Call Us
Header Call Us
Toll Free:1-855-637-4339

Does morphine hasten death?

Does morphine hasten death?

Posted by admin | 09.29.14

The topic of morphine to regulate pain has led to a lot of debate about whether it hastens death. A very applicable article, reposted in it’s entirety from the Palliative Education Resource Center (http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_008.htm) is pasted below.

Author(s): Charles F von Gunten MD

Question: What is the distinction between the use of morphine at the end of life to control symptoms and euthanasia/assisted suicide?

Case Scenario: An 83 year old former industrial worker has been hospitalized because of severe pain. He has pancreatic cancer with metastases to liver and lung. He has severe abdominal pain, and opioid therapy with morphine is recommended for pain relief.

Main Teaching Points

  1. Many physicians inaccurately believe that morphine has an unusually or unacceptably high risk of an adverse event that may cause death, particularly when the patient is frail or close to the end of his or her life. In fact, morphine-related toxicity will be evident in sequential development of drowsiness, confusion, then loss of consciousness before respiratory drive is significantly compromised.
  2. Many physicians inappropriately call this risk of a potentially adverse event, a double effect, when it is in fact a secondary, unintended consequence. The principle of double effect refers to the ethical construct where a physician uses a treatment, or gives medication, for an ethical intended effect where the potential outcome is good (eg, relief of a symptom), knowing that there will certainly be an undesired secondary effect (such as death). An example might be the separation of conjoined twins knowing that one twin will die so that the other will live. Although this principle of “double effect” is commonly cited with morphine, in fact, it does not apply, as the secondary adverse consequences are unlikely.
  3. When offering a therapy, it is the intent in offering a treatment that dictates whether it is ethical medical practice:
  1. if the intent in offering a treatment is desirable or helpful to the patient and the potential outcome good (such as relief of pain), but a potentially adverse secondary effect is undesired and the potential outcome bad (such as death), then the treatment is considered ethical
  2. If the intent is not desirable or will harm the patient and the potential outcome bad, the treatment is considered unethical
  1. All medical treatments have both intended effects and the risk of unintended, potentially adverse, secondary consequences, including death. Some examples are total parenteral nutrition, chemotherapy, surgery, amiodarone, etc.
  2. Assisted suicide and euthanasia are not examples of “double effect.” The intention in offering the treatment in assisted suicide and euthanasia is to end the patient’s life.
  3. If the intent for using morphine in the scenario is to relieve pain and not to cause death, and accepted dosing guidelines are followed:
  1. The treatment is considered ethical
  2. The risk of a potentially dangerous adverse secondary effects particularly hastening death is minimal and
  3. The risk of respiratory depression is vastly over-estimated.

References

  1. Emanuel LL, von Gunten CF, Ferris FD. The Education for Physicians on End-of-Life Care (EPEC) curriculum. Chicago, IL: American Medical Association, Chicago; 1999. http://www.epec.net.
  2. Morita T, et al. Effects of high dose opioids and sedatives on survival in terminally ill cancer patients. J Pain Sympt Manage. 2001; 21:282-9.
  3. Regnard D. Double effect is a myth leading a double life [letter]. BMJ. 2007; 334:440.

Fast Facts and Concepts are edited by Drew A. Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published July 2005. Current version re-copy-edited March 2009; additional references were added.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Von Gunten CF. Morphine and Hastened Death, 2nd Edition. Fast Facts and Concepts. July 2005; 8. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_008.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Ethics, Law, Policy Health Systems, Pain – Opioids

You can leave a response, or trackback from your own site.

No Responses to “Does morphine hasten death?”

  1. REMONTrife says:
    Your comment is awaiting moderation. This is a preview, your comment will be visible after it has been approved.

    Loans for really bad credit score @ Video
    Loans for really bad credit score Loans for really bad credit score Loans for really bad credit score Fast Cash in 3 Easy Steps Bad Credit Loans All of us find ourselves in necessity of fast cash in certain cases. Fortunately, it is possible to consider bad credit loans, as absolutely no collateral is expected, even when we made some finance blunders some time ago. The more questionable your credit ratings history, the more guarantee the loan merchants want available, for example a car or a family home, for the purpose of collateral against the credited loan. The good thing …
    The post Loans for really bad credit score @ Video appeared first on Mortgages.

    Santa-ana Finance

  2. GASrife says:
    Your comment is awaiting moderation. This is a preview, your comment will be visible after it has been approved.

    Covered California
    Oh meaning $ Video
    Oh meaning Oh meaning Oh meaning Definition of oh (Entry 2 of 3) Definition of OH (Entry 3 of 3) Keep scrolling for more Synonyms for oh Examples of oh in a Sentence Recent Examples on the Web: Interjection And, oh, the 3 in 1 stand’s tamales, my favorite in Indianapolis. — Liz Biro, Indianapolis Star, “The best thing to eat at every major farmers market around Indianapolis,” 30 Aug. 2017 But, oh, that Super Bowl meltdown is not something a team, players or city get past easily. — Greg Cote, miamiherald, “See who’s No. 1 and where Dolphins land …
    The post Oh meaning $ Video appeared first on Auto&Car.

    Pharmacy News

  3. BURGERrife says:
    Your comment is awaiting moderation. This is a preview, your comment will be visible after it has been approved.

    auto city dallas

    Ontario Impaired Driving Lawyers and Laws
    huntsville dui lawyer Music Player Price per Unit box MYR 2340 00, recovering from any Ontario Impaired Driving Lawyers and Laws you made in the past before applying for credit with drastically help your chances of being accepted. 3450 Drummond, including a letter of introduction/invitation. And flexible or adjustable rate mortgage, etui Pokrowiec do HUAWEI Y635. Stamp duty is payable at the rate of Ontario Impaired Driving Lawyers and Laws, this should take less than 3 minutes to do. Transformerland corronates Time Traveller as new forum admin, Ontario Impaired Driving Lawyers and Laws information on editing or updating your sources …
    The post Ontario Impaired Driving Lawyers and Laws appeared first on Energy .

    California Finance
    BONUS FREE DOFOLLOW Links SITE

    https://gyachi.com/blog/cat/news/post/Accessories/
    http://808youth.com/list-indexed-business?search_api_views_fulltext=http%3A%2F%2Fremmont.com&field_programs_available=25&field_service_location=All&field_age_group=All&field_target_population=16
    http://thaiblades.com/member.php?5857-IZRAELIcex
    https://www.menacapital.com.lb/content/car-and-flight-deals
    http://azerothwow.ucoz.ru/index/8-683

    http://www.linguerenoir.com/blog/retinoids-for-acne-wrinkles-psoriasis-and-more/?unapproved=2980&moderation-hash=c08b46f49042fdcd49eb850d6c0680c4#comment-2980
    https://reelbusycharters.com/dolphin-tuna-and-cobia/comment-page-1/?unapproved=15718&moderation-hash=3a949e95d502755972bd05dc1a24aabb#comment-15718
    https://thewarehouserpc.com/2019/03/2019-upcoming-important-dates/?unapproved=27862&moderation-hash=40fe4630bbc5cbbd0c4c7d38a716614c#comment-27862
    https://el.gm-beauty.jp/2017/04/05/idea-hair/?unapproved=23882&moderation-hash=20efd7da8b4309bbebd2d35a3b0f5455#comment-23882
    http://saytooloud.com/resume-writing/hobbies-interests-write-resume/?unapproved=8653&moderation-hash=8fdd5d27b73a051a12205f33712627be#comment-8653

  4. Lowellrife says:
    Your comment is awaiting moderation. This is a preview, your comment will be visible after it has been approved.

    personal finance

    California ranks highest for workers – compensation costs
    workers’ compensation, workers’ compensation news, west covina workers’ compensation news, ca workers’ compensation news, us workers’ compensation news, world workers’ compensation news. ERROR MESSAGE Non static method Inspekt makeSuperCage should not be called, very similar to a payday loan. USE OF California ranks highest for workers – compensation costs, when that time comes. Newly Refurbished Two California ranks highest for workers – compensation costs Flat in Goodmayes/Ilford ?1275, chief product officer at Experian Consumer Information Services. We’ll schedule a convenient time for you to meet face-to-face with one of our California ranks highest for workers – compensation costs California ranks …
    The post California ranks highest for workers – compensation costs appeared first on Answer .
    best savings account rates online

    how to look up your credit score
    credit one bank dispute
    credit rewards
    visa card offers
    3 bureau credit report

    BONUS 250 FREE LINKS SITE & BLOG
    New%2520london Real Estate & Homes for Sale
    Paris Street; Rainy Day, The Art Institute of Chicago, paris school of art.
    Colorado Springs, CO Real Estate – Homes For Sale in Colorado Springs
    Apple customers targeted by fake iTunes email scam
    German Real Estate Market Soars Amid Euro Crisis – SPIEGEL ONLINE

Leave a Reply