Morphine at End Stage

#1 Guest_Tippy_*

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29 February 2008 - 01:18 PM

Helen, If you do not wish to reply to this question, I will understand. While on pain medication for arthritis, my breathing was much better, almost normal. When I told my pulmo he said my breathing was not better but the pain medicine tricked the mind into thinking it was better. He explained that is why morphine is used at end stage emphysema/lung disease as it tricks the brain into thinking the body can breathe therefore letting the patient pass into death painlessly, effortlessly. However, the last 3 deaths I am familiar with the patients were given morphine but still suffered extreme shortness of breath right up to the very end. I’ve also read stories of others who watched a loved one pass while struggling for breath. I can’t bear to think of life ending this way for me and especially for my family. My question is: Under what circumstances would a patient feel distress at end stage? Could it be because he was not given enough Morphine? Could it be because he is resistant to morphine? Must he struggle for breath?

#2 Helen RRT

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29 February 2008 - 03:08 PM

Hi Tippy,
I had not heard the explanation of pain medication relieving breathing before but in a way it makes sense. Depending on the pain medication you were taking for arthritis, there could also have been some anti-inflammatory action going on that reduced swelling in your airways too. Morphine is a very good drug for relieving breathlessness at the end-of life, but morphine also depresses breathing, and many physicians are afraid that if they give the patient too much morphine it will hasten death. Patients can develop a little resistance to morphine, but not if it is administered correctly. I am not a pharmacist and no nothing about dosages, but from what I understand, morphine should be started at low doses, and the doses should be gradually increased as the patient gets closer to death. If the drug is slowly increased, the patient becomes gradually used to larger doses and it does not depress or slow down the breathing as much. I also have read that morphine given to patients with end-stage lung cancer is more effective in reducing the feeling of breathlessness than it is with patients with COPD...I do not know why this is so. Some hospitals allow therapists to give morphine through nebulizers to patients - basically an aerosol treatment with morphine and this also seems effective for patients with lung cancer who have severe shortness of breath. From my experience Tippy, when COPD patients are given an adequate amount of morphine, they do not struggle at the end of life. Doctors are usually cautious in bringing up a discussion about end-of-life with their patients because we never want patients to give up hope...but if you are comfortable discussing this with your doctor - he/she might be happy to talk with you your fears and how you want things handled when the time comes. None of us are going to leave this world alive - I have never understood why so many are reluctant to talk about death - I would much rather have my preferences known ahead of time than leave my children to wonder about what I would like to have done if my disease progresses to the point that treatment is no longer helpful. As one hospital chaplain once told me " the best gift parents can give their children is written instructions about what they would like to happen at the end of their lives" and from what I have seen in the hospitals and with my own parents - this is very true.
Best wishes for better breathing - Helen

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