If someone is very agitated (fearful) and/or has a disease history of pain then giving them medications that can reduce those occurrences can be very beneficial to allowing the person to relax and have a gentle passing from this world to the next. Fear, pain, and unfinished business are what make our “labor” to leave this world longer. All we have to do to slip out of our body is to relax.
They would have died with or without the narcotic.Īll of the above said, I am going to give you something to think about. If you give morphine to someone who is in the dying process hours before death and they die shortly after you administer the medication they most probably did not die from the drug. If you give a narcotic other than through an IV (let’s hope most people are not getting IV’s in the days to hours or a week before their death from disease) it is going to take a VERY long time for this medication to work. Even longer if the circulation is compromised which it is when a person is dying. Medications taken by mouth, skin, or rectum take a long time to be absorbed into the blood stream. It is circulation that makes medications work. Circulation is slowing down (mottling, very low 60/40 blood pressure). In the days to hours before death a person’s body is shutting down. No caregiver wants to live with the knowledge that the medication they administered made their patient die (I think this is the center of caregivers fear of narcotic administration). I will ask the obvious question here: If, when someone is in the dying process (days, hours or weeks before death), the morphine dosage were to make them die, is that really a consideration? Yes, I think it is. This tells me our bodies can take a lot of morphine and not stop breathing. A different person (body size, age) might have died.
He had no previous use of the drug, so its full effect acted on his body. I had a friend who drank an entire bottle of liquid morphine in a suicide attempt. That is part of the NORMAL dying process. If it is preparing to die then breathing and air intake will be effected.
We must remember that taking in oxygen by breathing is one of the ways the body lives. Then a small, small, amount of morphine will often ease the difficulty in breathing. UNLESS breathing is an issue, not the normal puffing and start and stop breathing that occurs weeks and days before death, but severe labored breathing.
If the person's disease history is one of no pain then there is no reason to give them morphine just because they are dying. There are diseases that do not cause pain. If the disease history of the dying person is one of experiencing pain, than we must treat that pain with whatever it takes and however much it takes to keep the person comfortable until their very last breath. First and foremost dying in itself is not painful. Here are my thoughts on the use of morphine at the end of life. What that tells me is how big the fear is, and how lacking the knowledge, around the use of morphine. In end of life care, double effect is a myth leading a double life.I have written many articles on morphine yet I repeatedly get this question. Using double effect as a justification for patient assisted suicide and euthanasia is not tenable in evidence-based medicine, he says. Palliative care specialists are not faced with the dilemma of controlling severe pain at the risk of killing the patient - they manage pain with drugs and doses adjusted to each individual patient, while at the same time helping fear, depression and spiritual distress, he adds.Īnd he warns that doctors who act precipitously with high, often intravenous, doses of opioids are being misled into bad practice by the continuing promotion of double effect as a real and essential phenomenon in end of life care. The Dutch know this and hardly ever use morphine for euthanasia, he writes. Its sedative effects wear off quickly (making it useless if you want to stay unconscious), toxic doses can cause distressing agitation (which is why such doses are never used in palliative care), and it has a wide therapeutic range (making death unlikely). The principle of double effect allows a doctor to administer treatment that hastens death, providing the intention is to relieve pain rather than to kill.Įvidence over the past 20 years has repeatedly shown that, used correctly, morphine is well tolerated and does not shorten life or hasten death, he explains. Mrs Taylor's request to use morphine to make her unconscious under the principle of double effect is a puzzling choice, writes Claud Regnard, a consultant in palliative care medicine. It follows the case of Kelly Taylor, a terminally ill woman who went to court earlier this month for the right to be sedated into unconsciousness by morphine, even though it will hasten her death.