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.



Connie, thank you for sharing how your husband’s death occurred. It certainly presents a puzzling picture. Being with many, many people at the moment of death I just want to give you something to think about: if the nurse gave your husband morphine and the very next moment he was dead the morphine dose (no matter the size of the dosage) did not have time to get into his blood stream and cause his breathing and heart to stop. His immediate death, with his talking just before the morphine was given, has me wondering. Something happened but since I do not know what his illness was I don’t have enough information to explore further. If you would like to contact me to talk further use my personal email barbara@bkbooks.com. My thoughts and blessings are with you. Barbara

connie gravelle
I was talkingbto my gusband when a nurse came in and asked my husband, ow is your pain. My husband her about a 3 or 4’ not too bad. Then she immediately gave him more morphine. He closed his eyes and died at that moment. . He was declared dead. My heart was breaking . One minute we were talking and then he was dead. He never opened his eyes again. What that nurse did was kill him. . You cannot convince me other wise. She had no business to give me another diose of morphine when he did not need it. I lost my husband of 41 years . I believe patients are overmedicated deliberately.
Barbara Karnes

Hi Diane, I just don’t have enough information to guide you here but here are my thoughts. I am wondering if your mother was complaining of pain during the hospice interview. What led hospice to think Morphine was appropriate? Was your mother short of breath due to the cancer in her lungs? Pain and shortness of breath are the two reasons I can think of that would require Morphine. Yes, her lethargy and non responsiveness (from what you have described) was the result of the morphine. I suggest you ask the nurse that gave the morphine why she thought your mother needed it. You mentioned you did not expect your mother’s death for 6 to 8 month. Numbers given by anyone are always misleading. We just can’t put numbers on how long someone has to live however the fact that she was alert and active tells me she probably had not entered the dying process. You have not said if your mother woke up or did not wake up and then died. Blessings! Barbara


Regarding an initial visit from hospice nurse to sign up for care is it typical that within the first 20 mins of meeting a patient that morphine is prescribed? And again two more doses within he next 30 mins for a total dosage amount of 45 ml? Our mother although sick was not expected to pass for another 6-8 mos. our mother was in good spirits and had even said she was wanting to go out that day for a meal. Four hours later she was lethargic and nonresponding after receiving morphine. Can you please advise on this practice if over medicating with morphine ? Our mother did have lung cancer. Thank you

Barbara Karnes

Betty, thank you so much for writing about your experience with the nursing facility and hospice. Unfortunately not all medical care professionals understand end of life progression and care. I find throughout this country there are too many professionals that believe dying is painful and narcotics are the answer. I believe their heart is in the right compassionate place. It is knowledge that is missing. I can’t say loud enough or often enough that dying is not painful, disease causes pain. Check the disease history to see if pain is an issue. If it is, medicate with whatever it takes to provide comfort BUT if pain is not part of the disease history there is no need for narcotics.
I am sorry you and your sister are in this situation. Have you thought of changing facilities and hospices?

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