Morphine for the Dying

[Brickjectivity]

That is a good point to consider. Assume however, the person did not have dementia undergoing the death process?


That is something I have considered as well. Drugs can be an 'assist' to spiritual experiences, to be sure. However, that comes at a price of distortion. To have a full presence of mind awakening to the spiritual, is always superior and more meaningful, impactful, and lasting than being high to get there. It's kind of 'cheating the Universe', in a way. The human mind does not need drugs in order to 'see God'.


Nor would I, but if it meant missing out on a valuable awakening experience, one would think it wouldn't be worth it. You only get to die once in a lifetime.

I have, believe it or not, thought something like this. What if we really have a ghost? Then does our mental state upon death affect what our ghost is like? I surely hope not. Its chilling.

 

[Windwalker]

I have, believe it or not, thought something like this. What if we really have a ghost? Then does our mental state upon death affect what our ghost is like? I surely hope not. Its chilling.

Are you a good ghost, or a nasty complaining ghost?

 

[9-10ths_Penguin]

I'm not aware of Christianity teaching that you shouldn't take morphine for dying. Don't think this is coming from a religious teaching.

Your OP claimed to be from a "spiritual perspective;" I took this to mean you were talking about religion.

... and your view has made it into religious contexts. For instance, the pain management practices (or lack thereof) in Mother Teresa's hospitals were based on a similar idea of there being virtue in suffering.

I explained my thoughts as to why we might not wish to chose it for ourselves, if you view death as transitional, and not an annihilation.

As a patient, you have the right to refuse medical care AMA. If enduring extreme pain is your personal fetish, you can indulge it.

 

[ChristineM]

Why the hell did you think I was suggesting it be forced upon others?

Your OP indicates that you would want your belief imposed on every one

 

[Windwalker]

Your OP claimed to be from a "spiritual perspective;" I took this to mean you were talking about religion.

A spiritual perspective is different than a religious perspective. That's why they have the term spiritual but not religious (SBNR).

... and your view has made it into religious contexts. For instance, the pain management practices (or lack thereof) in Mother Teresa's hospitals were based on a similar idea of there being virtue in suffering.

I'm not believing that we should invite suffering, or worship it. I'm more focused upon whether we should cloud our minds with drugs as we are dying. To @Vinayaka well stated point, if suffering is so extreme it overwhelms, then that would be a distraction as well. But those who practice meditation, can manage pain to a large degree without drugs. It's preferable to not cloud our minds with pain management, if possible.

BTW, the spiritual perspective is what comes through such practices as mediation. That's why religious fundamentalists don't like mediation and see it as threatening, or of the devil or such. It leads to questioning their ridgely held beliefs. Mediation has a way of seeing through the illusion of our beliefs, religiously held or otherwise.

As a patient, you have the right to refuse medical care AMA. If enduring extreme pain is your personal fetish, you can indulge it.

Extreme pain wouldn't be desirable. But is all death extremely painful? Do all people dying screaming in uncontrollable agony? One does wonder too, that our state of mind going into dying, doesn't itself directly affect the experience of pain itself? I believe it does.

But if you're dying of some horrible disease, that would be a factor outside of our overall mental dispositions, which does affect the degrees of pain we might otherwise experience. It would be preferable it they used a drug that didn't distort your mind.

 

[Windwalker]

Your OP indicates that you would want your belief imposed on every one

It does? You seem to have a habit leaping errantly in your judgements of what is being posted, and why. There's nothing there to suggest that. The entire post is a question, not a dogmatic belief.

 

[It Aint Necessarily So]

I have a question about the practice of giving morphine to the dying as part of hospice or comfort care, from a spiritual perspective. If one views death not as an end, but a transition of consciousness beyond physical death to the next 'life', wouldn't taking a narcotic as you shed this current body be clouding the mind and potentially missing valuable lessons about life? We can say that about living life itself on a daily basis, from one day to the next as well, that being 'doped up' removes or disconnects you from fully experience life in the moment. Would it make sense to be 'doped up' as you die then, if in fact there is a continuation of consciousness beyond the current physical form? Might there not be something important to realize at the moment of death, that being on drugs might cloud and deprive you of?

I'm a former hospice medical director for about ten years. Our mission is serve as midwives in death, to hopefully make inevitable death as pleasant as possible. It is only in this sense that we see death as a transition, not in a religious or afterlife sense. This mean, besides comfort care, when possible, having the patient comfortable, at home in bed and surrounded by loved ones when the timer comes.

Morphine is used for two conditions - pain and respiratory distress. Outside of the hospice setting, morphine is contraindicated in respiratory distress, as it not only relieves the sense of suffocation, it also diminishes the ability to breath, and can lead to death. In hospice, this is acceptable as long as the dose of the medication was not higher than necessary to bring comfort. That must be the goal, not euthanasia. If death is the intent, it's euthanasia and possibly murder, but if comfort is the goal and death ensues, it is called a second effect.

If you've got a patient gurgling and sputtering from a throat or esophageal carcinoma that makes normal swallowing impossible, and the only thing keeping him from drowning in his own secretions is that gag reflex, providing comfort care in the form of morphine might (probably will) lead to death - the second effect, which is never the goal, but is acceptable if it is the result of a therapy that eased suffering. Once again, the unethical and illegal part is giving more morphine after the distress has been adequately treated. That would have to be given to end life.

And we don't withhold care for religious reasons unless they are the patient's reasons. We would occasionally run into people that preferred suffering at death. Like mother Teresa (the worst possible choice for somebody running hospices), they may believe that suffering is the kiss of Christ: She said, "There is something beautiful in seeing the poor accept their lot, to suffer it like Christ's Passion. The world gains much from their suffering." and "You are suffering like Christ on the cross. So Jesus must be kissing you." Often they feel unready for heaven, perhaps because of life they think may earn them hellfire if they aren't purged and purified in this transition.

But to answer your question, I don't see value in withholding treatment on the possibility that it will make the afterlife better (I can't imagine why an experience at death would be called a lesson if permanent unconsciousness follows death).

I think that your post is a good illustration of the harm that religion can do. You're advocating extreme cruelty and you probably don't even realize it "Maybe we shouldn't try to ease the pain of the dying?" Give your head a shake.

Agreed. The Mother Teresa thing is a glaring example of that. It might not be widely known that she withheld adequate palliation from dying patients. It's not clear if her motivation was religious (likely), or she was influenced by the church that received the bulk of the money donated to her charities to ease the suffering of the dying poor. I blame the church for both of these - withholding care because of perverse beliefs, and defrauding donors. I'm imagining that as a secular humanist in hospice, her values would be the same as ours were, and the care similar given how much money she was given to support proper hospices, which patients never saw or benefitted from. I see her as a spiritual genius made worse and essentially negated by a church affiliation. Her patients did get a cot, a roof, and food, but they were needlessly allowed to live in squalor and needlessly allowed to suffer while dying.

Who the hell is trying to impose personal religious belief to remove comfort in death?

I mentioned the patient might be doing that, a request we respect. But it also might be the pastor or family that is advocating for the removal of comfort care. This is a problem, especially if one has power of attorney.

 

[Brickjectivity]

Are you a good ghost, or a nasty complaining ghost?

I won't answer that!

Are you not speaking of the impact of death upon ghosts? Are you actually just discussing the moment of death?

 

[ChristineM]

It does? You seem to have a habit leaping errantly in your judgements of what is being posted, and why. There's nothing there to suggest that. The entire post is a question, not a dogmatic belief.

The whole OP us worded against giving morphine based pain relief to those in pain. Perhaps you don't realise your own bias is framing the OP but it is assuredly written in the negative.

 

[Windwalker]

I'm a former hospice medical director for about ten years. Our mission is serve as midwives in death, to hopefully make inevitable death as pleasant as possible. It is only in this sense that we see death as a transition, not in a religious or afterlife sense. This mean, besides comfort care, when possible, having the patient comfortable, at home in bed and surrounded by loved ones when the timer comes.

Great! Thank you so much for responding. This is helpful feedback from your perspective working in hospice care.

I just mentioned in a later post the reason I ask is because I've just had three family members die in the past 5 years, and I was with both parents in their passing. My brother in law just died last week, and he too was given morphine. I question if morphine is being given in all three cases as a matter of course, or actual needs as you describe below.

I hear other posters react claiming that all death is horribly painful, and require being giving morphine, but my understanding is that no, not all death is painful, and no, not everyone really needs to be given that as a matter of course. I can understand its use in the cases you described below, but question its use as a given that everyone should be given it because dying is horrible. Is it?

Morphine is used for two conditions - pain and respiratory distress. Outside of the hospice setting, morphine is contraindicated in respiratory distress, as it not only relieves the sense of suffocation, it also diminishes the ability to breath, and can lead to death. In hospice, this is acceptable as long as the dose of the medication was not higher than necessary to bring comfort. That must be the goal, not euthanasia. If death is the intent, it's euthanasia and possibly murder, but if comfort is the goal and death ensues, it is called a second effect.

My father's passing was from Parkinson's. My mother from general heart failure. Both died at 89 years of age. My brother in law from brain cancer. I do not recall either my mother or father being in pain, and it appeared morphine was given as just a matter of course. My brother in law was not in pain from my understanding either.

Is it sort of like how they just give nursing home residents antipsychotics to "keep them calm", which the data seems to show that is more about the nursing staff than the actual patient. My dad didn't need any of that, until they he went under their care. That had a direct effect upon his mind for the one year he needed to be there before he died. Was that necessary for his care, or the nursing staffs?

And we don't withhold care for religious reasons unless they are the patient's reasons. We would occasionally run into people that preferred suffering at death. Like mother Teresa (the worst possible choice for somebody running hospices), they may believe that suffering is the kiss of Christ: She said, "There is something beautiful in seeing the poor accept their lot, to suffer it like Christ's Passion. The world gains much from their suffering." and "You are suffering like Christ on the cross. So Jesus must be kissing you." Often they feel unready for heaven, perhaps because of life they think may earn them hellfire if they aren't purged and purified in this transition.

I find that personally rather misguided sense of the spiritual. Sort of like whipping your own back with leather straps to be closer to God. That's a pathological view of the spiritual. Quite sick actually. That's all about the ego.

But to answer your question, I don't see value in withholding treatment on the possibility that it will make the afterlife better (I can't imagine why an experience at death would be called a lesson if permanent unconsciousness follows death).

I did qualify my question for those who believe death is simply a transition of forms, and don't hold to the annihilation of consciousness itself as a belief. Yeah, to those who think nothing at all continues, sure, get high, for quite literally in that case, tomorrow we die.

 

[Windwalker]

The whole OP us worded against giving morphine based pain relief to those in pain. Perhaps you don't realise your own bias is framing the OP but it is assuredly written in the negative.

God. Give me a break.

 

[firedragon]

I have a question about the practice of giving morphine to the dying as part of hospice or comfort care, from a spiritual perspective. If one views death not as an end, but a transition of consciousness beyond physical death to the next 'life', wouldn't taking a narcotic as you shed this current body be clouding the mind and potentially missing valuable lessons about life?

We can say that about living life itself on a daily basis, from one day to the next as well, that being 'doped up' removes or disconnects you from fully experience life in the moment. Would it make sense to be 'doped up' as you die then, if in fact there is a continuation of consciousness beyond the current physical form? Might there not be something important to realize at the moment of death, that being on drugs might cloud and deprive you of?

I understand different religions have different perspectives about this. What are your thoughts?

If my father dying of a cancer, and he is pain, I would want him to have pain relief. He has lived his life in full and if those last moments is some kind of experience and he has to go with full pain we are just being plain stupid. When you put on spectacles, maybe that is ruining some life experiences. If you take worm medicine, maybe you are taking away some experience. If you take aesthetic for surgery and you are out, maybe you are taking away some experience. With that kind of logic, you cant give your child a pain reliever.

 

[Guitar's Cry]

I guess that depends on where one considers the line between "physical" and "spiritual" lies. If there is a difference, then morphine should only be impacting the physical aspect, eh?

Consider how the body produces endorphins ("inner morphine") anyway, to help dull pain.

Having watched my mother-in-law die of pancreatic cancer, I support as much painkillers for the dying is necessary to ease this transition.

 

[England my lionheart]

The body produces chemicals to give us the best trip out of life,NDEs are a good example,a bright light,the feeling that you are floating and looking down on yourself are quite common.

Some people can take days or months to die and if their pain is such and you could help by giving morphine why wouldn’t you?,a supposed afterlife with nobody that’s actually ever seen it is a pretty dumb reason not to give pain relief IMO.

 

[Twilight Hue]

Or let them die in anguish and pain. Cool idea

I agree. Let those last days be as painless as possible.

 

[Twilight Hue]

The body produces chemicals to give us the best trip out of life,NDEs are a good example,a bright light,the feeling that you are floating and looking down on yourself are quite common.

Some people can take days or months to die and if their pain is such and you could help by giving morphine why wouldn’t you?,a supposed afterlife with nobody that’s actually ever seen it is a pretty dumb reason not to give pain relief IMO.

It's why I hate collective society. Blanket restrictions don't work. There needs to be exceptions and exemptions based on situations and circumstances.

 

[It Aint Necessarily So]

I just mentioned in a later post the reason I ask is because I've just had three family members die in the past 5 years, and I was with both parents in their passing. My brother in law just died last week, and he too was given morphine. I question if morphine is being given in all three cases as a matter of course, or actual needs as you describe below.

Sorry about your losses. Are we to assume that they were hospice patients at the end and receiving only palliative care?

I can't comment on what happened in the cases you cite, but pharmacological treatment of hospice patients is limited to treating existing symptoms. You don't treat pain unless it is there, although there is a principle in the treatment of unrelenting pain that once one gets it to a manageable level, analgesics are continued, since it takes so much more and so much longer to pound anticipated pain down rather than preventing it - Tylenol might be able to prevent pain that only a narcotic could control.

I would not prescribe morphine to a hospice patient who didn't have a symptom best treated with morphine, which will either be moderate to severe pain, or respiratory distress. It's not given automatically, and never more than what is needed to manage symptoms.

I hear other posters react claiming that all death is horribly painful, and require being giving morphine, but my understanding is that no, not all death is painful, and no, not everyone really needs to be given that as a matter of course. I can understand its use in the cases you described below, but question its use as a given that everyone should be given it because dying is horrible. Is it?

I haven't experienced death yet, but I've witnessed plenty, and if one can judge by the presence or absence of grimacing, writhing, or cries that are consistent with being in pain. Acute pain will also feature rapid heart rate, increased respiratory rate, and possibly perspiration, but these things are absent with longstanding (chronic) pain. Many people apparently die comfortably. It's long been my contention that if the patient is not conscious, he/she is not suffering. I base that on going to sleep with and awakening from sleep with the same headache, but being pain-free while sleeping.

Is it sort of like how they just give nursing home residents antipsychotics to "keep them calm", which the data seems to show that is more about the nursing staff than the actual patient.

That's another tricky area. I recall a nursing home patient that was so confused and combative, that we needed to use restraints and around-the-clock anxiolytics to keep him safe and eligible to continue living in the nursing home. I went to see him, prescribed restraints and Xanax, and wasn't three miles down the road when I was paged by a social worker who told me I needed to prescribe something else. I refused, and told her that if she wanted to co-manage the patient with me, she would have to write those orders herself (she can't, she's not a physician). Imagine somebody with no medical training wanting to give medical orders. Somehow, they overruled me and made the changes. How happy I was to have not acceded to this person's demands and written those orders myself when he broke a hip and had to be transferred to a hospital.

The treatment I prescribed was for the patient, not the staff, and it was necessary if he was to remain safe and in a long-term care facility. He never came back.

 

[Windwalker]

The body produces chemicals to give us the best trip out of life,NDEs are a good example,a bright light,the feeling that you are floating and looking down on yourself are quite common.

I think this touches upon my question. In the dying process, there are natural chemicals that occur, which are part of the death process and removes you from pain. Think of a gazelle being eaten alive by a lion. Pain shuts off as they transition from life to death. That particular experience is pure, not riddled with pain, according to the reports of NDE'ers. All suffering vanishes.

Some people can take days or months to die and if their pain is such and you could help by giving morphine why wouldn’t you?,a supposed afterlife with nobody that’s actually ever seen it is a pretty dumb reason not to give pain relief IMO.

As far as I know, the actual dying process or 'transitioning' generally does not take months at all. It's usually a matter of either hours or days, possibly up to three weeks. Leading up to that transitioning may take months, or even years. I'm not questioning doing pain management for actual pain. But it seems the assumption by many here is that all dying is a horrible painful process and morphine should be given regardless of whether it is or not.

My point is that dying itself, passing from life "into the Light", as described by NDEs, is a profoundly spiritual experience. If, you don't believe that you are annihilated at death, than it's comparable to spiritual experience in life itself, and is part of the whole as a continuum. Is spiritual experience diminished by being high? In my experience, it is. Dying is a one-time experience in this life, and do you want to 'pass through the veil' loaded, or with eyes wide opened?

For some, it doesn't matter. The spiritual is unimportant to them in this life, and according to those who believe in reincarnation, you'll just come back again and again until it is. But if it is important to your overall progress, then the question stands. Are you better served not being stoned at death? I'm just debating that question for myself.

 

[sun rise]

But when you make it a normal practice, if you are dying, you get morphine, that isn't dictating to others itself?

It's not a normal practice around here. My father-in-law was with us and in hospice care when he passed. No drugs were needed.

It should always be a choice including how much to take. Given my reincarnation belief, we've all died many many times. Dying while under pain relieving drugs would be another way to drop the physical body,

I also don't think we should be certain about what goes on during the moment of death. There's even "terminal lucidity" in Alzheimer's patients.“Awakenings” in Advanced Dementia Patients Hint at Untapped Brain Reserves

 

[sun rise]

"There is something beautiful in seeing the poor accept their lot, to suffer it like Christ's Passion. The world gains much from their suffering."

There's a big difference between necessary suffering and unnecessary suffering.

As far as I know, the actual dying process or 'transitioning' generally does not take months at all. It's usually a matter of either hours or days, possibly up to three weeks.

I don't have a scientific response but I do have a personal one. There was a friend in her 80's who decided that she had had a good life and it was time to go. She basically drifted off over a few weeks but came back fully aware when my wife played some music in her room because that woman had really loved music. After that she was basically unconscious.

My father-in-law went through serious fear of dying, had it disappear and his last words were "I'm ready now". In his case, the weeks before the last day were of fear and decreasing fear.

Sudden accidents or medical issues would be an entirely different matter, of course.