MORPHINE and Dying Patients

llerkl, ADN · Feb 5, 2011

"Terminal illness is often accompanied by severe pain and other unpleasant symptoms that cause undue suffering. The fundamental principle of palliative care is to alleviate suffering causes by intractable symptoms such as pain, dyspnea, agitation, and anxiety. The relief of these symptoms is not considered passive euthanasia or assisted suicide".*

*From American Society of Pain Management Nurses (ASPMN) Position Statement on End-of-Life Care*

I totally understand concerns though.....even though you want to keep your patient comfortable, you may feel like you don't want to be "the one" who gives "the dose" that ends up being the last one. We have an obligation to provide comfort/relief from pain, especially at the end of life. Sometimes it is just a difficult situation for all.

tencat · Feb 5, 2011

You are right, I am not a nurse. Thanks you so much for this explanation. I have been so worried that we might have killed my mother rather than just easing her distress. I do remember now reading in the hospice brochures that drowsiness may be a symptom during the dying process. When I sleep, I still think I'm sitting by my mother's bedside and that I need to be on guard for any sign of distress. Perhaps my mind and emotions will stop whirling over time. Thank you again for your kind reply.

Be gentle with yourself and take care of yourself. You've been through a horrible ordeal. :redbeathe

Morphine did nothing to your mom but make her comfortable while she was dying from a disease that couldn't be fixed. Reach out to your hospice folks if you need to talk. Just because your mom is gone doesn't mean they are not still available for you, especially the chaplain or grief counselor.

amps · Feb 7, 2011

Dear amps, I am so sorry for your loss. I can certainly relate as I lost my mother on January 29, 2011. She was 87, diagnosed with a partial small bowel obstruction, for which she had refused surgery. Along with the obstruction she developed pulmonary distress which the doctor and nurses attributed to the obstruction (which caused stomach distention) as well as her obesity and the fact she was bedridden, not to mention CHF. Strangely enough she had almost no stomach pain, but it was the pulmonary distress which was awful to witness, not just for myself but for the staff who was caring for her. I want you to know that I was with my mom during a lot of her struggling; however, she chose to leave this world after I had stepped out of the room for a 10-minute break. The hospice nurse had advised my sister and I that mothers, particularly, are protective of their children. So when they are dying, they tend to want to depart when we are not there. She advised us to give mother some space. Mother did exactly as the nurse had said she might. We left the room for a few brief minutes, and then she left this world. So please don't feel that you abandoned your mother. As you could not bear to watch her struggle, most likely she wanted to spare you further pain as well. She knew your heart was with her. I hope this brings some solace to your broken heart and ease the guilt you are feeling.
On the medication side; I can understand your concern that it did not get adminstered as you had requested. Perhaps the time of her death happened before her medication was due?? My mother died around noon, but her official time of death was recorded as the time the hopsice nurse officiated it; which was 1:30pm.
I have different guilt issues. Mine stem from the fact that perhaps my mother received too much morphine which rendered her unable to communicate with us. Hospice had only talked about relief from distress and at no time mentioned that she might be rendered in a sleep state. When I called with concerns on this matter, hospice said they felt her sleeping was simply the progression of her illness rather than too much morphine. I have my doubts.

Thank you for your responses. I always see "intent" of the medication as a way of judging it's effect. If the morphine was given to ease pain, emotional distress, and decrease anxiety than it was used appropriately. Only if it was given to purposely end life was it used inappropriately no matter who gave it or how much. I have asked for a review of my Mom's last 24 hrs including the doctors orders and the staffs interpretation of response. Hopefully this will help me. I am considering sponsoring an inservise for the nursing home staff in honor of my mother's memory specifically about using drugs at the end of life to sort of turn such a negative event it into something positive.

I too know of many instances when a person won't die until their loved ones leave but in my Mom's case it came a good 10 hours later and about 1 hr after her last dose of morphine.

anastasia1919 · Sep 24, 2012

Hello, I have a question about morphine induced nightmares.

My granddaughter was in a coma as a result of brain damage (thanks to a criminally incompetent home night nurse in Lincoln NE, who didn't know how a ventilator worked and what the alarm meant!), and to help her die peacefully and reduce air hunger, she was given large doses of morphine. I have just learnt that morphine causes awful nightmares, and I wonder whether administering morphine was the right thing to do after all. I can't bear the idea that my beautiful 3 year old died having nightmares.

Why is morphine administered if it causes nightmares for the dying?

Thanks to all for any comments.

SaoirseRN · Sep 24, 2012

Morphine is given because it works. I have rarely heard of people having nightmares. What I hear from those who have had morphine is they feel better because they aren't in pain. Perhaps it CAN cause nightmares, but I think the benefits of analgesic outweigh potential nightmares.

I've given buckets and buckets of morphine to dying patients and they are comfortable. Peaceful. If they were having nightmares they wouldn't be.

JustBeachyNurse, LPN · Sep 24, 2012

Hello, I have a question about morphine induced nightmares.
My granddaughter was in a coma as a result of brain damage (thanks to a criminally incompetent home night nurse in Lincoln NE, who didn't know how a ventilator worked and what the alarm meant!), and to help her die peacefully and reduce air hunger, she was given large doses of morphine. I have just learnt that morphine causes awful nightmares, and I wonder whether administering morphine was the right thing to do after all. I can't bear the idea that my beautiful 3 year old died having nightmares.
Why is morphine administered if it causes nightmares for the dying?
Thanks to all for any comments.

We're sorry for your loss but we cannot offer much information in this situation due to the site terms of service. As the other poster stated, morphine is given to patients because it works in a variety of ways, not just pain control.

Vickyanns · Jul 26, 2017

I was an Licensed practical nurse for 23 yrs I an now on hospice and just started liquid morphine I've had horrible pain before this even crying out for my mom, it's helped tremendously, please don't make your patient s suffer, just remember follow orders, when in doubt ask, if uncomfortable get different nurse or maybe explain to supervisor how makes u feel see if u can switch patients.ty

allnurses Guide · Jul 26, 2017

I was an Licensed practical nurse for 23 yrs I an now on hospice and just started liquid morphine I've had horrible pain before this even crying out for my mom, it's helped tremendously, please don't make your patient s suffer, just remember follow orders, when in doubt ask, if uncomfortable get different nurse or maybe explain to supervisor how makes u feel see if u can switch patients.ty

Thank you for sharing this with your fellow nurses and students, Vickyanns. I have always learned something new and valued these firsthand experiences "from both sides of the bed".

Although many people misunderstand the role of hospice and pain management, if we resolve to educate however we can for however long it takes, fewer people will suffer needless distress.

I say if crying for your mom helps, do that, too. ((Hugs))