborn son and daughter (we were all in the same house.) but, I could never tell after that last dose of her Xanax if she could hear me. I hated that she had woken so uncomfortable and that was her and my last memory. I had moved her 15 times and was crying telling her I didn’t know what to do to help anymore, bc she was never comfortable. And then she went back into her “coma” state with her eyes open for like 4 days and passed. How can she have heard me with all the pain and anxiety medicine? Was she in pain since her body maybe couldn’t even process the meds she was receiving?
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