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Bias Against Morphine for End of Life Patients with
Breathing Difficulty Challenged
Physician says it can add life by reducing the
struggle to breath
Dec. 1, 2005 – A physician with more than a half
century of medical experience is challenging what he says is "public and
professional bias" against the use of morphine in the final stage of
life for patients with breathing difficulties. Yes, morphine slows
breathing but his study suggests it can add life for those who have
breathing problems.
Because large amounts of morphine slows breathing,
doctors have avoided prescribing the drug to dying patients with
breathing difficulties for fear it would shorten life. However, the
author of this new case series suggests that some patients who receive
an appropriate level of morphine live a little longer because their fear
and struggle for breath are reduced.
The research is published in the current issue of
the Journal of Palliative Care.
"Much has changed in health care since the initial
concerns about morphine and breathing difficulties were documented in
the 1950's," said Miles Edwards M.D., Professor of Medicine Emeritus in
the Oregon Health & Science University School of Medicine and a clinical
consultant for the Center for Ethics in Health Care at OHSU in Portland,
Oregon.
"For decades, physicians have been advised to avoid
prescribing even small doses of morphine to dying patients with
breathing difficulties based on the traditional belief that the drug
made breathing more difficult and hastened death," says Edwards.
"However that line of thinking seems to be a
medical urban legend," he adds.
"In fact, this age-old advice should likely be
reversed for some patients. By slowing down breathing with morphine and
controlling panic, patients become fatigued less quickly. They are
breathing at a slower pace, but they also require less oxygen so the
condition and the drug don't act in conflict with one another as one
might think."
The research paper focused on five case examples
involving patients who had been given appropriate doses of morphine to
control their suffering in the final stage of life after a ventilator
was removed.
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This case series focused on patients who were on
ventilators at the end of life and who wanted the ventilators withdrawn.
The major finding of this case series was that each of the patients
lived longer than predicted by their physicians when morphine and
sedation were provided.
The paper provides details about each of these
cases, contradicting the longstanding beliefs that moderate doses of
morphine hasten death by suppressing breathing.
"Overall, the appropriate use of morphine in the
final minutes, hours or days of life is becoming a more accepted
practice by doctors nationwide," explained Susan Tolle, MD., Director
for the Center for Ethics in Health Care at OHSU.
"If a person feels that they are suffocating, they
struggle for oxygen and panic sets in. Much like a scuba diver who
panics, these patients are trying to use more oxygen than is available
to them. What Dr. Edwards has learned is that an appropriate level of
morphine can suppress this anxiety allowing a person to survive on less
oxygen and live longer. It also allows these patients to live out their
final minutes, hours or days of life in a more peaceful manner."
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