Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.
DNR and morphine drips: not necessarily active euthanasia (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 14:A1742 1995. Unique Identifier : AIDSLINE ICDB/96614890 Shapiro GR; Gatter R; Cancer Ethics Program of the Univ. of Wisconsin Medical School,; Milwaukee, WI 53201
Abstract:
Morphine drips have been traditionally used to treat pain, respiratory distress, and agitation. However, there has been recent concern that they are being used as a method of active euthanasia. A doctor could make such covert use of morphine only if his/her patient had a pre-existing do not resuscitate order (DNR). Although such motives are not documented in the hospital record, review of the record can reveal whether morphine is being used to treat patient symptoms. To examine the reasons for starting morphine drips, we designed a retrospective multihospital chart review of inpatients with cancer or AIDS hospitalized between 11/1/93 and 10/31/94. We report here preliminary results from one of these hospitals. During the study period there were 550 admissions for cancer or AIDS. Of these, 15% (82) received morphine drips. 83% (68) of the charts were available for review and 40% (27) of these showed a DNR order. The morphine drip was ordered at or after the time of DNR in 74% (20). In only 1 of these cases was the use of morphine not clearly linked to symptom control. In 3 other cases morphine drips were initiated as part of the plan to withdraw aggressive treatment ('comfort care only'). 2 of these 3 cases involved the move from intermittent to continuous iv morphine for the ongoing treatment of pain. In the other case the morphine drip was ordered to treat agitation in a patient with no previous morphine use, and this order coincided with the DNR order. Therefore, though the use of morphine drips in cancer and AIDS patients is usually linked to the treatment of new or ongoing symptoms, there appears to be a small but significant number of cases (11%) where the doctor has linked the decision to withdraw aggressive treatment with the decision to begin a morphine drip. This does not necessarily imply these doctors have active euthanasia as their motive. For, they may view the foregoing of aggressive treatment as necessary permission to treat symptoms with morphine drops.
Keywords: Acquired Immunodeficiency Syndrome/PHYSIOPATHOLOGY *Euthanasia Human Infusion Pumps Medical Audit Morphine/*ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Neoplasms/*PHYSIOPATHOLOGY Pain/*DRUG THERAPY Palliative Care *Resuscitation Orders Retrospective Studies ABSTRACT 960530
M9650015
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Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.
