Expert: Dr Ian Jackson - please note UK based - 1/17/2008

Question
QUESTION: Hello -- If a person with advanced cancer is put on a morphine drip (starting off at 1 or 2 ml?? and then going up to 10 ml), is there a point at which it will ultimately end this person's life? Is so, how long would somebody have to be on the drip for?

What about if the person hasn't eaten in about 2 weeks and is barely drinking any liquids? Would that lead to the person's death?

Thanks for your help,

Rachel

ANSWER: Hi Rachel
In the UK we do not believe or practice in euthenasia. We do however give patient enough painkiller (often morphine) to ensure they are not in pain. In some patients this dose has to be increased - because the pain is so bad or because their bodies become accustomed to the drug and so they need more to achieve the same effect.
Now hypothetically, if someone is given a drip of IV morphine this can be increased until they eventually stop breathing - at this point unless something is done to help them with their breathing they will die. This would not be immediate but would be quite quick in a patient who is poorly like you describe. They would not be aware of what was happening.
So it is possible for this to lead to someones death.
I hope this gives you the info you were looking for.
Kind regards
Dt Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Does the situation I describe sound like euthanasia? It was never referred to as such.

My mother was on the drip for 11 days. Is 10 ml (or was it mg?) an hour enough to lead to death? I was told it wasn't that much medication. She could also push a button to get extra medicine for break through pain but there was a limit on how much extra was dispensed per hour.

(By the way, she worked up to 10 ml per hour; started off at 1 or 2.)

Is there medication someone in her situation could be on without making the patient out of it?

Thanks,

Rachel

ANSWER: Hi Rachel
What you describe does not sound like euthenasia. Your mother had a background infusion of the pain killer and was able to 'top up' for breakthrough pain. This fits with my description of managing severe pain in a terminally ill patient where the body gets used to the pain killer and so the dose has to be increased.
It sounds like her needs were handled well. I'm afraid there is little other option for most people as most drugs that are pain killers also tend to make the patient sleepy. The confusion can be the effect of the drugs combined with the disease process, the pain and just the loss of organised night/day sleep pattern.
I know only too well how it feels to lose a parent this way and so understand the reason for the questions. From the information you have provided it sounds like she was managed well and there was nothing else you should have been asking for on her behalf. It is not easy once you lose the ability to talk to them with any coherence but it is important that she was kept comfortable and did not suffer. I often think confusion and sleep at the very end would be a blessed relief - it can't be nice knowing that you are going to die shortly.
Finally the reason for mentioning euthenasia is because I get questions from all over the world. Very few tell me where they are from and so it can be difficult as medical practice is different across the globe. I also get questions from budding writers with hypothetical questions a bit like your first one.
I hope the above helps you a bit though I know only to well that knowledge doesn't always stop you from asking could I have done more.
With kind regards
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Thank you for your kind words and reassurance, Dr Jackson -- I appreciate it.

Just one thing I'm wondering: what kind of effect would this morphine drip (like my mother had) have had on a person not terminally ill? Will people not termainally ill suffer no real effects from it after 11 days?

I understand that the goal was to make her pain free and that was good.

Thank you for all your time and help,

Rachel

Answer
If someone did not have any problem and was fit and eating normally then depending on the dose given they may feel very little or a bit sleepy and sick. Their bodies would get used to the drug and then they would need more to achieve any degree of sedation. Their bodies would also gradually become 'dependent' on the drug and if it was stopped then they would have severe side effects. Drug addicts gradually need more and more of these drugs to achieve the same 'hit' they are looking for as their bodies get used to the drug.
So there are effects but I suspect not the type you were thinking about.
Dr Ian Jackson