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Hospice Care/Palliative sedation



Can palliative sedation (terminal sedation?) be achieved with just morphine? (No anti-anxiety medication.)

Can palliative sedation be achieved by morphine given orally but not a tablet? I know someone in hospice care who was receiving morphine orally but it wasn't a tablet -- some sort of liquid that could be absorbed? Not sure, exactly. There was no drip because apparently the staff couldn't find a suitable vein.

What is the range of time before a person dies that he will become naturally unconscious? (Unconsciousness that is not induced by medication.)

Thank you for your help.

Dear Rachel:

Thank you for writing.

Sadly, I really cannot answer your questions, and I doubt anyone else will be able to either.  There are too many variables related to different diagnoses, different circumstances....  No one knows when someone will die.  They don't always "go to sleep" before dying.

The liquid morphine is what I have used with patients in the past.  Generally, actively dying patients do not swallow tablets.  Liquid under the tongue is fast, effective and most importantly, kind.

Hospice usually does not do injections.  Sticks are painful and the exact opposite of what hospice desires for hospice patients.  Hospice looks to relieve and elimintate and prevent pain, anxiety, unpleasant symptoms.  Being stuck is just not necessary.

Personally, I would advise my patients to avoid any "hospice" (and the quotations are because I do not believe any true hospice nurse or physician would EVER advocate hurting a patient!) that would permit sticking a patient.  Even somnolent patients can absorb liquid morphine, which is placed a drop at a time under the tongue.

I'm sorry I cannot provide more specific information.  I'm so sorry for the loss of your friend.


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Christine Johnson


I can give suggestions, encouragement and direction on what hospice is and is not, when it is appropriate, and how to go about getting it. I am familiar with Medicaid and Medicare hospice benefits. I can answer general questions about disease process, what dying looks like, how hospice handles pain and other symptoms, what to expect from a hospice when end of life nears. I can provide support, direction and encouragement related to spiritual matters and psychological matters related to death and dying.


I am a certified hospice and palliative care nurse, and have been the director of nurses for three hospice centers, under two different companies. I have also worked as a contract hospice nurse for a large American hospice company. On a personal level, my father died without benefit of hospice (it was not popular then). I have taken care of dying patients in hospitals and recognize that for most of us, it is preferable to die at home (or in our residence, wherever that may be), comfortably and without anxiety. Also I had no support when my father died; hospice clients are the whole family (however that is defined by the "patient"), and support is provided at least a year after the patient passes. These are the sorts of things (and probably others) that I can help with.

HPNA (Hospice and Palliative Nurses Association)

none yet

Registered Nurse (TX), Licensed Marriage and Family Therapist (TX) ADN Nursing, Excelsior College, Albany, New York (2004) 4.0 GPA BA, Psychology (minor Social Work), Oklahoma University, Norman, OK (1986) 3.67 GPA MHR (MA) Human Relations, Oklahoma University, Norman, OK (1988) 3.5 GPA

Awards and Honors
Phi Beta Kappa (and others)

Past/Present Clients
Unable to name as this would violate their privacy (and HIPAA....)

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