End-of-life care: Pain control carries risk of being called a killer

AMA News ^ | April 16, 2012 | Kevin B. O'Reilly

[caww]

When people are obviously dying in the very last stages of advanced cancer, artificial nutrition and hydration is not necessary.

I understand, from a religious perspective, that when the "body" is dying the "soul" is preparing for flight, if you will, and has no need for food or water. That the patient has a sense about this and why they request less and less water and don't want either food or drink.

I saw this occcur with my mother, who was a nurses aid for many years, and she knew how the nails start to change color as the body dies....I saw her checking hers often the last two weeks. In the last two or three days she would only ask for ice chips...to wet her lip... and then not even that.

So I have to agree fully with cancer patients when in the last mile there is no need...they're getting ready to go to their heavenly home.

[caww]

It’s not all that unusual for a terminally ill person to experience a rebound and appear to get better and then very suddenly take a turn for the worse and die very suddenly

Yep..that's exactly what my mom did...I was shocked when I got there to visit and she was chit-chatting and laughing with family members..sitting up in bed no less...but the nurse explained to me, when I inquired about this happening, that it is very common.

To me it just seemd like God was giving the family a last 'family moment' before she left..and she did die two days later.

[mdmathis6]

trisham said:”Anecdotal evidence is simply not very reliable”

Anecdotal evidence is one thing but lil Flower was speaking of her personal experiences that she had to document as part of being a case manager for a Hospice company...documentation that could be used against her if not properly followed thru.

The legal premise when used in court cases against nurses is “If it wasn’t documented, it wasn’t done.”

Michael Mathis RN(26 years and counting)

[Sisku Hanne]

Past tense. It was a part time job I had back when I was in college. And I did refuse further hospice assignments. Not that I was squeamish about caring for patients in the end stage of life - I also worked in a catholic nursing home, which was a rewarding experience.
My only other personal hospice experience was my grandmother. At age 96 she had a serious bout with pneumonia and the hospital doctors said she had only a month to live. She was placed under hospice care (while living in a personal care home) for the next 2 1/2 years until she passed peacefully of old age. I do not count that as a negative hospice experience. We only thought it odd that she was a hospice patient for 2 1/2 years with nothing wrong with her aside from the normal aging issues you would expect. But after reading this thread, I understand.

[the808bass]

What conclusions have you come to about hospice based upon your experience and this thread, specifically?

[Brian Kopp DPM]

And If the pain is too great ... the person can’t serve or worship.

My religious beliefs are different from yours. Your statement would nullify any conversation with a good Baptist or an atheist.

You've never read about or don't believe in deathbed conversions such as in Luke 23?

40 But the other criminal rebuked him. “Don’t you fear God,” he said, “since you are under the same sentence? 41 We are punished justly, for we are getting what our deeds deserve. But this man has done nothing wrong.” 42 Then he said, “Jesus, remember me when you come into your kingdom.[d]” 43 Jesus answered him, “Truly I tell you, today you will be with me in paradise.”

How could Dismas have converted in the midst of the agony of crucifixion if your first statement is true?

If your first statement is false, how many deathbed conversions are thwarted by terminal sedation?

[Sisku Hanne]

If you're referring to my grandmother's case, I had always thought that hospice was focused specifically on caring for those in an imminently terminal condition. In fact, I thought that you could not receive hospice care unless you were in that dire state(at least that is how it was back when I was with VNA). I did not realize had since begun expanding into longer-term care scenarios, such as with my grandmother. My uncle had power of attorney and we were not consulted or involved in her medical care decisions. From reading this thread, I gather now that hospice may have been able to offer more hands-on care than was normally provided in that small personal care home. It was not a positive experience, but I also can't say it was negative, as the others were.

Between 4 traumatizing experiences with 3 different hospice care providers & an experimental cancer treatment program, (the details of which I will not share), the horror of the Terry Schaivo incident, and the "peek behind the curtain" at who is funding the "evolution" of hospice care, I personally have a very negative opinion of hospice. However, out of respect for others here who are dealing with the raw grief of recent loss, I'm not going to salt their wounds by enumerating my grievances. My own grief is too fresh for me to be objective. However, I'm sincerely glad for those who have had good hospice experiences or who have provided exemplary hospice care.

[hocndoc]

We know that none of the men on the cross that morning were in so much pain that they were unable to worship. And One had no need for conversion. (And who’s to say that the man who asked Jesus to remember him had not been converted and even baptized before. That’s the argument of many Church of Christ preachers.)

Nevertheless, different people have different pain and even different pain tolerances.

My own mother, on the way into the hospital for her last admission, chirped up at admissions with, “I have the best insurance there is: Jesus Christ!” On the day she died, the sheets hurt her legs, a breeze caused her to cry out in pain and we couldn’t get her pain under control at all, even with doses that should have knocked her out. In addition to (probably because of) paraneoplastic neuropathies, she had a series of lacunar infarcts that made her brain CT look like Swiss cheese. She was barely thinking and talking nonsense.

(She died of another stroke while in the MRI machine, with me at her head, singing to her. Even though our family had made our wishes that she not be resuscitated, the neurologist wanted this one last test, the paper work wasn’t finished, the hospitalist hadn’t signed the order and I had to interfere to prevent a full code.)

Perhaps if you’d studied in San Antonio, you’d have more first-hand experience. The Family Medicine residency program where I trained took the Podiatry residents for a few months of training on the in patient medicine service.

[Brian Kopp DPM]

Thanks for sharing this.

And Yes, San Antonio is a highly regarded Podiatry residency in our specialty, for good reason.

I stayed close to home and completed my residency locally.

[Lil Flower]

>If your first statement is false, how many deathbed conversions are thwarted by terminal sedation?<

Why are you having difficulty understanding that giving a person morphine at the end of their life is not “terminal sedation?” Why do you want people to hurt and be uncomfortable when they don’t have to be? I find those who are so opposed to pain meds haven’t had enough pain to need them, yet.
Morphine is not some boogy man drug. It is very effective at quick pain relief, but it is also short lived. Within 2-3 hrs it has worn off and you have to administer it again.
My husband worked, drove, etc. for 8 months taking a higher dose than average of oxycontin. He had a broken hip due to the disease avascular necrosis and due to family issues had to postpone his surgery. I think its cruel not to at least try to relieve someones suffering just because a family member or caretaker has some unfounded fear of pain meds. Do you know how many times I’ve been told by family members they don’t want their dying loved one to have a narcotic for pain because they fear their loved one will become addicted to it! It leaves me scratching my head but some people really have a hard time dealing with death so they cling to ideas that somehow help them avoid the elephant in the room: that their loved one is dying.

[Brian Kopp DPM]

Why are you having difficulty understanding that giving a person morphine at the end of their life is not “terminal sedation?”

I assure you, I know the difference between proper pain control and terminal sedation. Morphine can be used for proper pain control. It can be and is used in conjunction with other meds for terminal sedation, and it can be and is used to mask the symptoms of pain and discomfort when water and food are prematurely withdrawn to bring about a premature death.

Why are you having difficulty grasping that these latter incidents are well documented and going on in segments of the hospice and palliative care industry?

Why do you want people to hurt and be uncomfortable when they don’t have to be?

Where have I said I want people to hurt and be uncomfortable? That is the false rhetoric of those who are trying to push the euthanasia agenda, if you weren't aware. Careful falsely employing their rhetoric. Folks might start to question your motives when you employ the tactics of the euthanasia promoters.

[Lil Flower]

>Careful falsely employing their rhetoric. Folks might start to question your motives when you employ the tactics of the euthanasia promoters.<

Well I don’t give a shit what other people think of me. I also don’t give a shit what tactics euthanasia promoters use , either. I’m just telling you that you can use morphine, ativan, and other medications to control restlessness and pain without it becoming terminal. However, keep in mind that the person in question is in fact dying. And I really think some people are so frightened by that fact, that they grasp at straws to make some sense of it all.

[Brian Kopp DPM]

Just so long as they really are in the process of dying, we’re in agreement.

The problem we’re talking about in this thread is when it’s employed to facilitate a premature death.

I don’t think you grasp or admit that this is going on, or how prevalent it is becoming.

[Lil Flower]

You’re right I cannot grasp it. You have only heard these things happen. You have personally never seen it yourself. I have first hand knowledge and experience in Hospice and have never seen, nor heard of from other colleagues, what is claimed here. I will go with what my own eyes have seen vs something you have heard second hand.

If I’m shown otherwise with facts, then I will certainly acknowledge it.

I did mention earlier in this thread that I can certainly picture this evil administration turning Hospice into something evil, because they are evil.

[Brian Kopp DPM]

You have only heard these things happen. You have personally never seen it yourself.

Have you even read this thread?

Please go back and read what I posted about what happened to a close personal friend of mine, a retired priest.

I've sat down and talked to Terri Schiavo's brother, sister, and mom. Their foundation fields calls about cases like the ones I'm describing every day. So does Ron Panzer of the Hospice Patients Alliance, who I talk to on a regular basis. Are you calling them liars?

I'm glad you had the opportunity to work in a good hospice where these things apparently weren't happening.

But you are in denial about the reality going on elsewhere in some segments of the hospice and palliative care industry.

[metmom]

How bizarre that that the medical community which espouses euthanasia resists giving enough pain medication to make someone comfortable because it might kill them.

I guess by denying the pain medication, they think they can build a better case for euthanasia so people don’t suffer unnecessarily.