MORPHINE and Dying Patients

Nurses General Nursing

Published

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

I think that giving a pt. who is about to pass should be given enough morphine to make them as comfortable as possible. Whether or not it speeds up the time the pt. has left on this Earth, IMHO doesn't equate the amount of pain and suffereing that pt. would go through without the medication. I agree with suespets in one regard when she says that she doesn't agree with giving a patient more morphine than needed to be comfortable. There is always "too much" of a good thing. Though, and I mean you no disrespect suespets, but I don't think an end life pt. who has no chance of recovery and is literaly on their last final breaths is too worried about anyone interfering with a "higher plan", if anything they probably want their suffering to end as soon as possible so the can return to whoever it is that they believe in, or if not, just to be able to finaly rest in peace.

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Specializes in med-surg.

The Vatican, which usually veers well on the side of prolonging life, supports the Doctrine of Double Effect - if your intent is to relieve pain, even if shortening life ios a forseeable side effect of doing so, then administering analgsesia to terminally ill patients is not only permissable but morally required. In other words, it's better to help relieve pain. Hope that helps.

I am a student nurse and what I have been taught is that pain is what the patient says it is. Through taking care of seriously ill patients that can no longer express thier wishes, I have learned that sometimes the extension of life by what we can do medically borders on cruelty and keeping the client out of pain is sometimes the only intervention we have available.

Please, please, please...make a living will. Let your family know what your desires are. Please make sure that at least one person who really cares about knows what you want and will have the backbone to speak for you when other family members insist that you must be kept alive even when there is no hope.

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Specializes in Corrections, Cardiac, Hospice.

I have been a Hospice nurse over a year now and have been a part of literally a hundred deaths. I have never, never, never seen morphine kill someone. I have, however, seen it make people comfortable and relaxed. I have noticed that instead of screaming out for me to kill them, they are able to exspress to their loved ones their feelings. I have seen them go from 48 breathes per minute to 20 after a few doses with a lot less distress.

Please read Myth #4

http://www.hospicenet.org/html/pain_myths.html

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.
i don't agree w/ giving more morphine,just cuz all the other nurses are,when a pt. doesn't appear in any distress whatsoever(gen hospice pt's)then i know my dose ended their life,& vatican or not,i don't like interveneing in the"HIGHER PLAN"

There is no higher plan that would suggest pain is the way to go! There is no reason to withhold pain meds from a pt unless they are totally comatose and show no resp discomfort or VS indicating pain. I have medicated brain dead pts to the hilt due to obvious resp distress. When a family member is standing by that bed, waiting for their loved one to pass, u do not want it to be a gasping,seizing person they remember.. I sleep well.

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Specializes in ICU, PICC Nurse, Nursing Supervisor.

if used as intended morphine does not kill so your dose will not end their life. i hope this is a typo and you care more for your patients then to let them die in pain..

i don't agree w/ giving more morphine,just cuz all the other nurses are,when a pt. doesn't appear in any distress whatsoever(gen hospice pt's)then i know my dose ended their life,& vatican or not,i don't like interveneing in the"higher plan"
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Specializes in med-surg, telemetry,geriatrics.

Nurses that withhold morphine to dying patients. Have no understanding of end of life processes and issues, dying with dignity, and generally show a lack of compassion that a NURSE should have! They are prolonging a humans suffering for their own individual agendas whether it be THEIR religous beliefs, fears, and /or ignorance. Enough said!:nono:

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Specializes in Nursing Home ,Dementia Care,Neurology..

My very first injection as a student nurse was to a terminally ill patient.Two hours later she died so I had given her her final injection.I also washed and dressed her body that day.Was I upset by it?Yes a little but knowing that she had died peacefully without pain was more comforting than watching someone fight and suffer every inch of the way to eternal peace.

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Specializes in Jack of all trades, and still learning.

When I first started nursing I found this issue very hard to deal with. Was I involved in procedures causing someone to die?

Over the years I am beginning to accept that death is a part of the continuum of life. We medicate ppl who are in pain from other causes. Why not for the pain of conditions that end in death? We should be listening to our patients. We should be observing our patients, and we should give appropriate care. We give medications to dry up secretions (depending on what school of thought you follow), anti emetics are given, etc etc. When we turn a patient for care, why shouldn't we give extra pain relief prior to doing so? Whats wrong with giving ppl control with pain medication administration pumps where ppl can give their own boluses? (We call them Grassby's, or D-LSTs)

We won't ever be able to treat the cause; otherwise the person wouldnt be dying. So we treat the symptoms. As such, I don't see that giving morphine to ease pain is wrong. Dignity, control and comfort are everything, for a person and family who are losing everything, not just a loved one, but a way of life...

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Please keep in mind the treatment objective: relief from pain.

ASPMN Position Statement on Pain Management at the End of Life

The American Society for Pain Management Nursing (ASPMN) believes that it is an ethical obligation for pain management nurses to advocate and provide for effective pain relief and symptom management to alleviate suffering for the patient receiving end-of-life care.

Ethical Tenets:

“The nurse who provides pain management uses personal and professional codes of ethics to

guide pain management practice that is characterized by respect for human dignity” (ASPMN,

1996, page 62-67.).

Beneficence is the ethical principle of “commitment to do good and avoid harm” (Thompson,

1996).

Nurses individually and collectively have an obligation to provide comprehensive and compassionate end of life care, which includes the promotion of comfort and the relief of pain, and at times, forgoing life-sustaining treatments (American Nurses Association, 1998).

“The duty to benefit through relief of pain is by itself adequate to support the use of increasing doses (of opioids) to alleviate pain, even if there might be life shortening and expected side effects” (Cain & Hannes, 1994, p. 161).

There is an ethical obligation to provide relief that is based on the pain report and mutually agreed upon goals as defined by the patients in collaboration with the healthcare team (Agency for Health Care Policy and Research, 1992; 1994).

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Specializes in Tele/ICU/MedSurg/Peds/SubAcute/LTC/Alz.

My first patient that I did hospice care on, I couldn't sleep when I got home. Through my experience, it doesn't really bother me anymore. As long as the are comfortable that is all that matters to me.

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i don't agree w/ giving more morphine,just cuz all the other nurses are,when a pt. doesn't appear in any distress whatsoever(gen hospice pt's)then i know my dose ended their life,& vatican or not,i don't like interveneing in the"HIGHER PLAN"
Perhaps God's "Higher Plan" was to provide for medication to relieve their suffering and compassionate nurses to care for them in their final days.

Here. You must have missed this: Morphine eases pain, doesn't shorten life

http://www.reuters.com/article/healthNews/idUSKIM44142020070404

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Specializes in psychiatry,geropsych,LTC/SNF, hospice.

I have absolutely no problem giving whatever I can whenever I can to make a dying person's end of life the most comfortable I can. In my belief, I would be truly lacking as a nurse to do otherwise. As mentioned by others, and supported by the links provided, morphine when given appropriately eases breathing, not stop it. What dignity is there in allowing a patient to die in discomfort when we have the ability to do otherwise?

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