Opiate use and euthanasia

Printed from: https://newbostonpost.com/2015/11/16/opiate-use-and-euthanasia/

Without adequate guidance from health care professionals, many terminally ill patients and their caregivers question the appropriate use of morphine and other opiates at the end of life. When is the medicine palliative and when is it euthanizing? The answer is found in timing, dosage, and intent.

Pain is one of the greatest concerns for people with a terminal prognosis. The fear of suffering and loneliness can cause tremendous distress, exacerbating already grave physical symptoms. Euthanasia opponent Dr. Jenny Driver, a member of the Brigham and Women’s Hospital Division of Aging and Co-Director of the Older Adult Hematologic Malignancy Program at Dana Farber, includes “freedom from severe pain and uncontrolled symptoms during the dying process” as one of three crucial goals of a good death.  Driver, who also teaches at Harvard Medical School, identifies the other two elements as the need to be surrounded by loved ones, and to have no “unfinished business,” i.e., being at peace with oneself, with family, and with God.

But addressing these issues while supervising the treatment of dying patients is more than most physicians can handle. Driver says an important part of the solution is better palliative and hospice care: “Ideally, hospice care would begin six months before death, but the average length of stay for most hospices is only seven days.”

Administering a high dose of morphine to an actively dying patient is justified if the primary goal is to alleviate excruciating pain and not to deliberately kill the person. It is an important distinction for both terminally ill patients who are afraid of unbearable pain in their final hours, and for their caregivers who want to ensure that their loved one is not euthanized.

As a result, many patients face inadequate attention. Both they and their families often feel overwhelmed at having to navigate a maze of medications and treatments.

Writing about these end-of-life life issues in The Atlantic, self-described progressive physician Ira Byock states, “If the moral worth of a society can be measured by how well it cares for the most vulnerable of its members, the America in which I live and practice medicine scores poorly. Much of the suffering I see among people with advanced illness is preventable.”

Byock argues that the solution is not physician-assisted suicide, which he says is “something my fellow progressives should fear and loathe.” Instead, he suggests improving the quality of medical treatment and doubling the ratio of nurses and aides to patients.

But even with the best of care, many terminally ill patients and their families have lingering questions about pain medicine and specifically, opiate use. As symptoms become aggravated, more effective drugs such as morphine are required to alleviate discomfort. When a person is in his final hours, a physician may use large doses of morphine to relieve severe pain and allow the patient to have a comfortable death.

Those who are morally opposed to euthanasia wonder whether such high doses of the drug are licit, since they may hasten death in some cases. The key lies in the physician’s intent and the purpose of the medication. Administering a high dose of morphine to an actively dying patient is justified if the primary goal is to alleviate excruciating pain and not to deliberately kill the person. It is an important distinction for both terminally ill patients who are afraid of unbearable pain in their final hours, and for their caregivers who want to ensure that their loved one is not euthanized.

Dr. Driver puts it succinctly: “The dose must be in proportion to the symptoms. When a patient is actively dying, it is acceptable to give a larger dosage of morphine to make the last moments less agonizing and to give necessary relief.”

Contact Mary McCleary at [email protected].

NBPValueoflife

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