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.


Betty Barlow

I can not believe your article! I know for a fact that my elderly sister has been and still is being over-medicated for the past several months. Sadly, the courts are taking their time in researching the information I have given them. The court appointed Guardian ad litem has finally, after 90 days, checked into my allegations against the group home where my sister is residing and hospice involvement. He was horrified at what he found out concerning her medication and the way she looked now compared to when he first saw her three months ago.

When my sister was first placed in a group home by another family member, she was walking and enjoying her life. Within a couple months, she was unable to walk without assistance, even with her walker. We discovered from the hospice book that she had been put on medication (along with morphine) that causes lapse of memory and other symptoms similar to having been diagnosed with dementia. She has not been diagnosed with dementia yet the symptoms appear the same.

The public needs to be aware of what is happening in group homes and hospice’s involvement. I understand the Attorney General is investigating several cases in the state of Arizona and hopefully this type of euthanasia will be stopped and those involved will be prosecuted.

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