As a hospice nurse with years of experience, I have encountered many situations where family members are hesitant to allow their loved ones to receive medications such as morphine and lorazepam. One of the main reasons for this hesitancy is the belief that these medications will hasten death, leading to euthanasia.
In this article, I want to address this concern and help family members and friends understand the use of morphine and lorazepam in hospice care.
The Purpose of Morphine and Lorazepam in Hospice Care
Morphine and lorazepam are medications used in hospice care to manage symptoms such as pain, anxiety, shortness of breath, and terminal restlessness/terminal agitation that can occur in the last few weeks of life. These medications are not used to hasten death but rather to improve the quality of life for the terminally ill patient.
One goal of hospice care is to provide comfort and dignity to patients during their final days. Morphine and lorazepam are essential tools in achieving this goal. These medications can help ease the patient’s physical and emotional suffering, allowing them to spend their remaining days in comfort and peace.
The Misconception About Morphine and Lorazepam
Unfortunately, there is a common misconception that morphine and lorazepam are euthanizing agents. This misconception arises from the belief that these medications can cause respiratory depression, leading to death.
While it is true that extremely high doses of morphine and lorazepam can cause respiratory depression, this is not the intended effect of these medications when used in hospice care. The doses used in hospice care are carefully adjusted and monitored to achieve maximum symptom relief while minimizing side effects.
Let’s put this into perspective. The typical starting dose of morphine for a terminally ill patient in hospice is 5 to 10 milligrams every two hours as needed. If you add the milligrams over 24 hours, you have 60 milligrams (5 milligrams x 12 doses) to 120 milligrams (10 milligrams x 12 doses). Did you know the maximum daily dose of morphine is 1,600 milligrams? The person receiving 5 mg of morphine every two hours is getting 3.75% of the maximum daily dose, and if they were getting 10 mg of liquid morphine every two hours, they would only be getting 7.5% of the maximum daily dose.
The Last Dose Effect
If your loved one is on hospice services, one of the common things that perpetuates the misunderstanding about morphine and lorazepam is what’s called the “last dose effect,” whereby your loved one who is terminally ill and close to death receives a dose of morphine or lorazepam and within an hour or less dies. Rather than seeing the death as a natural progression that would have happened even if there were zero medications involved, one or more family members or caregivers will blame the medication as the cause of the problem.
If I may, I would ask you to consider that a terminally ill loved one will die naturally sooner than the non-terminally ill. That this person who is terminally ill is so close to death sudden events like a heart attack or respiratory arrest are far more likely than a healthy person who is not terminally ill. And that as they are heading towards a natural death, there is something that a family member, a caregiver, or a healthcare professional will do for that loved one who is terminally ill within the last hour of their death. And that something done out of love — providing incontinence care, which often involves turning the patient left to right or right to left and vice versa to change their brief, providing oral care to clean their mouth and lips, or giving them their scheduled or as needed dose of morphine or lorazepam — is not making them go faster, but keeping them as comfortable as possible in those last hours of life.
As I conclude this article, I hope that if you were hesitant about these medications, you would be less hesitant and more open to speaking about them with your hospice nurse. If you are considering hospice, you are open to discussing your valid questions with the provider of your choice.
Conclusion
Morphine and lorazepam are essential medications in hospice care. They are used to manage symptoms and improve the quality of life for terminally ill patients. It is important to understand that these medications do not speed up the dying process and, as such, cause euthanasia. By working together, we can ensure that our loved ones receive the best possible care during their final days.
