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.
55 comments
Thank you for such a a concise explanation. I gave my parents pain meds during hospice..they were in pain and needed relief. Sometimes we doubt ourselves, but helping someone feel better is important..and it helps to be reminded of it.
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BK Books replied:
I’m glad I was able to put your mind at ease. Narcotics given correctly bring comfort. Blessings! Barbara
I have 2 experiences this year and both confused me. My grandmothers husband was fighting cancer at home after he was given 2 months to live , he refused morphine besides the patch and then the pain was awful and he was moaning with each breath for days while not eating for 5 days at a time due to not wanting to feel sick then as a nurse turned up to give him anti sickness she heard him say he wanted to die and so she gave him anti sickness and morphine injection and as she left the house he was vomiting and unable to cough as if the morphine somehow stopped him having the strength to cough! Did morphine relax him too much to cough up the
Vomit ?
A month later my father in law was taken into hospital where his cancer had caused internal bleeding and they said there was nothing they can do and that his blood pressure and body temp will keep dropping until he died. He was talking and normal until they started pumping him with morphine and he went into a coma type state but he was breathing so hard and snoring and twitching and looked like the morphine had caused him to breath with so much effort and then all of a sudden he opened his eyes looked around the room cried and then took his last breath. Did the morphine cause the breathing to be difficult ? Did the morphine cause a heart attack Or will blood pressure dropping cause the awful breathing and snoring ? Just felt like they gave up on him and gave him morphine to end his life ! Cause
Of death was spontaneous gastrointestinal haemorrhage which was caused from metastatic renal cell carcinoma
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BK Books replied:
Hi Tanya, I am so sorry for these experiences—for you and your family, your grandmother’s husband and your father in law. Neither of them, from what you say, seemed properly handled. I am shocked the nurse, was it a hospice nurse, left? From what you described the morphine did not have enough time to get into his blood stream and have any effect. He would have choked with or without the morphine. With your father-in-law’s death from what you described (dropping blood pressure, unusual sounds, facial expressions) he was doing what people do as they are dying not because morphine was causing them. He would have died with or without the morphine. Hospitals don’t tend to just “give up” on people. Hospitals are trying to keep people alive. My blessings to you and your family. Barbara
My dad didn’t get enough of pain medication at the end and he was on hospice. He was in pain continuously. Wish he had been on a morphine drip.
Dear GK, about your blog comment question of did the Valium given cause death? I don’t have enough medical history to know if your father’s death was the result of stopping his medications and/or taking Valium. What I can say is when I deem a person weeks from death I stop all medications except pain meds. When death is eminent why prolong the labor of dying. When restlessness and agitation is severe enough to put the person in danger of hurting themselves then Valium is very appropriate. It doesn’t hasten death but keeps the person out of harms way of falling out of bed, or otherwise hurting themselves. When we enter the dying process, months before death, our personality doesn’t change, it intensifies. If we were controlling and irritable in living then as we approach death we will be more controlling, more angry, more irritable. Those changes have nothing to do with us, the family.Hindsight, looking back over what we might have done, gets us nowhere. How well we live our life now is the job of us the living. Remember no one sets out to do a bad job. We always to the best we can with what we have to work with in the moment. My blessings are with you. Barbara
Dear Trudy, I have read your comment on my blog about morphine killing. Your description of your husband’s last hours are certainly disturbing. I don’t know your husband’s medical history to have an opinion of why or what was occurring. What I do know is 26 years is too long to carry the guilt. We always do the best we can in any given situation. None of us set out to make mistakes or do a bad job.I want you to sit down and write your husband a letter. Writing is important, don’t just think, write, what is in your heart. Write what you have carried all these years, the guilt, the sadness, the fear you felt, the lack of knowledge you had, the helplessness you felt. Write what you wish you had done, what you would do if you had a “do over”. Let all the tears, the anger, all the feelings and thoughts you have carried all these years out and down on paper. Then burn the letter, go outside and throw the ashes to the wind. Watch the ashes fly away and with the ashes all the thoughts and anguish you have carried for so long.It is time you live in the present. It is time you let how well you live your life be the gift you give your husband. Blessings! Barbara
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