Morphine and withdrawing food and water... is this ethical?

My mom had a bad infection, when they admitted her (82 and advanced dementia) they inserted a breathing tube - she was septic…Before the infection, she was a happy dementia. she’d sing songs and still recognize a few names… Now there has been a twist, ever since the breathing tube removal they’ve had her on morphine, all day drip, she has good vitals but is completely unresponsive because of the morphine… We signed her to hospice so she could have ‘dignity’ … When I went to the hospital today, and boy do they move fast… i saw she was still unresponsive, she was on IV drip of morphine with no food or water, IV stand was empty except for morphine…Talking to her Dr, the plan of action was to keep her on morphine to make her ‘comfortable’, and only give her food or water if she asked, but since she’s completely unresponsive on morphine, she can’t ask. So the nurse said she’d be unresponsive and in no pain until the dehydration killer her in a week.I asked the doctor how their plan isn’t considered euthanasia, and she said “it just isn’t” … We want her to have a natural death, the hospital doesn’t see how morphine to keep them sedated combined with no food or water is actively participating in her death. Worst part is, Drs say this is a common outcome. So my question is… was I over reacting? To me, keeping someone in a morphine stupor and letting them dehydrate and die in ‘comfort’ isn’t a very Catholic thing. Or is it ethical and I don’t understand it? – End result for today… morphine was stopped, she became somewhat awake and was sucking ice chips… Is it crazy to think letting someone die of dehydration is cruel?

It depends on the situation. My stepfather had end-stage Parkinson’s and had to be admitted to a skilled care facility. He had difficulty talking, feeding himself, was unable to walk, etc. When he got there he decided not to eat or drink anything, said he was not hungry and had a living will which stated no feeding tube, ventilator, etc. He made it understood that he did not want anything to prolong his death. He was given morphine for pain and comfort. He died 12 days later. This is not improper. He was in his sound mind, and had a right to refuse treatment because there was absolutely no hope of recovery. Also, when a person is dying, bodily systems , like kidneys, start to shut down, and when that happens, force feeding liquids or administering IV fluids can cause pulmonary edema and heart failure, making the person even more uncomfortable and causing difficulty breathing.

So there are a number of factors to consider: first of all, the patient’s wishes. Secondly, is the illness terminal and is the person near death? Is there a chance of recovery? Is the patient able to make a decision? People who are near death and unconscious do not experience hunger and thirst, their organs are failing, and as I said, it can cause more discomfort. We are allowed to let nature take it’s course. And of course, this is what is behind the idea of hospice care–comfort care and pain relief. If your relative desires food or water by mouth they will give it to her, but generally artificial means like feeding tubes and IV’s for fluids are not used. When a person is terminal, they usually only add to their discomfort, and often patients pull them out, which causes more harm.

This is not euthanasia. It is not actively participating in her death. It is allowing death to take place naturally, and the body goes through stages in the dying process, shunting blood to where it is most needed, the heart, lungs and brain, and away from the less critical organs and extremities. they may not be able to digest food or excrete urine. Giving meds to relieve discomfort is compassionate care and should not be denied to a pt. in pain just to keep them awake unless they refuse it. Morphine also reduces “air hunger” when a person is dying, making breathing more comfortable. All of which is perfectly ethical in a terminal patient near death, and especially in hospice care.

In case you are wondering, i was an RN for 32 years in a Catholic hospital and took care of many dying patients in the ICU and had to deal with these things many times. So I know that what the hospital and hospice and have done are ethical and legal, and also in line with Church teaching. God bless you and your family, I know how hard it is to be in your situation.

As the previous poster said, that course of action would be proper if the person’s organs were shutting down and food would only make her uncomfortable. I think you are right to be concerned if she had good vital signs though. But then again, this might have been her care plan. It really doesn’t sound too far out there to me.

Without all the details, this cannot be fully answered. I don’t understand why denying her food and water would be good - at all. But based on your statements, this does sound wrong.

ncbcenter.org/publications/end-life-guide/

I seriously doubt any patient would be allowed to die in this way or for it to be considered reasonable or ethical. Having worked in a hospital, there are many, but a finite number of possible reasons. Without knowing her full history or treatment plan, this cannot be fully answered. Read the document link I posted above.

Best,
Ed

Thanks. I was going to post that too.

Barring other circumstances which would make nutrition / hydration dangerous, or there being other circumstances not mentioned in the initial post, there should be no reason they should not be feeding her or sedating her.

What is happening to your mother sounds like what is called “terminal sedation” and is a form of euthanasia. As you described, it is a method to hasten death. You don’t mention where you are from, but this is being used frequently in the Netherlands and gaining traction in Britain and some places in the US. In other posts I have been mentioning this for a couple of years that it would be used more frequently.

You can talk to the physician again and request she be taken off morphine except as needed (they will use the term “PRN”) and request that you be notified / give them permission prior to any administration of the drug.

You can request a hearing with the hospital ethics committee through the Social Worker or Administrators office. You can also contact a lawyer to make the request or intervene.

As well, hospice in the US is fully revocable. You may remove her at any time. You can also call the hospice office or look at your sign-on forms for the number of their ethics or ombudsman to file a complaint or request other treatment than sedation.

Good luck with your situation, and keep being an advocate for your mother!

when she was admitted, she was septic, she was unresponsive… she was singing two days prior. The hospital has only seen her as an unresponsive dementia patient. Scans of her lungs and organs were all good… they took the tube out and she was breathing fine on her own. But they started morphine when they took the tube out for comfort. They had never discontinued morphine until we brought it up today. After asking “why aren’t we at least trying to establish how much of Mom is still alert and in there?” … the hospice Doc said 'we’ll stop the morphine, no problem at all" When Mom was alert later today she wanted ice and water but had a hard time swallowing. The morphine may well be the best course of action is she is unable to feed herself and has pain, if she refuses food, i’d want her comfortable but understand that is the body shutting down… But i was shocked that the hospital thought that terminal sedation was the best course of action from day one, instead of maintaining fluid and nutrition. Now if that hurt her, of course we’d not want her in pain… but it wasn’t offered. When I asked the nurse “so we have her on a morphine drip, and she is unresponsive… and you’ll only feed her if she expresses hunger, but with the drip she is unresponsive, and on and on… how is that not euthanasia?” … the nurse shrugged her shoulders and said “i don’t have an answer”… The hospice staff told us the wouldn’t do extraordinary care, never said we’re not going to feed or hydrate her. Made me think of Terri Shiavo. before last weekend, my mom would put down a bacon cheeseburger and strawberries for dinner… this week she’s close to death. Its odd being on the inside looking out, you see both sides. When I distill it, my conscience says to deny anyone water is wrong, but if it would hurt her, then its for the greater good. Thanks for the advice and prayers. I’ll pray on it, God always tells my insides whats best… I do think, If I had a dog that I sedated and let dehydrate until it died, i’d be charged with cruelty.

I am so sorry for what you are going through. Praying. Would it be possible for you to consult with a priest regarding this matter? God bless you.

i’m stopping by the Rectory tomorrow… i’ll bring some coffees and get some thoughts!

Go with your gut feeling. If it feels creepy, let your feelings be known. Be an advocate for your Mom. Make sure she gets Last Rites if she’s Catholic. Morphine makes it easier for the staff to do their job, but if it isn’t the right thing for your Mom, speak up.

None of us here answering so far are trained theologians and in end-of-life scenarios, only a person with all the available information should be trusted. Your priest is your best guide here and from other similar situations having been brought up, there’s also a National Catholic Bioethics center (I may have the name wrong) that you could consult. Hopefully another poster who knows what I’m referring to can post a link to their site.

Prayers.

Ah, so there is a name for this practice. I lost a family member to it last year.

OP, I hope your mom is comfortable and you can enjoy a few more weeks or months with her.

Peace,
B

I very much want you to be right. My mother has Parkinsons and I am my parents executor. My Dad has a bad heart so it is possible I will face this. Your post is great comfort to me, but I will double check with my priest, so I too can include this option in my living will. One step past a DNR I think. Thanks again for your post!

OP, I would talk to a priest and maybe a bioethicist about this. I would not assume that the morphine was administered with malintent. I am very uncomfortable with the idea of withholding hydration.

If hydration causes pain, that lets go with the morphine. She’ll pass. But the second we said “HOSPICE”… she was put on a heavy morphine drip, no chance at conscousness, no chance at seeing if she’d rebound. The Nurse said “This is how we do it, morphine and then they pass”… It seemed cold and methodical. I think about what my mom would do for me, and she’d advocate for life, only if for a few months, weeks… days. A natural death. But morphine to make her quiet until dehydration kills her? That seems barbaric. When my kids were a week old, they couldn’t tel me they needed food, but I had the duty to feed them. If an 84 year old needs food, but can’t communicate that, how is that different?

I agree with your post as a nurse myself.

Mary.

Feeding can be inappropriate when there is a risk of the patient aspirating the food, which can cause pain, suffering and infection.

I am afraid that you might be oversimplifying it and imagining hospice as a euthanasia unit. There are some people who are clearly in the dying process and should be allowed to go peacefully. The analogy of children and the very elderly has limits. However, as I said earlier, I am very uncomfortable with withholding hydration. I went through this with my 96 year old aunt. The nursing home Director of Nursing, the hospital, and the hospice all seemed to have somewhat different ideas. I really felt torn.

I agree with you. Despite what doctors and nurses claim, this is not a natural death. A natural death does not involve a morphine drip to render the person unresponsive.

I would also be very skeptical of doctors and nurses today in a situation like yours. There is just to much talk of euthanasia in certain ideologies. You know your mom, her doctors do not. You and the hospital staff don’t want her so suffer unnecessarily, but you also want her to have a measure of lucidity in order for you to read her quality of life. I’m glad to hear that you did not just fold to the doctors plans.

So we took her off Morphine, she hasn’t regained consciousness… My dad (almost 60 years of marriage) told her tonight “its ok to go and see your family in heaven, I’ll see you again soon” … she will probably pass tonight or tomorrow. Either way, Heaven gains another Saint. please keep her in your prayers.

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