The most common example of a hospice myth is about the use of morphine. Some report that it caused their loved one's death because they noted that the person died soon after they received a dose. The reality is, that morphine provides symptom relief and when the person is comfortable, they can let go. A person’s spirit does not have an easy time transitioning when the patient is in pain or is agitated having trouble breathing, or dealing with psychological stress
Another purpose of this book Demystifying Hospice: The Secrets to Navigating End-of-Life Care, is to dispel myths like that and help the world understand that medications are always given carefully. It is against the law to over-medicate to facilitate a death. All hospice staff take this responsibility very seriously.
There is a well-known phenomenon about comfort and dying. Dying is a very difficult process unless the patient is comfortable.
If you have questions about the use of morphine that resulted in a death soon after, please read on, and consider the variability and scope of this issue and what that person you are thinking about may have experienced.
From my 20 years as a hospice nurse, I can tell you ways this phenomenon was interpreted, understood, explained, justified, and rationalized by family and/or the hospice staff. Here’s a list of many of the possible things that might have happened, between the time the med was given and the time the patient died. You might think of others.
They gave the med AND THEN the patient died!
What happened in that IN BETWEEN period of time?
Pain was relieved
Breathing was no longer labored
Anxiety was reduced
Agitation went away
The person saw a deceased relative welcome them and they realized they didn’t have to be afraid
They saw a figure central to their religion welcome them and were not afraid
They recognized that they were forgiven for all their transgressions
Their spirit let go of the need to stay alive for someone else
They took the hand of their deceased spouse, child, parent, lover and left with them.
They did a life review of their happy moments
They did a life review of their sad moments, but saw them as just lessons learned
They realized they didn’t have to be afraid of the medicine
They saw a bright white light that so many others have reported and felt at peace
They recognized that all the family members would be fine and that their dying was not going to be a crisis for them
They recognized that the family members have been fantastic about ensuring the quality of their life during the dying process and when they are gone, the family will not have to do that any longer
And accepted their desire and ability to let go ……AND THEY DIED!
I hope for many, the list above will help reduce their fears about morphine and if and when asked about it, they will feel comfortable sharing some of those ideas.
As for the Wonderful uses of morphine, many hospice patients think they have an allergy because in a hospital setting, it was used intravenously for a pain episode and they experienced hallucinations, and nausea and were very loopy. The only true allergy to morphine sulfate is anaphylaxis, which is when the throat tightens up and this can be life-threatening. Giving a med by IV allows the body to absorb much more quickly, than when it is given orally.
If someone had a true allergic response, Dilaudid (Hydromorphone) would be given instead. The understanding of those other side effects can be that it was given in a higher dose than needed.
In hospice, we always start low and titrate up as needed. The starting dose is given under the tongue at 0.5mg, which equals 1/25th of a teaspoon (.25ml) and relief can be assessed every 15 min. and the dose is increased at that interval or at 30 min or at 1 hour to achieve a reduced respiratory rate, that is more efficient and reduces the anxiety experienced for those with lung conditions. Watching out for the reduced respiratory rate can help determine an effective dose, which is also assessed at 15-30-minute intervals.
If it’s used for pain relief, there is no ceiling dose! Increased doses can be given at 30–60 min intervals until the pain is relieved and then that time interval and dose becomes the scheduled dose. The Mu receptors eat it up and the ‘sedative’ effect will go away after 24-72 hours of giving it per a schedule around the clock.
Morphine allows the diaphragm to expand larger and at a slower rate. The blood vessels open up and the patient gets more O2 per minute which improves their condition and reduces anxiety. Opening up the blood vessels gets the med to every pain source more quickly. Many people with chronic respiratory issues walk around with a bottle of liquid or capsules of morphine in their pocket or purse, which they take per the schedule, which works for them. These are young or old patients, who move about freely and work and manage their families and their lives comfortably.
Many worry about addiction. That happens when the pain source is no longer present and all the euphoric senses become what the person desires and feeds by continuing to take a narcotic. It is of critical importance, when dealing with hospice patients that this question must be asked; If the person is terminal, is there any reason to be concerned about addiction? If the patient is still in a curative care setting, managing narcotic use and being concerned about addiction is very relevant.
And it’s from a plant, for those who prefer something natural instead of synthetic! One patient refused anything that could not be labeled ‘organic’ and when the origin of morphine was explained to her and she used it, she was shocked at how effective it was for her cancer pain. She had worked with several other alternative medical practitioners using energy medicine, massage, chiropractic, and supplements that did not manage her pain.
Conclusion; like all other meds, when used carefully, morphine is not to be feared but instead, highly respected for its uses. The world needs to hear this message and stop believing the myths that abound. Far too many people have died miserably because their caregivers refused to give the med that would control their symptoms.
Spread the word!
To purchase Barbara's book, Demystifying Hospice, you can purchase a signed copy or downloadable PDF at Author Spots or a digital copy on Kindle Ebook
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