Parents say doctors hastened death for dying kids

[azurnoir]

It's a situation too agonizing to contemplate — a child dying and in pain. Now a small but provocative study suggests that doctors may be giving fatal morphine doses to a few children dying of cancer, to end their suffering at their parents' request.

A handful of parents told researchers that they had asked doctors to hasten their children's deaths — and that doctors complied, using high doses of the powerful painkiller.

The lead author of the study and several other physicians said they doubt doctors are engaged in active mercy killing. Instead, they speculate the parents interviewed for the study mistakenly believed that doctors had followed their wishes.

A more likely scenario is that doctors increased morphine doses to ease pain, and that the children's subsequent deaths were only coincidental, said lead author Dr. Joanne Wolfe, a palliative pain specialist at Dana-Farber Cancer Institute and Children's Hospital in Boston.

The American Medical Association, American Academy of Pediatrics and most other mainstream doctor groups oppose mercy-killing but say withholding life-prolonging treatment for dying patients can be ethical.

<snip>

The third hospital was Children's Hospitals and Clinics of St. Paul, Minn. Dr. Susan Sencer, a cancer specialist there who did not take part in the study, said in a text message that doctors will often tell parents this when dying children are suffering: "'To alleviate pain and suffering we may need to increase the narcotics; increasing the narcotics may result in respiratory depression, which may hasten death,' so that they are aware of the trade-off."

Wolfe said the study highlights the challenges of treating dying children: Parents cannot tolerate seeing their children suffer and do not know about all the legal options for pain relief, which can include sedating children into unconsciousness. Also, many doctors are uncomfortable discussing such issues.

http://seattletimes.nwsource.com/html/health/2011224639_apusmedeuthanasiachildren.html?syndication=rss

[mn9driver]

1. People who have watched a loved one die of cancer

...quite often go through this thought process. The amount of painkillers needed to keep end stage pain under control is staggering. Two examples:

1. My father-in-law was dying of end stage lung cancer that had metastasized to his bones. As his pain increased the hospice people began giving him oral morphine drops, which gave him relief. After a week, he began to have morphine dreams which terrified him, and he stopped taking the pain medication. Within 48 hours he died of heart failure due to the stress brought on by the recurrence of the pain.

2. My mother was dying of pancreatic cancer. At the end, she was wearing two Fentanyl patches plus taking powerful oral pain meds. She died peacefully, and was certainly heavily medicated as she drew her last breath. After she died I wondered if the medications hastened her end, but came eventually to the realization that they may just as easily have slightly extended her life by keeping the horrific pain at bay.

There is no easy way to contemplate the details and what-ifs when you watch someone you care about die in pain. And there are no black-and-white answers, either.

[azurnoir]

2. agreed * 1000 n/t

[pansypoo53219]

4. my grandfather had to endure lung to bone

cancer on tylenol 3 cause morphine contipated him. we should have got him pot.

[Warpy]

6. You should have gotten him mega laxatives

and he should have gotten the morphine.

Morphine doesn't actually touch bone cancer pain, but it does allow the person to catch some sleep now and then and it does a great job of reducing the anxiety that always accompanies pain.

Hell, even if he'd had to have an enema every other day, he should have gotten that morphine.

I'm not nagging you after the fact, just telling you what to do should you ever find yourself in that situation with someone else you love.

[Warpy]

3. I've been in that situation, although not with kids.

When a terminal patient starts getting restless and moaning, you give the medication if there is a DNR in place. Families are told that adequate pain medication might hasten death, but usually not by much.

Sometimes they fool you, and their respiratory rate increases. Sometimes it doesn't get any worse. Sometimes they die sooner rather than later.

However, relieving pain at that stage is usually a lot more important than dragging death out for a few more hours, making it more miserable.

This story only seems shocking because it involves kids.

[roguevalley]

5. my dad waited until we were all there and he was on morphine. then

he slipped away so sweetly, I thank God. No one deserved it more. Mama never woke up.

[bemildred]

7. Keeping terminal patients pain free definitely can "hasten their death".

So what? It's a good thing. When you get to that point, short and sweet is the way to go. Keith said it best.

[supernova]

8. Shock factor title to a relatively sane article

about dying kids. This article is only shocking to someone who has never had to watch someone they love die of prolonged illness. I think it most have been the writer.

Past a certain point controlling pain becomes the primary objective, not eeking out more living. And the person knows that, even if that person is very young. It doesn't make it any less sad though. :-(

What is really horrible are the laws governing when docs can dose opiates like morphine. The person is dying and officials are worried about addiction?!? End of life care shouldn't factor into laws about addiction at all.

[hedgehog]

9. It's my impression that people who've gone through a lot of

pain and been on opiates a while can tolerate higher doses and need higher doses for simple pain relief.

FWIW - I've seen my kids knocked out by Tylenol 3 after having their wisdom teeth out. I think sleeping is part of the effect of opiates! So what's the big hairy deal about a dying person sleeping? It's not like they're going to miss the event!

[supernova]

10. lol

" It's not like they're going to miss the event!"

true! :D