Dying in Pain

[RhodaGrits]

Must We Die In Pain?
Matthew Herper, 08.19.04, 6:00 AM ET

In 1995, a group of researchers funded by the Robert Wood Johnson Foundation published a shocking result in the Journal of the American Medical Association. At some of the nation's top medical centers more than half of cancer patients passed away in serious, uncontrolled pain. But guidelines from the World Health Organization indicate that 85% to 90% of cancer patients could have their pain controlled by oral medications. It seemed like a solvable problem.

The Wood Johnson Foundation and the Soros Foundation were among the groups that worked on trying to improve the care of the dying. (The Soros Foundation's Project on Death in America spent $45 million on improving end-of-life care.) What do we have to show for it? Patients still die in pain. A recent study by Joan Teno at Brown University found that of patients in nursing homes with excruciating pain, 42% were still suffering after a second assessment.

What's the problem? Part of it is that some doctors are hesitant to prescribe some of the most powerful pain medication, out of fear of patient addiction and potential legal trouble. Experts in pain management know not to worry, but run-of-the-mill M.D.s are often overly cautious. "All they hear is 'doctor got sued,'" says Susan LeGrand, director of education at the Harry R. Horvitz Center for Palliative Medicine at the Cleveland Clinic, "and then they go, 'Oh my gosh, I'm never writing that scrip.'"

<snip>

http://www.forbes.com/2004/08/18/cx_mh_0818pain_print.html

(Another study funded by that hate-monger Soros /sarcasm off)

[Gyre]

1. That's why you don't want to die of any terminal disease

far away from a major teaching hospital. :)

Gyre

[htuttle]

7. You got that right!

Even if you're not dying, teaching hospitals are the place to be nowdays. That is if you don't mind the occasional parade of interns passing through.

I spent time in UW Hospital (Madison, WI) with ulcer problems, and they had no qualms hitting me with the morphine when the pain got up to '9'.

[Nay]

2. I never understood why it bothers anyone that DYING people

get addicted to painkillers. So what?? In that case, addiction is a good thing!

[Warpy]

11. There should also be concern for people LIVING

with severe pain and undertreated. Chronic pain eats you up. You don't get a day off for good behavior, nor do you get any vacation time accrued for all your suffering. Chronic pain is the single most untreated problem in this country. Why? The DEA.

Since they haven't been able to do much about illegal drugs coming into this country, they've decided to lean on doctors who prescribe perfectly legal pain medication for their patients. Any doctor who prescribes narcotics is at risk of arrest and of having his license to practice revoked. Every time the DEA arrests a pain specialist, the estimate is that 50 to 70 other physicians are alarmed enough to cut their chronic pain patients off their meds.

Chronic pain is very treatable with opioid drugs. A study of 100 chronic pain patients prescribed long acting opioids produced no addictions. A study of nearly 11,000 hospitalized patients in the Boston area in the late 1980s who were given opiates turned up four new addictions. I think those are statistics we can cope with.

Untreated chronic pain is too often resolved by the sufferer through suicide after years of social isolation and solitary suffering. Chronic pain kills, and nearly every death is attributable to the climate of fear the DEA has fostered among physicians.

[no_hypocrisy]

3. My mother was lucky. She had slight discomfort as the cancer

metastasized. She was put on morphine that put her into a coma and she quietly and painlessly passed away.

I am/was grateful that she didn't suffer. To be truthful, she was so relatively painfree that most of us believed she was coming home from the hospital.

[maveric]

4. I work in a critical care unit of a convalescent home

where many of my patients are dying from cancer. What shocks me are these doctors that are "conservative" on prescribing powerful pain meds because they don't want to make the patient a drug addict.
WTF! :wtf: These people are not going to get better. None will leave the facility with a pulse. Who gives a shit if they are addicted to morphine if they are dying and in excruciating pain.

I got written up for using the terms "cruelty" and "prolonged agony" in front of this one shithead doctor that wouldn't prescribe morphine to a throat cancer victim.

I'm sure that if that doctor was suffering she wouldn't hesitate to take the morphine.
Sheesh!

[medeak]

6. good for you

she's probably dipping into the samples as well.

[LizW]

8. They're not afraid of causing addiction

that's an excuse they use. They're afraid of malpractice suits and criminal liability. When my dad was in the final stages of colon cancer, and his pain was becoming unbearable, his oncologist became unreachable. Our repeated calls for help were not returned. We finally turned to our hometown family doctor who prescribed morphine. He taught my brother how to give the injections and he explained the dosage.

He also explained the risks of respiratory depression associated with morphine. And most importantly, he told us to keep Dad at home if we could because in the hospital where they have to record every dose they simply would not be able to give him the amount of medication required to keep him out of pain.

In a way, I can sympathize with the doctors' fears. Family members may want to do everything they can to keep their loved one comfortable, even if that means giving enough medication that the person goes into a coma and slips away. But when the moment of death comes, some people panic and aren't ready to let the person go, and they may transfer that grief and anger onto the physician and claim that he did something wrong. If it is down in writing on a hospital chart that the doctored ordered morphine, there is always a malpractice attorney who can get an expert witness to say that it was a lethal dose. It is risky, even when the doctor is only trying to be compassionate.

I have great respect for doctors who take these kinds of risks to help dying patients not to suffer.

[benburch]

5. I put my foot down for my Mom.

I told the doctor; "OK, can we get her some morphine, please? She's terminal and I can see no point in experimenting with lesser drugs."

And they got her a morphine demand pump right away, which really helped her in the last three months of her life as we took care of her in her home.

You have to be agressive with the doctors some time and demand what you know you need.

[RichardRay]

9. Hospice care focuses on this issue

I work as a hospice care volunteer helping support the dying process of folks with a wide variety of terminal conditions. It is one of the cornerstones of hospice that very few, if any, people need to die in pain. Some people wish to have more mental acuity than can be retained with full palliative care, but that's a choice each can make, not a medical requirement.

Hospitals, teaching or not, are there to prolong life, not ease death. Until there are thanatotic specialists graduated from top medical schools I would far rather die under the care of a good hospice program and a committed hospice team than in any hospital or other in patient care facility.


Richard Ray - Jackson Hole, WY

[IdaBriggs]

15. On Behalf of the Families, Thank You.

My great-aunt died last week; she had Alzheimer's, and wasn't able to tell us about the cancer that took her. The hospice people were great, and made sure they got her the medication she needed to relieve her pain. They were a great comfort to us, and on behalf of them, I thank YOU! :)

[kimchi]

10. It makes no sense.

There are a very few living persons who need morphine in order to have any quality of life. What is the harm in giving it to a person who is dying? For what it is worth, both my mother and mother in law received morphine in a large enough dose to cause the breathing to slow so that they could die peacefully (on purpose). And I highly doubt they get in trouble for the euthanasia that I've seen upclose.

Keeping pain medication from someone who is dying in agony is cruel and inhumane.

[AngryAmish]

12. Hospice care is truly beautiful.

People who do this are doing God's work. The aid and comfort provided to my mother will always be remembered.

[Malva Zebrina]

13. when my mother was dying of cancer

I went to the nursing desk and insisted they contact the MD and insisted that she be ordered pain medication. She was.

[VOX]

14. My mom's doc was cool. Once she elected to have her feeding tube...

removed, her doc spoke with my brother and me. We all understood that nothing heroic was to be done, and the morphine was started liberally. She slipped away only a few hours later.

It was short and merciful. We should all be so lucky.