In end-of-life care, injections are used to manage distressing symptoms and ensure comfort, not to end life. Common medications administered by injection (often via a continuous subcutaneous infusion using a small pump) include morphine and midazolam.
Lethal injection is the practice of injecting one or more drugs into a person (typically a barbiturate, paralytic, and potassium) for the express purpose of causing death.
Other studies, too, found that morphine, midazolam and haloperidol were the most prescribed drugs in the palliative setting [30–33]. These drugs are given to relieve symptoms such as pain, restlessness and agitation, which are frequently seen in advanced cancer [2].
Giving medicines – using a syringe pump
End of life care should begin when you need it and may last a few days or months, or sometimes more than a year. People in lots of different situations can benefit from end of life care. Some of them may be expected to die within the next few hours or days. Others receive end of life care over many months.
But the body tries valiantly. The first organ system to “close down” is the digestive system.
Medicine for pain – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil. Medicine for breathlessness – midazolam or an opioid. Medicine for anxiety – midazolam. Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.
What to do for someone who is dying
The median survival of patients treated with high doses of morphine was 27 days and was 37 days for those treated with very high doses. Patients treated with low doses of morphine survived for 18 days.
Hospice Isn't About Giving Up
It's not a place to speed up the process of dying. A doctor suggesting hospice does not mean they're giving up on providing care and medical treatment. It's end-of-life care, but this doesn't mean giving up hope. It means shifting focus from curative treatments to comfort and support.
Change in breathing.
Changes may include Cheyne-Stokes breathing or shallow breaths with periods of no breathing for a few seconds to a minute, as well as rapid, shallow panting. These patterns are common and indicate a decrease in circulation as the body shuts down.
Palliative Care. Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses. Hospice care helps people with illnesses that cannot be cured and who are nearing death. The goal is to give comfort and peace instead of a cure.
For some people, the dying process may last weeks. For others, it may last a few days or hours. A dying person's experience may be influenced by their illness or medications, but certain signs and symptoms are common.
Physical signs of dying
Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
Often people associate morphine with the last stages of life, but this is not always the case. Some people are on the same dose of morphine for many years, as it helps them with their everyday life.
In the last 48 hours of life, common symptoms include significant changes in breathing (faster, slower, pauses, noisy), increased sleep/unresponsiveness, confusion or delirium, cold/mottled skin (especially extremities), decreased appetite/thirst, loss of bladder/bowel control, and restlessness, often with a "death rattle" from fluid buildup, as the body slows down and organs begin to shut down, emphasizing comfort care.
Final stage (minutes before death).
In the last minutes of life, breathing becomes shallow and may stop altogether. The heartbeat slows and eventually ceases. The body may make reflexive movements, such as small twitches, but these are not signs of pain or distress.
Morphine tablets and liquid work in 30 to 60 minutes but wear off after 4 to 6 hours. Slow-release morphine can take a day or two to start working but the pain relief will last for longer.
You can live for a long time without eating, but dehydration (lack of fluids) speeds up the dying process. Dying from dehydration is generally not uncomfortable once the initial feelings of thirst subside.
The “three magic phrases”—you will not be alone, you will not feel pain, we will be okay—struck a chord with me not only as someone who has sat beside dying friends, but as someone who has wondered what I would want to hear if it were me.
It is the goal that no one dies alone. But believe it or not, it is a choice and the hospice philosophy recognizes and celebrates that choice. Hospice staff and volunteers can attest to the dying choosing when they will die. People working with the dying are aware that some wait to be alone to die.
Pain at the end of life is most commonly associated with the pathology causing the disease and ultimately leading to death. Based on acuity, pain can be acute or chronic.
Syringe drivers may be set up at a time when the patient is already approaching the end of their life, because the syringe driver is the best option to manage their symptoms. Some people think the syringe driver is responsible for the someone's condition getting worse, but there's no evidence for this.
The 80/20 rule is part of the Medicare hospice rule that ensures most hospice services are delivered where patients feel most comfortable — at home. Under this guideline, at least 80% of all hospice care must be provided in a patient's home setting, such as a private residence, assisted living, or nursing facility.
While White Lady, Salt and Sugar, Miss Emma and M are among the most popular street names for morphine, there are few lesser known street names including Morpho, Dreamer and God's Drug. Some are a play on the name “Morphine,” while others are a nod to the feelings produced when using.