Underlying his concerns was a strong sense of moral responsibility. He was his mother’s protector. He was her voice. He had a duty to keep her safe…

Morphine’s essential place in hospice care.

When I began work in a hospice, I quickly came to see morphine as a wonder drug. It was used so much more effectively in palliative care than with the med-surg patients I had cared for in the hospital!

Morphine can be given via multiple routes, it’s easy to titrate, its side effects are well-known and therefore easy to manage, and it can bring dramatic pain relief as well as markedly improved breathing.

It was common for us to admit patients to hospice whose pain had never been controlled, and they were often dumbfounded at how easily their pain could be managed. The proper medical use of morphine was literally life changing for them.

Addressing family members’ concerns.

As a result of my hospice experience, I’ve always been a big believer in patient and family education to debunk myths and highlight the optimal uses of this drug. And yet education alone isn’t always what family members need when morphine is prescribed for their loved ones. Especially when the patient is at home and it’s a family member, not a nurse, managing the drug.

“Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake… ‘I wish you hospice folks had never brought morphine out here… Now she’s dead for sure and it’s my fault.'”

In this month’s Best of the Blog column, “Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine” (originally published on this blog), social worker Scott Janssen shares what he has learned about family members’ perspectives on morphine. Caring for someone you love who is seriously ill can be a huge emotional, intellectual, and moral challenge.

Just something about morphine.

And, as Janssen notes, “There’s just something about morphine that can raise anxiety in caregivers.” A family’s resistance to the use of this drug may not reflect a simple knowledge deficit or misconception.

While we nurses tend to see family resistance to morphine as irrational, their hesitation to give this important palliative drug may reflect something deeper about what the use of this drug in their terminally ill family member means to them. And this may be worth keeping in mind.

Author Scott Janssen is a hospice social worker.