Morphine at the end of life

Status
Not open for further replies.

KevinM

Distinguished member
Joined
Mar 30, 2019
Messages
102
Reason
PALS
Diagnosis
06/2019
Country
US
State
FL
City
Tallahassee
I will "rant" about the fears around death that keep it in a cone of silence even in a terminal disease community, that let you, Kristina [we have corresponded since] think for one moment that jail was a possibility for titrating morphine to full comfort near the end of life.
This is a very pertinent and “right on” comment, as is the norm with you. However, I do need to comment on the issue of access to morphine, at least in Florida, in the event that a PALS does not wish to continue life prior to the determination that death is imminent.

Present Florida law prohibits physicians from prescribing any opioid for more than three days for.acute pain, though an exception can be made for prescriptions up to seven days. As my GP said, someone could come in with a broken leg and he can’t prescribe more than three days of narcotics. As he ruefully commented, they threw the baby out with the bath water with the new laws in the face of the opioid hysteria.

More importantly, no physician I have interviewed in Florida (five in all) will prescribe morphine outside of hospice, which again gets to the issue of a PALS saying “enough is enough” before the end game is apparent. I know from your posts regarding your husband, you found a physician willing to do so outside of hospice,and I understand his breathing had declined to a point that made such a request more pallitable, but that does not appear to be the case in Florida.

I imagine that leaves many PALS (myself included) fearful of having to endure months of suffering they might not otherwise wish to occur as we wait for hospice to make a determination of six months or less to live. That leaves the unpleasant reality of taking matters into your own hands, which as Katrina described, may not be possible once progression occurs to a certain point.

These are difficult conversations, but the days of finding a willing physician in Florida to work directly with the family instead of through hospice does not appear possible. Kevin
 
Last edited by a moderator:

lgelb

Forum Supporter
Moderator
Joined
Nov 5, 2009
Messages
8,052
Reason
Lost a loved one
Diagnosis
09/2009
Country
US
State
WA
City
Seattle
Kevin, this is where DADT comes in. You don't want to go into a doc saying "enough is enough" or talking about acute pain. The indication is air hunger/progressive respiratory insufficiency. And advance interviews with docs you don't know would only raise legal concerns. I am talking about a doc who knows you whether as a friend or patient. And I'm not talking about a cupboard full.

My husband's PCP had last seen him 6 months ago. She had no clue about his breathing. She had previously written codeine for cough. She went on my word that he was experiencing air hunger, which he was [for the first time, note -- your BiPAP should keep you comfortable till the very end]. That was also why for the first time, he was unable to transfer out of bed.

So this was the end game -- which every PALS has the right to play with their own rules.

This was portal messaging, 100% legal. She works for a large hospital system, so she decided to include the acknowledgement that morphine could shorten his life. I have heard nothing here to suggest docs in FL don't recognize respiratory insufficiency.
 
Last edited:

KarenNWendyn

Forum Supporter
Moderator
Joined
Jul 29, 2017
Messages
3,251
Reason
PALS
Diagnosis
07/2017
Country
US
State
OR
City
Southern Oregon
My recent opioid story.... I realize this not end of life.

When I had my g tube placed (July 1), I was given a dose of opioid with the surgery and another 1 mg of Morphine in the recovery room on my request. When they determined I was clear to be sent home (after about 2 1/2 hours in recovery), I asked if I would be sent home with any pain medication. Their response: “You can take Tylenol as needed.” (No kidding!)
If we didn’t happen to have a Vicodin tablet at home left over for something else, I might not have made it through that first night.

just an example of how reactions to the opioid crisis have swung overboard.

obviously air hunger and hospice pose different situations.
 
Last edited:

KarenNWendyn

Forum Supporter
Moderator
Joined
Jul 29, 2017
Messages
3,251
Reason
PALS
Diagnosis
07/2017
Country
US
State
OR
City
Southern Oregon
I imagine that leaves many PALS (myself included) fearful of having to endure months of suffering they might not otherwise wish to occur as we wait for hospice to make a determination of six months or less to live.
This is something I’ve also wondered about.

My plan, once I’ve decided I’ve had enough, is to either do VSED+ Morphine/ Ativan, vs Death with Dignity, which we have in Oregon. If I’m not already on hospice, I will request to be put on it to spare my CALS any possible legal repercussions (and also to have their support). If I am met with resistance along the lines of “ You’re not within 6 months of death,” my response will be that I am about to stop eating and drinking, so I’m definitely within 6 months. We’ll see how that goes over. I feel it should be my call. I realize Laurie and her husband did it without hospice.

Thanks for the topic.
 

lgelb

Forum Supporter
Moderator
Joined
Nov 5, 2009
Messages
8,052
Reason
Lost a loved one
Diagnosis
09/2009
Country
US
State
WA
City
Seattle
We're talking about a caring loved one/friend, a State-specific advance directive and a bottle on hand for air hunger, written by any doc. I just hate to think of you guys spending any time on this, that could be used for looking at the autumn leaves, etc. And of course, "unnecessary suffering" is just that.

Most PALS naturally decrease nutrition in the last days/weeks -- nature's way of tapping you on the shoulder.

At the risk of sounding like the angel of death, I've messaged with P/CALS in a variety of places, including way more conservative countries, with no prosecutions for CALS. It's only potentially an issue if you breach the "cone of silence," sad to say.

Best,
Laurie
 
Status
Not open for further replies.
Top