It is the most dangerous misinformation about hospice that
exists. I run into it so often that clearly somewhere it must have become woven
into our cultural ideas about how people die when hospice is involved. I am
speaking of the idea that morphine is given to purposefully hasten someone’s
death.
You cannot blame people for this falsehood, as there are
many explainable reasons why this belief has been thought to be true. The first reason is coincidental
approximation; meaning often when someone is in the dying process they may be
having pain or trouble breathing that requires morphine to alleviate the
symptom. Family members in the room see the medicine given and hours later when
the patient dies they connect the morphine to the death. This is quite frankly
an improbable connection. Usually a person has required morphine days before
death, at the very same dose. If it was the morphine causing death, it would
have happened days earlier.
The other problem with this improbability is how morphine
works. Contrary to what many think,
usual doses of morphine do not stop people from breathing or cause respiratory
arrest. In fact, morphine actually eases the work of breathing, increasing
oxygen delivery. Instead of harming
someone’s ability to breath, the morphine given near the end actually makes it
easier to breath.
Another reason this wrong idea has become a part of culture
is due to dissemination of information.
I overhear families say such things as “Well, they are starting
morphine, so it won’t be long now.” This phrase is passed on, as if the two
were connected. Someone being on morphine has little predictive value on
prognosis. What we really should be
passing on is information about the symptoms that do indicate dying. The
phrases “They are no longer able to swallow, so we think it is near” or “We
haven’t been able to rouse him for over 24 hours, so I think you should come”
offer much more truth and connection to the timing of death than morphine use.
One of the largest culprits of the mistruths of morphine rests
with the media. I have watched movies
that depict small amounts of morphine being given as a means to hasten death.
It is a glamorized view of something medically improbable. Any medicine, even Tylenol, given in
unreasonable quantities can cause death, and morphine is no exception. But the
notion that just one more dose will end life, as is often depicted on the
screen, has only harmed the reputation of a perfectly useful medication.
The idea that we as humans even require morphine at death
has also perpetuated this false belief. We actually don’t need anything to die.
Death is a natural process of systems shutting down as we sink into ourselves
to the point of unresponsiveness.
Morphine, if used, is only a tool to reduce symptoms that cause
suffering. I have just as many patients
pass with no medications in their system, as those with medications.
So the next time you hear someone mention morphine as
related to dying, be bold and clear up the misinformation. It’s the only way we
can hope to change the culture.
