My knowledge of health care is minimal and sometimes when making palliative care decisions, that can be a blessing in disguise.  Twice now, I have been faced with consenting to give morphine to a loved one.  Years ago, my mother-in-law was dying of cancer at home so I learned how to inject morphine to control the pain she was in.  One day I made the usual injection but she very quickly passed away thereafter.  It was disconcerting to say the least.

Recently my own mother was nearing life’s end.  Nurses and doctors said that she likely had a few days to live.  When Mom began to look uncomfortable and irritable, the doctor recommended morphine.  He said that many people think that morphine is used only for pain.  However he said that morphine is used for heart patients as well, because it relaxes the muscles.  I consented to give my Mom morphine in order to alleviate her discomfort and her struggle to breathe.  Thirty minutes later, Mom passed away peacefully.  My sister (a nurse) later told me that morphine does relax muscles and therefore often results in a patient passing if their body is in such a weakened state.  

I wouldn’t have changed my decision to ease my mother-in-law’s or my mother’s suffering but I think that people should understand morphine to avoid surprises.

There is no evidence that morphine or other opioids accelerate the dying process when used in dosages needed to control pain or dyspnea. In fact, there is evidence of the opposite effect. Palliative care providers notice that once pain is controlled, the dying process seems to slow down sometimes. This hasn’t been proven in prospective scientific studies, but pain is a stress on the body and it seems logical that relieving pain decreases the burden of illness on people who are frail.

People may think morphine contributes to the dying process because it’s often used when people are in advanced stages of illness. The patient is declining because of the illness, with or without the morphine. This is particularly noticeable when someone elderly has pain from cancer or another illness that’s strong enough to require pain medication such as morphine. In such instances the burden of illness is significant.

 

I've contacted our Clinical Nurse Specialists to see if they have additional information to share with us.

Colleen 

JD’s concern about the morphine speeding up the dying process is a common concern and I'm glad you shared the answer to ‘Does morphine make death come sooner?’ on the forums. Here's some additional information:

We also call this the “last dose phenomenon”- when medications are being given regularly to a dying person, someone will end up giving the “last dose”. This can feel worrisome, with concerns that the medication tipped the person towards dying. However, we know from the literature that proportionate doses of opioids administered for distress do not hasten dying, and point out that the "last dose" is typically the same as previous doses that were well tolerated.

If the context is one of symptom distress, the patient is typically alert and breathing more rapidly than normal...in such circumstances the tolerance for opioids is high. This is also seen in opioid-naïve patients presenting to emergency in severe pain; the stimulus itself produces the tolerance to opioids and results in the inherent safety in opioid administration.

In terms of resources, the ‘Pain’ article is good as there is a whole section on ‘opioids’ and ‘myths about opioids’.