MORPHINE and Dying Patients

Nurses General Nursing

Published

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

It's hard being the one to give a "death dose". I medicated a patient with 10 mg of MS and she died within minutes. I didn't feel bad because the day prior she was restless and expressing horrible pain. The next day I came in, and she was comatose and in the process of dying. He BP was horribly low but her respirations were rattly and tachypnic. Knowing her pain suddlenly wasn't cured overnight, I gave her the medicine.

Did my giving her the Morphine kill her? Did the cancer kill her and I just sped it up?

I'd like to think her last breaths were comfortable and her pain was relieved and I pray some nurse does the same for me when I can't speak for myself.

*nods*

There is a big difference between making someone euphoric in their last moments than euthanasia.

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Specializes in Ante-Intra-Postpartum, Post Gyne.

They were just talking about this in my Nursing2007 Journal

...When the hospice team provides appropriate dosage of morphine to manage the pain, the patient may die. But she doesn't die from the drug, but from the extent of the disese...

...Morphine, named for the Greek god of sleep, is often falsely accused of causing death when it actually relieves suffering, allowing patients to more fully live whatever time they have left.

Teach patients and their families that small, frequent morphine does help relieve that frightening sensation of breathlessness, a common end of life symptom. Yes, morphine can depress respirations , but thats just the action we want for a patient with tachypnea and dyspnea...

I have watched people die, they are going to go anyways. Why make them go in pain because a family memeber wants to spend every last second possible. I think it is better to have a shorter time with quality than longer with pain. Like they said above, teach. But not just the family members but nurses too....

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alois,tweety, you've reiterated what i'm trying to get across!i'm not saying i don't ever gi ve the stuff,but gen they die w/o my dose.or i might give it after ,say 6 hr's.not the q 3 others have been doing.just because it was suggested by a nurse who is'nt even there on my shift. to see the pt. is definitely comfy(so is fam) and ,like was said, this is just judicious, if not bringing a higher power into it.

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Specializes in Med/Surge, Psych, LTC, Home Health.

It's interesting that this thread has come up. I currently work on a very intense Med Surge floor that "specializes" in cancer care. We see many patients die on our floor. A few days ago I cared for a young man who was dying of tongue and throat cancer. I got an order to titrate his Morphine PCA up to 6 mg per hour. Now, like I said I am glad that this has come up because... I too have had reservations about giving so much morphine as to very hastily "speed up" the process, or to "snow' the patient.

Anyway though, I ended up giving him 5 mg hour and Ativan. He later became very agitated; he couldn't breathe. His O2 sat was very low, I found. I sat him up 90 degrees in the bed and bumped his 02 up to 4 liters. He rested very well after that, and died about 2.5 hours later, peacefully. He SEEMED to be at rest anyway. I really hope that he was.

He also had on two Duragesic patches, one 125 mg and the other I think, 25 mg.

I just wonder, after seeing your posts.. that still doesn't seem like enough medicine. I also worry that I "killed" him by giving him more O2. I don't know... I'm really very new to this intense level of end of life care.

But these posts have all been very helpful and I do thank all of you.

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Great topic.

No..never!

We have frequent hospice pts, and often treat them with Roxanol and Ativan..I want to make them comfortable.That's all I CAN do to help them.( My Mom died of pancreatic cancer and all I could do was make her death as easy as possible.I believe that personal experience made me a better nurse.)

I think all of us should have to take CEU's or something along those lines on death and dying, truely. Beyond nursing school.

I work with more than one nurse who feels uncomfortable giving these meds to the dying, and have actually seen them refuse to do it!!! Thus, education...our beliefs/fears cannot outweigh our duty.

If the meds are written PRN, scheduling times can benefit the patient also.

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Specializes in cardiac/critical care/ informatics.
I also worry that I "killed" him by giving him more O2. I don't know... I'm really very new to this intense level of end of life care.

But these posts have all been very helpful and I do thank all of you.

You can't kill someone with too much o2 unless they have COPD and that isn't usually fast.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
alois,tweety, you've reiterated what i'm trying to get across!i'm not saying i don't ever gi ve the stuff,but gen they die w/o my dose.or i might give it after ,say 6 hr's.not the q 3 others have been doing.just because it was suggested by a nurse who is'nt even there on my shift. to see the pt. is definitely comfy(so is fam) and ,like was said, this is just judicious, if not bringing a higher power into it.

Sometimes all we have to go on is our instincts and our physical assessments. Sounds like that's what your doing. Your medicating is rationally based, not peer-based or fear based. So I would say keep up the good work.

What we have to overcome, which is what the original post is about, is our fears of dosing a dying patient.

Also, sometimes witholding medications is as much a powertrip/playing God than medicating them is.

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btw, i have been told by a very sweet, very christian rn who knows how i feel about snowing people,that she would give any ms04 that i'm not comfortable with:i haven't had to call on her,& she knows what i have given that pm. i agree w/ further education,but your own beliefs will still be heavily weighed by yourself,i think,unless your a mushroom.you being anyone.

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Specializes in Med/Surge, Psych, LTC, Home Health.
You can't kill someone with too much o2 unless they have COPD and that isn't usually fast.

Thanks... there are just so many things about dying patients and how their bodies are working (or not working, whatever), and things that I have been told will actually make the process quicker.

I didn't know that if you deep suction a dying patient it will hasten the process. I thought that deep suctioning would make them more comfortable but I didn't realize it was either not a good idea or... probably rather pointless really?

I bring that up because i had a patient a couple of weeks ago who was *drowning* or at least sounded like she was. In fact she had secretions coming out of her mouth, even. I yankaur-ed her but that didn't help a lot and the family still wasn't comfortable and she didn't seem comfortable. So I thought deep suction would help. I called the RT who said she would suction the back of her throat but not go all the way down. This did help.

Later I was told that deep suctioning will "send them over the edge".

(BTW this pt had end stage CHF and COPD, not cancer)

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Specializes in Med/Surg, Psych..
as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!you become hospice,your talking ,you walking,your eating,your in moderate pain, you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???when did i become god, (or the devil)?btw, i work in a christian home.

We are all entitled to have our own beleifs, its like the issue of abortion, some people think its ok and the others dont. No one is pointing finger at you here. Please do not take it personally:)

Even though I have personanlly experienced the horror of pain by watching my sister dying from cancer but I feel that in order for us to understand our patients better specially the one who are not able to communicate their needs to us anymore, we need to put our sleves in their shoes so that we can understand what it would be like to lay there on the bed with whole bunch of tumors inside you basically eating you alive and you are in horrible pain, you can not tell anyone and you are basically at the mercy of the nurses and doctors.

So when I assess my patient this is what I do, I put myself in their shoes and as a nurse try my best to put aside my beleif....I simply think of that dying patient...nothing else.

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i'm hearig examples of people who, for instance, were in dior pain, or who had vss.india\cating possible pain:i'm talking about neither.i read the article ,and i wonder how you prove someone is in pain,when they are unconscious?it's interesting to note,who wrote these articles, pharmacuetical companies, or what is the agenda? also, i'm a great believer that the lord planned that his people would find pain relieving drugs.i just don't believe in snowing pt's for fam. closure, or so staff can say"next".iv'e doubted studies before,that have been shown latter ti be wrong.

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please excuse all the typos, i was too intense to remember to proof read.

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