Morphine: the Best Drug at the Worst Time?

The hospice nurse has strongly suggested using morphine for the patient’s increased pain.

You are the patient, still alert and oriented, able to make your own decisions. What will you say to the nurse?

You have the authority—the durable power of attorney for health care—to make decisions when your loved one is unable to choose. What will you say to the nurse?

Every person and family is different. Some, when faced with the toughest decisions in hospice (like starting morphine for pain management), surprise themselves when they are all in agreement. Other families, who may easily agree on whose house to go to for Thanksgiving, or the right gift for Mom and Dad’s fortieth wedding anniversary, either debate or procrastinate about morphine as an option. And nearly every hospice professional has encountered a chaotic, angry, opinionated—yes, over-the-top dysfunctional—family that seems to go to war when a drug like morphine is a loved one’s suggested next step.

Morphine is an effective, scary, and powerful medication. It often becomes the tipping point for resisting or accepting hospice’s comfort care philosophy.

Nurses sometimes use a scale with “faces” to ask about a patient’s pain. Those same faces can represent how various people react to using morphine. Which face are you?

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What is morphine’s reputation?

It’s not a good medication, but a bad drug. If someone has pain, she or he should take aspirin or Tylenol. If the hospice nurse wants to use morphine for your pain, that’s little different than some “street person” hooked on heroin and always desperate for the next “fix.”

Or worse . . .

Sure, morphine will mask the awful pain, but it makes you incoherent and drowsy. You won’t be able to have any last, good conversations. You won’t even know who’s holding your hand.

And worse yet . . .

It kills you. Everybody can find a story on the Internet or from a friend of a friend about family members giving morphine to their loved one . . . and shortly after that dose, the patient takes a final breath. Why did they die? Was it me that delivered the fatal dosage? Blame yourself. Blame the nurse. Blame the hospice. Blame morphine.

Morphine is none of these things.

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Once, after a hiking accident, an emergency room nurse gave me morphine. No one asked me if I wanted it. With my left limb broken in three different places, any movement caused severe pain. By the time you notice the next comma, (there it was) my pain had dramatically diminished.

For most people, morphine works quickly and efficiently.

It didn’t work for my mother. After Mom’s sudden and serious cancer diagnosis, and following the mixed results of back-to-back surgeries designed to give her temporary relief, she confronted terrible pain. But she’d already instructed the doctors to not use morphine. In the recent past, morphine’s side effects may have caused her to experience delusions. Her wishes were honored and other medications—for Mom, it was dilaudid—helped ease her physical anguish.

Morphine won’t always be the best choice for pain.

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Morphine, when prescribed by responsible medical staff, is a tool for most patients that can be extraordinarily successful at reducing or eliminating pain.

Of course, an overdose of morphine could kill you. But so can water! One of the most troubling public revelations in recent years has been the use of extreme torture methods like “waterboarding.” Words can’t describe my disgust for any form of torture against any creature. But, for the most part, it’s “only” water. We need water for life! But drowning does kill. Flooding kills. Consuming too much water will likely harm you, or even cause death. Too much of anything is bad.

Because of allergies, or prior “bad” reactions (like my mother’s), or when members of a family endlessly argue about using morphine while the patient suffers, there will be other choices for pain management. Every good hospice, and every good hospice physician and nurse, will listen carefully to a patient’s needs and try to respond with appropriate, acceptable choices.

Morphine, administered properly, will not be addictive for a patient with a life-limiting disease.

Morphine, with the guidance of the hospice medical staff, may cause patients to be incoherent and drowsy . . . making communication difficult. But without the medication, the pain will become literally unbearable. A suffering patient will suffer even more. Morphine is never an easy choice, but as options for comfort become limited, it is a compassionate, necessary choice.

Morphine does not hasten death or cause death. The disease is killing you.

Nothing I offer here is easy to write or read. If morphine is being considered for you or your loved one, you are likely in the final stages of a devastating illness. All decisions—including medications—can cause spiritual, emotional, familial, personal, and physical anguish.

When a hospice nurse or physician is suggesting morphine as an option, they are doing so because they are kind, compassionate, and focused solely and completely on caring for you.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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Comments

  1. Two years after my father died, at age 94, having only been obviously ill for 24 hrs due to a “shredded cardio vascular system”, my sister called me and said: “It’s your fault Dad died!”
    I had been a Hopice Volunteer for years and am a staunch advocate for palliative care. The doctors had informed me that he’d had a massive coronary, there was a blood clot in his left ventricle, and he wasn’t metabolizing oxygen, I knew a decision had to be made.
    I was the only family member there, and spoke to my Dad. He asked me: “Am I going to pass away?” I answered honestly, telling him that his condition was very serious. I will NEVER forget his response: “This isn’t too bad, I have no pain.” After promising him I’d keep it that way, I talked to the Docs, approved the morphine and said ” no extraordinary measures”. He died peacefully, with his family all around him, about eight hours later.
    The call two years later was the result of an article my sister had just read that stated that morphine decreases respiration. She was livid, believes we have to suffer to pay for our sins, and rather than argue, I just said: “In compassion, I elected to keep Dad pain free and I’d do exactly the same thing tomorrow “.
    She has truly never forgiven me – has never acknowledged that my Dad wasn’t metabolizing oxygen anyway – but my conscience is clear and at peace.

    • Judith-
      Sigh. Yes, families disagree. I hope some form of communication continues and there is some “forgiveness” from your sister. The decisions you made were not easy, but clearly for the best for your father. Thanks so much for sharing!

  2. My wife had a very high tolerance for pain and avoided taking medication as much as possible, especially narcotics. When she went into home hospice, the nurse gave us medications to use including Morphine. Towards the end, when I would ask about the pain and did she want something for it, it was always maybe, but not the Morphine. The last day her best friend came by to visit. When she left, she pulled me aside and told me she is in great pain. How do you know? I asked. She could tell by the furrow in her eyebrows. I hadn’t noticed, but I immediately administered the Morphine. There was then a sense of calm in her demeanor. Why were we both so stubborn?

    It’s been a year and half, but i still can’t get over the pain we let her suffer through.

    Thank for your writings. I’m now a Hospice volunteer, and they are very helpful to me.

    Mark

    • Mark-
      Thanks so much for sharing your time with your wife. With many patients (with so many loved ones), they decline/refuse some of the “stronger” drugs. There are more reasons for “Why?” than anyone can list . . . and some reasons that couldn’t be captured by any reasonable words. We all get “stubborn.” But I am glad that her best friend spoke up and your wife had a “sense of calm.” Truly, thanks for sharing . . .

  3. Morphine is not GODS will!! Our Lord and saviour JESUS CHRIST suffered on the cross for us all!! So show your respect and obedience to JESUS and accept him as your GOD!! Suffer for him as he suffered for you!!
    Satan will take you if you do not repent your sins because you are doped on devil drugs!

    I’m kidding but considering this site slips in scripture and is probably based in the US; a place where Christian insanity is rife and children are still being indoctrinated in droves into believing ludicrous iron age nonsense. I thought I might give my input, and ask a question.

    I am curious how often religious dogma gets in the way of providing humane care for the dying. I am sure once pain becomes excruciating any refusing zealot will fold and accept the pain medication. Do family members then have the power to deny their bible thumping kindred the relief of strong pain killers?

    • Dear Peter:

      You are funny guy.

      Not.

      At least not in my view when you post comments with divisive language on a site dealing with dying, death, and grief. These are tender subjects. Does this hurting world really need more people judging or belittling others?

      As the site’s author/editor, I debated about “allowing” your post. But I decided I would. But that doesn’t mean that I wasn’t offended by your words. I am.

      In your last paragraph, you wrote:

      I am curious how often religious dogma gets in the way of providing humane care for the dying. I am sure once pain becomes excruciating any refusing zealot will fold and accept the pain medication. Do family members then have the power to deny their bible thumping kindred the relief of strong pain killers?

      My answer? Well, trying to read between the detritus of your inflammatory language, some MAY possess the power to say no to helpful pain medications. If a hospice patient can speak for him or her self, and make their own decisions, then it will be up to them to determine the choices. Some want strong pain relief and are willing to be “drowsy.” Others want to stay alert and will be try to handle the pain. I could list other “this or that” examples. Bottom line . . . thoughtful hospice nurses and physicians will provide guidance, but one of hospice’s goals is to make sure the patient and family are participants in all decisions.

      However, if another person is formally designated as the “Power of Attorney” for health care decisions (and the patient can no longer make decisions) he or she becomes the person who says “Yes” or “No” to various choices. While the assumption is that the person with the “Power of Attorney” will follow the values and goals of the patient, I suppose there will always be exceptions. In hopefully rare cases (like your example of someone’s faith creating tension) they can be unsettling exceptions.

      Religious faith—along with family history, cultural norms, political ideology, and many other “influences”—play good and bad roles when individuals and families are facing death.

      Every person, and every family, is different. For the most part, the hospice team tries to find the most appropriate ways to support the family and their decisions. Sometimes that is easy. Sometimes it’s not.

  4. You can delete it of course. It was an outburst.
    I am searching for hospice information for a friend who needs assistance, certainly not from clergy.
    Best Wishes, Peter

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