It was mid-October 2008 when the medics rolled the elderly man through the glass-enclosed lobby.

To his left was a sweeping view of the Long Island Sound and bright orange and crimson trees, but the view was nothing to him.

Before making the 15-minute ride from Yale-New Haven Hospital to Connecticut Hospice, the man was told he had maybe three days before his heart would fail completely. He couldn’t catch his breath. His eyes were wide, his fingertips dusky from lack of oxygen.

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His hospice doctor, Joseph Andrews, was desperate to ease the man’s breathlessness. “For patients, that’s more terrifying than pain, paralysis, or the inability to get around,” Andrews said. “It’s the worst thing.”

Another doctor suggested morphine might help.

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The drug relaxes the muscle walls of blood vessels, Andrews said, increasing capacity and reducing the lungs’ urgency. Coronary arteries can also more efficiently carry oxygen-rich blood away from the heart.

The man’s doctors knew well that too much morphine can stop the lungs completely, so they tried just a tiny amount: one-quarter of a milligram.

Morphine is seen by many physicians and laypeople as a sort of single-purpose, liquified grim reaper, and understandably so: It is dangerous and addictive. Older physicians in particular were typically not trained to use it, Andrews said, and can resist recommendations to use morphine even for cancer patients with severe bone pain, for fear of killing them.

Morphine’s reputation as a killer underscores one of the more persistent myths surrounding hospice care, namely, that it serves as a grey market euthanasia service for the terminally ill, where the drug is given in generous doses to every patient — even those who do not want it.

Talk to any experienced hospice nurse or physician and they’ll tell you that such notions can lead to significant complications: family doctors refusing to prescribe morphine for dying patients who are in extreme pain; relatives refusing to give a dying family member prescribed morphine, or exhorting them to reject hospice care completely and opt for the ICU.

Hospice clinicians get it. People don’t want to risk killing someone, even if it means seeing their loved ones suffer. Clinicians also understand that they share some of the blame, for failing to clearly communicate the methods, goals and expectations of using  morphine. Because the medication is often prescribed during a patient’s final decline, family members are sometimes left to wonder if, in agreeing to the treatment plan, they have helped bring about their loved one’s death.

Morphine can have other less lethal side effects that require vigilance, and doctors and nurses are not always clear about those potential complications either. Still, clinicians say, it can be frustrating to encounter people whose misconceptions lead to unnecessary suffering for patients.

The elderly man was tall, slightly heavy-set. He’d been a teacher. He was quiet, loved to read books. His wife was alive but he’d lost her to dementia and a nursing home. His three children were nearby, though, and the grandkids. He was well-loved.

And now his children came in, looking like they were going to a funeral. They asked if they should call people to come say goodbye, and Andrews told them it was probably a good idea.

He asked them to consider morphine. It was worth a try, they said. They made their calls. They braced.

Their dad went to sleep, which was something.

He woke later to smiling faces. His breathing had eased dramatically, his skin color had returned to normal; he was fully alert, wide awake. He chatted with visitors. He told his life story.

He got six more weeks like this.

Andrews said he remembers countless stories about how morphine had helped patients with respiratory distress, as well as patients with severe pain. Most recently, a patient had been immobilized by her cancer pain until she received small doses of morphine. She promptly flew to South America to spend time with family members.

Control and mobility, Andrews said, are among the most important factors in improving a dying patient’s quality of life.

Soon after the man’s breathing eased, he started a new routine. Twice a day he’d ask his children or grandchildren or nurses to bring his cap and his overcoat and they’d wheel him to the waterfront with his oxygen tank.

He’d stay as long as the gathering cold and darkness allowed. He saw the tides flow and the leaves fall and gulls and boats pass. In early December he began sleeping more, and then he slept entire days away, and then he died.

But that November reprieve.

“It was one of the best morphine stories I can remember,” Andrews said. “He had a great run.”

  • On nov 9 2017 my bellissima Mamma unfortunately past away from negligence by DR I was her power attorney in health ect she was given morfine, norc, and other without my permission Investigation was made they claim From Raleigh NC she was well taking care of .. Asheville N.C. risk management and their attorney claim same , mom was from Italy Calabria she also had angina and some respiratory symptoms ect this and from her dr family she was not supposed to have I never gave permission or was asked to me plus they refused autopsy said was not necessary she was there at solace center hospice building,
    Only to stay for few days but on 4 day they said she can’t come back home ? And they wanted to bring her rest home was impossible to find in 24 hours in 5 day she died my hearth is broken forever she was my only family I had
    It happens every day this negligence and this people gets away with it
    I broth to court on my own cause I could find attorney in N.C. that wanted to help amazing..
    And was dismissed cause judge said I brought wrong people to court? Like dr and director of the building who else was I supposed to bring? Plus the claim investigation was done with care
    If it was why I was never asked or signed permission plus why they refused autopsy?
    Very sad 😢

  • I recently lost my father to Alzheimers/Dementia. He received hospice care for almost a year, and during that time he actually did quite well, considering he was bedridden and had lost most of his mobility. His blood pressure was usually near normal and his oxygen levels were always good. He could still remember most of the important details of his life. The disease appeared to be progressing slowly enough that my father’s doctor actually considered taking him off hospice entirely. My father remained in stable condition for about 10 and a half months following his diagnosis, although he was said to be in stage 6.

    His condition literally became very critical over night. He had a terrible coughing spell while eating dinner one evening. The next day he was out of breath and completely lost his appetite. He was also diagnosed with pneumonia in both lungs. Although he was given a rigorous course of antibiotics, the next three days were his final decline as he progressed into stage 7.

    I couldn’t believe it all happened so fast. We finally had to administer the hospice-provided medications that I assumed we would never need, morphine being one of them. My father was given a small dose of morphine exactly three times over a four day period to help with his shortness of breath. The first day, his lungs had filled with fluid and he was fighting very hard for air at over 40 breaths per minute. His nurse advised me to administer the morphine (although I was afraid to), and it helped immensely. My father slept though the night and seemed somewhat refreshed the next day, though he obviously still had pneumonia. He was given another mild dose of morphine the night before he passed away. That night, he also refused to wear his oxygen anymore, which bothered me a great deal. No matter how many times I put it on him, or how it was fastened, he took it right back off. He ultimately died in his sleep.

    I do not blame the morphine for my father’s death, although I wanted to at first. On further reflection, I believe that death would have came even sooner had we not given it to him. The morphine seemed to keep him around a few extra days. He passed away peacefully in his sleep and didn’t spend his last night gasping for air. I am grateful for that. I have had to come to terms with the fact that there is no cure for Alzheimers, and blaming myself or blaming the morphine is not going to change anything.

    Rest in peace Dad.

    • Sorry for your loss.

      My dad died of dysphagia as a function of Alzheimer’s exactly one week ago. His cognitive decline was incredibly rapid- Stage 4 to dead in a year.

      His first and only run in with aspiration pneumonia was 10 days before he went.

      He was in hospice (at his NH) for about 30 hours thanks to Ativan and morphine (and atropine) admin’d sublingually.

      I’m not sure if I’m envious of you or should count my blessings.

  • Hi I haven’t been on here for a while I have a aunt that is near death she’s hanging on but the doctors say prepare ourselves this is the 3rd relative that I will lose to cancer in 2 years I was in contact with someone on here who asked me to let her know whether I was able to see my Aunt which I am pleased to say I have it was very nice to see my aunt and to be able to see her and bring her news and grapes and a gift which she really appreciated so please think of me and other people that are going through the same fate as Death is inevitable for us all I pray every night for my Aunt not to be suffering or in pain she’s at the phase where she now cannot swallow and this is one of the symptoms of the end of life but I do believe that she will be greeted by Gods Angels and to see all my relatives that are already in that heavenly place

  • Thankyou for this article. My mother passed away at 64 years old almost a year ago and ever since I couldn’t help but think that the choice on morphine was what killed her .

    • I lost my aunt a few days ago and my dad 9 years ago and another Aunt 5 years ago Cancer is a bloody horrible disease it doesn’t care what age the person is you don’t even have to be a smoker to get cancer one of my aunts wasn’t a smoker and she died with a year as she was misdiagnosed and the doctor said she had a virus and gave her advice to keep warm and stupid advice they gave her antibiotics well antibiotics didn’t help as it was CANCER !!
      My aunt told the doctor and they ignored her intuition it was cancer and she was only 62 and leaves beside my cousins
      My other aunt died less than a week ago and is in the funeral directors poor love she really suffered at the end I think it was described to me as drowning absolutely awful and then the hospice gave her a sedative to calm her my mum said she never wants to see that again I bursted into tears knowing how she suffered no one should have to go through that ever and my dad was in a coma state so he didn’t suffer and went peacefully I still miss them all especially as I only saw my aunt 2 weeks ago and she died on the 9/2/20 so I fill very upset at losing so many close relatives especially my dad he didn’t know he had cancer at all the doctors didn’t pick it up just like my Aunt mid diagnosed again he lasted only 5 weeks going from not knowing he had cancer in the first place to lasting only 5 weeks oh my god I was in a state of shock please remember every one that writes on here know what your going through whether we have cancer or we know some one who has cancer to just losing someone to this horrible disease take care every one from Karen

    • Hi Brooke, I had to reply to you because my dad also died at 64. He passed away a day after his birthday this January. I too gave him morphine that night and I still feel like it hastened his death. Although, I know he was suffering and that it eased his pain.

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