MORPHINE and Dying Patients - page 16

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

  1. by   talaxandra
    Vancouver Son - in my experience, low-dose morphine can, sometimes, shorten the dying period, but only by a period of hours, and only for a person who's already close to dying. Its primary use in these cases is to reduce anxiety, improve cardiac function, and ease respiratory distress.

    While large doses can supress the brain's respiratory drive (which is what kills people who overdose), in small doses this is only true if there's serious kidney or liver function, or advanced respiratory disease.

    I agree the doctor should have discussed things with you and your family, but if it were me I'd have explained what it was about your mother's condition caused me to conclude that she was "probably nearing the end" and how this time was different to the previous admissions where she'd bounced back.

    You didn't say how long your mother was in hospital on the occasion, nor what kinds of investigations she had; and in any case the ToS prevent diagnosis. There are certainly elements that flag a significant change, particularly the shallow breathing and difficulty swallowing. And, at least where I work, subcutaneous (rather than IV) hydration is used almost exclusively in end-of-life care.

    The langage health care practitioners use sometimes has different meanings to us than to lay people - if I tell a colleague that a patient doesn't look very well, for example, it means that I have serious concerns about their wellbeing or potential to deteriorate without warning. It's often difficult, especially for less experienced staff, to realise that these code words aren't heard the same way by all audiences. I have many times had the experience of a doctor telling me s/he'd explained a patient's condition to family, only for me to realise when speaking to them that there had been two, very different discussions - what s/he said and what they heard. I wonder if that might be the case here.
    Last edit by talaxandra on Aug 21, '10
  2. by   leslie :-D
    Quote from Julieann79
    My grandmother had 2 shots of morphine within 6 hrs and she was gone. But, she was 101 and had pnemonia in both lungs. The Dr. said "I don't even think a 40 yr old could fight this". I'm glad that they gave her morphine in the sense that it helped relieve pressure from her chest and back. On the other hand I was sad because she wasn't coherent. I would have loved to have had one last conversation with her. I guess morphine is good in some ways, but not others.
    when folks are in need of strong narcotics, there is always that balance betw alleviating pain and maintaining coherency.
    from your description of your grandma, it sounds like she definitely needed the morphine.
    otherwise, her death would have been miserable...
    nothing worse than the feeling of drowining in your own fluids.

    had you observed her struggling like that, i highly doubt that conversation would have been on your mind.
    however, of course i sympathize w/you wanting that 'one last time' with her.
    but from a professional point of view, i am very relieved to hear she got that morphine, and that she died peacefully.

    please accept my condolences.
    she lived a wonderfully long life.

    leslie
  3. by   VioletKaliLPN
    vancouver son~
    i am sorry you lost your mother.

    you do not have to be terminally ill, such as a dx of cancer, to be "nearing the end". people die from natural causes all of the time. their bodies become weak, they begin to have difficulty breathing, fevers, etc. these patients deserve comfort.

    all of my experience is in ltc, with the elderly. i have seen many patients pass away without having a 'terminal illness', they begin the steady decline downwards. we ensure their comfort is a priority.

    your mother did not have to have a terminal illness, like cancer, to be 'near the end'. her body was wearing out. she was 86, chronic diahrreah, which is no small matter, and she may have had other undiagnosed issues.. she began the breathing patterns that were hallmarks of impending death, and they desired to make her comfortable.
    Last edit by VioletKaliLPN on Aug 21, '10
  4. by   tencat
    Quote from Vancouver Son
    I think you know Morphine speeds up dying. But I didn't.

    Our mother was declining - no doubt - at 86, in and out of hospital on various stomach ailments (primarily chronic diarrhea), but always bounced back. Then she came down with low fever and was put to bed. Breathing shallow, unable to swallow, subcutaneous IV, etc, and the Dr said 'Well, she's probably nearing the end" and ordered morphine as required. Now you need to know my mother was not "terminally" ill - no cancers, etc, just old and beaten down by vague, undiagnosed ailments. From the time they administered the first low dose of morphine (two in total) to the time of her passing, it couldn't have been more than 4 or 5 hours. So in my humble opinion, as a professional, but not a 'medical' pro, the morphine relaxed her to such a degree that she could no longer fight for life - let alone breath. Remember - this was someone who was NOT terminally ill with any life-threatening condition - other than old age. Cynical? You bet. Should Doctors explain this to families in advance? Absolutely!
    So sorry for your loss, but your mother DID NOT, DID NOT, DID NOT die from morphine!!!!! She WAS terminally ill if she was unable to breathe and could no longer swallow: that's the body's way of telling us we are ready to die. Why should she have to fight to stay alive at 86? We do not live forever. 86 is elderly and a perfectly normal age to pass away, even if we are not ready for our loved one to go. Truly, I'm sorry you think the morphine killed your mother, but PLEASE don't perpetuate the 'myth' that morphine will kill people. The health care professionals should have explained to you about death and dying and how morphine allows those who cannot breathe comfort in their last hours rather than having to struggle for breath.
  5. by   leslie :-D
    Quote from Vancouver Son
    I think you know Morphine speeds up dying. But I didn't.

    Our mother was declining - no doubt - at 86, in and out of hospital on various stomach ailments (primarily chronic diarrhea), but always bounced back. Then she came down with low fever and was put to bed. Breathing shallow, unable to swallow, subcutaneous IV, etc, and the Dr said 'Well, she's probably nearing the end" and ordered morphine as required. Now you need to know my mother was not "terminally" ill - no cancers, etc, just old and beaten down by vague, undiagnosed ailments. From the time they administered the first low dose of morphine (two in total) to the time of her passing, it couldn't have been more than 4 or 5 hours. So in my humble opinion, as a professional, but not a 'medical' pro, the morphine relaxed her to such a degree that she could no longer fight for life - let alone breath. Remember - this was someone who was NOT terminally ill with any life-threatening condition - other than old age. Cynical? You bet. Should Doctors explain this to families in advance? Absolutely!
    i don't how i missed your post, vancouver.

    i agree with what the others are telling you, about morphine NOT causing your mom's death.
    she may not have had any diagnosed illness, but she was indeed, terminally old.
    even if your mom died of natural causes, she displayed the applicable symptomology before she got the morphine.
    with my yrs of experience as a hospice nurse, i can say that she would have likely died within hrs anyway...
    and not "bounce back".

    all that said, i truly am sorry for your loss.
    it sounds like you miss her tremendously.

    btw, did you read the study where folks who are on palliative care, with their pain being properly managed (with morphine and other opioids), that they actually live longer?
    if anything, evidence is showing us that the opposite is true:
    that when folks get relief from pain and/or other distressing symptoms, it shows they are living longer.

    what i'm telling you, is morphine did not hasten your mom's death.
    it just sounds like it was her time to go.

    heartfelt prayers for peace and healing.

    leslie
  6. by   LMoonRN
    Principle of double effect: You are giving the morphine to treat pain and/or dyspnea and as a consequence the morphine may hasten death. Hastening death however is not the original intention. To treat pain,dyspnea, and reduce suffering is and should be the intention. The morphine is not killing the patient, the underlying disease or condition is.
  7. by   Vancouver Son
    Thanks to all for your thoughtful replies. I'm not suggesting morphine 'killed' my mother (hydra morphine I think it was called), her underlying conditions and age were the cause. I am however simply wondering why medical professionals don't fully explain that administering this drug can, essentially, speed up the ultimate end as it evidently reduces the person's ability to fight back when they are such a weakened state. As I said - maybe you know this - I didn't, and there was no explanation from the doctor that this could speed things up. I'm not suggesting right or wrong, just raising a pretty legitimate question in my mind. The fight for life is instinctive - so medicate to make the patient as comfortable as possible for sure - but taking action that may speed things along seems "euthanistic" to me. I agree, she was dying and the drugs may have reduced her distress, I don't have the answers..but appreciate your views above. I think my mother received the best care she could have received and I thank God she passed away in Canada.
  8. by   talaxandra
    Hi Vancouver Son,

    I'm glad to read that you don't think the morphine caused you mother's death, as I had thought from your first post that maybe you were concerned about this aspect.

    A couple of things: first, though many people fight until the end, that's far from always the case. Sometimes, particularly after repeated bouts of illness, people just quit, even though they've battled successfully many times before; I've also seen people who had a fair to good chance get a diagnosis (most commonly of cancer) and give up, dying within days even though the disease is not yet terminal.

    The other thing, which leslie addressed on the previous page (in response to julieanne79), is that the morphine was given to reduce symptoms that would otherwise have made your mother's last hours miserable. Had it been given to assist her to die faster then 'euthanasia' would have been an appropriate phrase. However, when a drug is given for symptom relief, even if hastening death is a foreseeable possibility, it isn't euthanasia - this is known as the Doctrine of Double Effect. The DDE allows health care practitioners to prescribe and administer medications like morphine to relieve pain and other unpleasant disease symptoms, even if the dose or frequency or patient condition means that death is more likely to occur sooner. If health care staff were to withhold these kinds of medications out of concern of hastening death then very sick and dying people would be significantly undertreated.

    That said, it certainly sounds as though nobody explained that a possible consequence of relieving what sounds like respiratory distress (from your description in the first post) may be that your mother died a little sooner. However, in my experience, based on over twenty years of acute care nursing, someone who dies after receiving two small dose of morphine (or hydromorphine) over a span of four to five hours is imminently dying regardless.

    I hope, in posting, that we have addressed any concerns you have that, without the medication, your mother would have bounced back, as she had during previous admissions. I am sorry for your loss.
  9. by   tencat
    Vancouver Son: I reread my post and it sounds kind of harsh, so I want to apologize for that. I didn't mean to be snarky. I'm sorry your mother passed. I'm glad you're willing to try to understand why and how morphine fit into that picture.
  10. by   dukesgal
    When my grandpa was in the hospital from complications of pneumonia, he suddenly took a turn for the worse and lost consciousness. On that last day, we knew he would not recover, but our family opted to make him as comfortable as possible. I still remember holding onto his his hand as the nurse administered that last dose of morphine and his respirations slowly decreased. He died about 20 minutes later. I don't believe it hastened his death, I just believe it was his time to go. He was comfortable and it was peaceful for our familiy to be there for him and not see him in agony. I think that particular experience has made me a better nurse and advocate for my patients to get effective pain relief.
  11. by   leslie :-D
    when my mom was in icu and unconscious, a mso4 gtt was started after we dc'd txs.
    within a couple of minutes, we could see my mom's entire face relax...
    my point being, never assume that folks aren't uncomfortable just because they're unconscious.

    i always study/assess my pt's faces and muscle tone, even when obtunded or comatose.
    i want to see total relaxation, no matter how much medication it takes.

    leslie
  12. by   Vancouver Son
    Thanks all for explaining the hydra morphine. I accept it was my Mum's time to go. If anything, I wish we could have made her a bit more comfortable some hours earlier than we did. At the end of the day this is a 'nurse's' forum..so appreciate your indulgence. I hope your health care reforms in the US are true reforms that will benefit all and not turn out to be yet another game designed to line the pockets of insurance companies. Fight for it. We're fighting to keep our system against powerful lobbies. No one's mother should suffer. Best of luck to you and yours.
  13. by   amps
    My 94 1/2 year old mother recently died from respitory failure, pulmonary edema congestive heart failure, ischemic cardiomyopathy, acute and chronic renal failure and endstage dementia. Her breating was extremely labored and noisy and she was working very hard at breathing. The staff gave her morphine 5mg about every 6 hrs and I (coming from an ICU background) thought giving less mg more frequently would have made her more comfortable. I have been with lots of patients during their last living moments but seeing my mom suffer so much at the end hurt beyond words. What do you think about the dosing of the morphine? Should it have been less and given more frequently?

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