MORPHINE and Dying Patients

Nurses General Nursing

Published

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.

After seeing both sides of this issue, (my mom was a brain cancer patient and we cared for her in our home until she passed away and with hospice's help in pain mgmt), I would never worry about giving too much morphine or hastening her death. I just dont believe that happens. The morphine does what it is supposed to do, relieve pain. It was so important to us that my mom die as comfortable as we could possibly make her. Why make anyone suffer in severe pain when they are dying.

Marta

Specializes in cardiac/critical care/ informatics.
It seems a heck of a lot of ms04 is given by other nurses than the orders i've followed through on, i guess the lord won't hold it against me if I believe i'm assisting someone in dying but don't know it for sure.What is the difference between dr.kevorkian and ms04 orders for dying pt's?

Ok it is VERY unlikely the dose of ms you give is going to kill the pt. UNless you give it when their resp. is 4. If paitients are getting ms around the clock they build a tolerance to it. Besides if it is ordered to give you are covered, and just becasue a patient is asleep or in a coma DOESN'T MEAN THEY CAN'T FEEL PAIN! this has nothing to do with be a christian at all.

The Difference is Dr. Kevorkian actually assists a person with dying by giving a lethal dose of potassium, as well as a sedative so that they don't feel the affects of the potassium.

Specializes in Med/surg, ER/ED,rehab ,nursing home.

I know I used to feel a bit uneasy with large doses ( in my inexperienced life) but no longer do. I have seen enough suffering, and have seen how the morphine does not do anything much except give relief. Is this any different than a type of anesthesia? How about turning a dying patient? Sometimes they will DIE, quit breathing, heart stop, after turning them. God choses when you die/ and relies on us to provide comfort if we can.

Specializes in LTC.

I have been a Hospice nurse for many years. I don't have a problem with keeping my patient as comfortable and pain free as possible during their last hours. I would do nothing to hasten their death but when my time comes I hope I have a nurse who is kind enough to smoke me. I'd rather ,as they say, "Go quietly into the night". ALOHA

I have no problem w/giving morphine, esp to a dying pt. It's sad that so many people have had to suffer when they die. It's so sad when someone does die, but if they can go peacefully, that is so much better.

Specializes in Med/Surg - Pain Management.

As pain management is a particular interest of mine I am very happy to see the replies to this thread. If a patient is dying then make them comfortable. That is what pallative care is all about. However, don't forget the other patients...those not dying but with moderate to severe pain. They too deserve pain management. I am constantly frustrated with nurses who say they don't believe the patient is in as much pain as they state. For those of us in acute care we need to start believing and medicating accordingly. Note I don't refer to detox or drug rehab issues...the point is for acute pain & chronic pain in the patient without a history of addictive disease to be believed. But....even the patient with addictive disease deserves pain management. If they are dying or not they will be more likely to be tolerant and need even higher doses due to their addictive process .

i feel they should have what ever they need for pain. you want to keep them confortable as they are dying.you dont want them in pain .

Specializes in geriatrics and hospice palliative nursin.
feelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?

BTW, if the order is for every 3 hours and YOU decide to withhold a routine dose you are making a medication error. A patient may be on routine morphine for many reasons, and to withold just because they are asleep or unconscious is wrong.

Specializes in Trauma ICU,ER,ACLS/BLS instructor.
As pain management is a particular interest of mine I am very happy to see the replies to this thread. If a patient is dying then make them comfortable. That is what pallative care is all about. However, don't forget the other patients...those not dying but with moderate to severe pain. They too deserve pain management. I am constantly frustrated with nurses who say they don't believe the patient is in as much pain as they state. For those of us in acute care we need to start believing and medicating accordingly. Note I don't refer to detox or drug rehab issues...the point is for acute pain & chronic pain in the patient without a history of addictive disease to be believed. But....even the patient with addictive disease deserves pain management. If they are dying or not they will be more likely to be tolerant and need even higher doses due to their addictive process .

I think u should cut and paste this to all threads on this board having to do with ER and questionable pain issues. You stated it much better then I ever have.

As pain management is a particular interest of mine I am very happy to see the replies to this thread. If a patient is dying then make them comfortable. That is what pallative care is all about. However, don't forget the other patients...those not dying but with moderate to severe pain. They too deserve pain management. I am constantly frustrated with nurses who say they don't believe the patient is in as much pain as they state. For those of us in acute care we need to start believing and medicating accordingly. Note I don't refer to detox or drug rehab issues...the point is for acute pain & chronic pain in the patient without a history of addictive disease to be believed. But....even the patient with addictive disease deserves pain management. If they are dying or not they will be more likely to be tolerant and need even higher doses due to their addictive process .

I am so happy to see your response. I am not only a nurse but a chronic pain patient. Let me tell you, it is very difficult to get people to truly understand what we experience on a daily basis. I have had chronic excrutiating lower back pain for 14 years, actually since the day my daughter was born. It has gotten progressively worse, I have tried everything, including the fluroscopic S/I Injections. My doctor has me on vicodin and I have taken it for years now, I worry all the time about the amount of tylenol in it, so I have been weaning myself off it. I would rather deal with the pain I guess than the liver damage that can happen with that much tylenol. I certainly wish they would treat chronic pain patients with the same respect they do cancer patients. I have no choice, I have to work, take care of my family and live life, no matter how much pain I am in, so good pain mgmt would be helpful. I can't just lay around in bed. Kudos to those nurses that are working in the field of pain mgmt. I could never do that, because I would empathize too much and it would be too hard to see people suffer and know there's not much you can do for them. Just so no one starts to think I am working as a nurse while taking vicodin, I'm not. I am now working as a travel agent because spending so much time on my feet was too painful for me, so due to my chronic pain, I have not been able to do the job I love, was trained to do and thought I would be doing for the rest of my life!

Specializes in Hospice, Psych, Geri, LTC.

I do Hospice in the home, NF, inpt settings and use Morphine alot. It is the drug of choice for extreme SOB esp if the pt is dying. If the pt is actively dying it only gives them comfort so they may die comfortably and with some dignity. If they are in distress, alot of pain, active I say go for it..get the order from doc to give the pt some peace.I have never felt like I was killing someone by using Morphine and have never been accused of it by the families or facilities.We are pt advocates.

Suespet I respect your opinion but just because a patient 'looks' comfortable does not necessarily mean this.

If a patient was in pain and receiving regular pain medication before the active dying, non communicative phase, then they still have pain. Pain does not miraculously stop once they are unconscious.

Pain medication still must be given to ensure their pain is controlled as best we can.

That is what we do being their advocate and care giver. We remain one step ahead and vigilant of all we can do.

The Lord certainly knows where our hearts are and that is doing the very best we can in our comfort measures of those patients put in our care until their (we pray) comfortable death that they request.

Amen sister! I have worked with a pediatric population who also (the little ones) cannot always communicate their issues, so I gave them regular doses of meds to relieve their pain, even though they couldn't tell me. It's not the same, exactly, but same principle. Just because they 'look' comfortable does not mean they are.

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