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 was in the last stages of COPD. We took him to St. Alphonsus in Ontario, OR, and they immediately transferred him to the Boise VA hospital. When arriving at the VA, they admitted him and we talked about the care that he would be given in the days until he passed. My dad and I had talked about this for some time, since he was worsening every day. I took care of him for 22 years, so I knew what he wanted. He had a DNR and did not want to be kept alive in the end. The Boise VA started giving him Morphine and Ativan in scheduled doses. The nurses were great, one of them even coming in early to see if my dad was in pain. He would actually give him meds a little early if he looked like he was in pain. The night before my dad passed, the nurse that was on duty took it upon herself to play God. She thought it was “unethical” for the doctors to give him so much medicine, and that it enhanced the death process, so she skipped several doses. She would come in a half an hour late for doses, and not even give him a dose if she thought it was too soon. Because of this woman who thought she could play God, my dad died in excruciating pain. I am now looking into filing charges against her because of this. I promised my dad he would not die in pain and he did, because of this woman.
Hi Lisa, there are doctors and then there are other doctors. Some we can trust our loved ones with, others, not even our pets. The question is how do we know who to trust and who not to. It used to be we knew our physician. They knew us and our bodies because of years of being involved with us. Today we are bounced from one physician to another, all in the name of specialists.
How fortunate you are to have your mom on hospice. As you have learned they are the experts in pain management, medication side effects and all end of life care. End of life care is not like “getting better” care. It is different and most hospices excel in addressing the difference. Some physicians don’t know, or at least treat, as if there is a difference.
I am sorry you and your family had this unfortunate experience. How good for all that hospice is with you now. You are in my thoughts and blessings. Barbara
My mother has extensive Non-Hodgkins lymphoma. A month ago she was told she has a few months to live. she started morphine for the pain but she has become incredibly lethargic (sleeps most of the day), strange breathing, body and hand twitching, even having hallucinations, in and out of consciousness – generally very confused and out of it – seemingly all overnight. We thought that her condition has drastically escalated after hearing the news and that this may very well be the end.
However – one visit from a nurse at the non-profit st lukes hospice and she ascertained that not only had the doctor prescribed too high a dose of morphine for my mom (which caused the weird breathing/loss of consciousness and twitching), but that the water pills she had been taking for the lymphedema had been causing dangerously low blood pressure. The reason for her confusion (lack of blood to the brain). So all these symptoms were med related. Nothing to do with the cancer. She could have died from hypotension if she didn’t stop the water pills.
The doctors who prescribed these powerful drugs did not follow up with my mom on how she was coping on the medication. All the while we thought it was the cancer so didn’t think to question the doctors.
My take on this is:
Medicine is extremely dangerous – do not assume that doctors prescribe the correct amount Do not blindly trust anyone in medical profession.. especially from someone who profits from it Doctors no longer seek to cure patients, they just handle the symptoms without looking at the root cause. Which then most of the time means the patient suffers a new set of symptoms from the treatments given.Cancer patients do not have cancer from lack of radiation and chemo. They have cancer for a reason. We need to find out what the reason is.
My mother had chf and hospice gave her morphine and she never regained consciousness after that, then died in two days. I always felt it was the morphine but they said no.
Hi Michael, It is very challenging caring for someone you care about and watching them approach the end of their life.
It sounds like your brother in law has entered what I call labor. If pain has not been an issue during his disease process then he is probably not in pain now. What you are seeing is his labor to leave his body. Just think of the little chick working to get out of its shell. We, the watchers, see the struggle and it is upsetting to us. You can certainly give him a bit of Morphine if it will make you feel better. From what you have written it appears we are talking weeks to days before death comes. I interpret his actions as activity dying. Sounds like he is doing a very good job of releasing his body. I see nothing pathological or abnormal happening. His occasional moans are just a part of the natural dying process. I don’t think they represent pain. I am glad to see you have hospice services.Talk with your hospice nurse about your concern of using morphine.
My blessings are with you and your family. Barbara
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