MORPHINE and Dying Patients

jmgrn65, RN · Nov 24, 2007

no if they are actively dying then you are only making them comfortable, they are going to die whether or not you give them morphine. Can you live with yourself knowing they suffered and died, or they were comfortable and died.

cardiacRN2006, ADN, RN · Nov 24, 2007

I've been slightly uncomfortable with what other people might think of me when I'm titrating a morphine gtt on a withdraw of care pt. We titrate it to comfort. Honestly, I want them to look pretty darn comfortable for the family. So when I'm at 15mg an hour or more, I start to wonder if people think I'm trying to speed up the process (which, of course, I'm not).

I'm not uncomfortable with the actual act....I just want my pts comfortable, my family comfortable, etc...

txspadequeenRN, BSN, RN · Nov 24, 2007

i have done a lot of hospice and they will die either way you go, so send them out peacefully. i have given so much morphine you could fill several swimming pools . sometimes giving several cc's (20mg/1 ml) every 30 or 15 minutes. of course these are cancer patients and are actively dying. i have no reserves what so ever about giving it.. if they are in pain and dying ....give it

SuesquatchRN, BSN, RN · Nov 24, 2007

I have only been in one situation where I where full responsibility for a patient who was in great pain and dying. I actually was praying that he would die on my shift so his suffering would cease.

I hve no reservations at all.

SICU Queen · Nov 24, 2007

I have no reservations at all about giving morphine to a dying patient. Could it speed up the inevitable? POSSIBLY. But it's much more humane to hasten what is going to happen anyway rather than let someone suffer as they die.

If you're ever feeling uncomfortable about giving morphine, just think about letting someone die in pain and gasping. The choice should be easy.

As far as people thinking you're giving too much, DOCUMENT. As long as you are documenting that the dose is necessary, you'll have no issue. Remember, what you're doing is for the PATIENT. That is what is most important.

TazziRN, RN · Nov 24, 2007

a) a dying pt is going to die no matter what we do. i would rather see a pt die as comfortable as we can make him/her, than moaning and crying in pain.

b) pts dying from things like cancer will take higher doses of morphine than other pts. you may feel like you're snowing them but you won't be.

EmmaG, RN · Nov 24, 2007

The highest titration I've given was actually done via two continuous PCAs. One was infusing just shy of 500 mg / hr. of morphine, the other ran 10 mg /hr of Ativan. This patient had oral cancer, invasive and metastatic. It was horribly disfiguring and her physical suffering and pain was indescribable. But we got her comfortable.

Because of the tumor she couldn't speak, but she was still able to hold her daughter's hand and feel her presence. I was honored to have been caring for her the day she died, quietly and very peacefully. The morphine didn't kill her. It made her final days comfortable. To have done any less for her would have been inhumane.

Later, her daughter brought a portrait of her Mom for us to see what she "really looked like." She was a strong, beautiful woman. I will never forget her.

talaxandra · Nov 24, 2007

I looked after an end-stage cancer patient when I was a student ( a hundred years ago, when there were a lot fewer options) who was receiving a gram on morph an hour IV plus 300mg boluses up to three times an hour. He didn't die in any kind of hurry, but those last few days were significantly more comfortable than they would otherwise have been.

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.

Shantas · Nov 24, 2007

I have lost my sister from Cancer when she was only 27. We were born in poor third world country, where the treatment that were available at that time was very limited and old fashioned.

I sat beside my sister and witnessed her screaming with pain from her wound and I did not see any one giving her any kind of analgesic to releive her pain. I was 16 then and It was just horrible to watch my sister crying with pain.....I felt helpless and angry that I could not help my sister.

So I know many of us feel uneasy about giving morphine to our dying patients but I am for it because I know that my patient will be comfortable and will not suffer.

Its just awefull and I hope no one will ever have to experience what we experienced with my sister.

Elvish, BSN, DNP, RN, NP · Nov 24, 2007

Thankfully it doesn't happen often where I am but I've done it before and would do it again in a heartbeat.

When I was a newbie not yet off orientation, I had a pt - young, maybe early 30s - dying from AIDS. He had horrible bone pain, and horrible periph neuropathy. He wasn't on some of the big doses other posters have mentioned, but I was giving him (if I remember correctly) 20mg q2hr. It didn't make him die faster.

If they are in pain, their bodies will metabolize the drug. You won't kill them. You will ease their pain. You want them to die peacefully. Watching people suffer to die is NOT pretty.

suespets · Nov 24, 2007

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"