Overmedicating As Death Approaches

I received the following comment on my Blog. "They are overmedicating Mom” (The family said of hospice professionals). “Following a brief rally, she slept most of the time and died within a week." Her sons concluded she was being overmedicated with pain medication; with less medication, she would wake up and be alert again. They wanted Mom back, understandably, but that was not to be and it was not because of the pain medication...she was dying.

You are correct in your assessment. Mom probably did not die because she was over medicated. The family concerns you mention are so often exactly what people believe, however. That if Mom just didn’t have the pain medicine she would talk with them, would be alert and may even not have died when she did.

What most people don’t know is that months before death from disease or old age the dying process begins. A person begins eating less and less, sleeping more and more and withdrawing inward, talking less and less.

In the weeks before death a person is asleep more than awake, eating almost nothing and generally does not initiate conversation. They will respond when spoken to although often are confused.

In the days to hours before death a person is generally non responsive, meaning they may be moving and talking but not making sense and not responding to the world around them. This is the normal progression of gradual dying from disease or old age.

How much medication a person has is not the issue here. This progression will occur with or without medication. Withholding the medication will not have the patient waking up and talking if indeed death is days to hours away. Withholding the medication will leave the patient less comfortable (if pain has been an issue in the disease process then maybe in severe pain), overly agitated, restless and possibly with aggravated air hunger (difficulty breathing).

The guideline to use for administering narcotics as death approaches is to look at the person’s disease history. If pain has been an issue through out the disease process then continue giving the narcotic’s prescribed dosage. (Over the course of time the dosage of pain medicines is often increased.)

If pain was not an issue during the disease process then just because a person is dying does not mean pain is present and that a narcotic is appropriate. For restlessness a mild tranquilizer is effective. For labored breathing a very small amount of Morphine can ease that discomfort.

Dying is not painful. Disease causes pain. Know that we the watchers generally have a more difficult time watching our loved one die than our loved one who is actually dying does. The person dying is so withdrawn and removed from their body in the days to hours before death from disease or old age they are not experiencing their body and its sensations in the same manner as a healthy person.

I made the new DVD, New Rules for End of Life Care, in part to address the misconceptions people generally have about the use of narcotics during end of life care including the separate issues of addiction and of dying. Educating families that caring for someone at the end of their life is very different from caring for someone who is going to get better is crucial during this challenging time.

15 comments

Suz

I’ve watched several people be over medicated. Some even die. Hospice should not be about drugging a patient up so they’ll be a less burden. I’ve seen it. People can be awake. They can have that time with their family. They may sometimes be in pain. Helping manage that is what should be done. It’s gotten way out of control.
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BK Books replied:
Hi Suz, thank you for your comments. There is so much misunderstanding and lack of knowledge surrounding end of life pain management. Education is the key. Blessings! Barbara

barbara karnes

Hi Amy, about your concerns of your mom being over medicated. Right now, today, contact your hospice nurse. Have her come to the house today, and talk with you about your concerns. Have her explain why she is giving your mom the medications she is. If you are not satisfied with the conversation, completely comfortable with her explanations, then call her supervisor and explain what you are thinking and feeling. DO NOT just be unhappy and concerned BE proactive. They work for you. Ask questions, get answers you are comfortable with. You can email me at barbara@bkbooks.com. I would like, if you have time, to know how this works out for you. My thoughts and blessings are with you and your mom. Barbara

Amy Sullivan

Last night my mom was up eating ice cream after having dinner. Tonight she is knocked out. She has wound care and does have some pain. She recently was in a rehab facility and then long-term care. They recommended coming home with hospice. On day 3 of hospice, they started on heavy-duty drugs that the skilled nursing facility did not give her, and didn’t think she needed. Shw has not been out of bed or eating because she is so drugged up. I am extremely angry right now. If they had felt like she was in that kind of pain at the skilled nursing facility, then I think they would have given her more than Tylenol 3.

barbara

Hi Pamela, I am so sorry for the experience you had as your sister was being cared for by a hospice. Please talk with the hospice administrator and tell your concerns. If you do not feel the response is appropriate report the hospice to Medicare. There is a hotline for suspected abuse. This may be the place to start with your complaint -https://www.hospicepatients.org/hospic55reportfraud.html
OR: https://oig.hhs.gov/fraud/report-fraud/
As with anything there are “good” hospices and there are “not so good” hospices. The not so good need to be held to account. Thank you for writing to me. Blessings! Barbara

Pamela Casey

As far as the comments from Betty Bartlow I am in full agreement my sister was recently placed in hospice she she and I were up and talking about going to Laughlin the following weekend she was fine then all of a sudden hospice nurse came in and wanted to take her to the Hospice Care Center Ryan’s house and within 24 hours max my sister had passed away and I know it’s because of over-medicating. And I’d also like to mention the fact that when I went to see her I had asked her nurse how my sister was doing and the only words that came from that woman’s mouth was and I quote " she’s dying" I don’t find that to be a very compassionate nor professional answer to give a family member I obviously already aware of the fact that my sister was ill and dying the answer I might have been looking for was how is her mind set how is her blood pressure so on their monitoring ( so-called) which of course I was told the reason for them wanting to take her to this facility to begin with to monitor her I was never given any answer other than the one I just listed above.

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