Using Morphine for euthanasia instead of Nembutal
Morphine is commonly prescribed as a slow release (SR) tablet.
MS Contin and Kapanol are marketed forms of morphine. These tablets are usually taken once or twice a day. They are designed to slowly release the morphine in order to give ‘background” pain control. For the onset of sudden (breakthrough) pain, a fast-release form of the drug such as ‘Ordine’ (liquid morphine) is often prescribed.
Many very sick people take these drugs to control the pain of serious painful illness. Sometimes people stockpile morphine tablets, believing that by not taking the full prescribed dose they can acquire a lethal quantity. The problem, however, is in establishing what constitutes a lethal dose of the opioid.
Knowing how many morphine tablets to accumulate and then take to bring about death is a little like asking the length of a piece of string.
Taking a single drink made up of crushed SR morphine tablets may cause death, but the result can also be unpredictable. The fast-acting liquid morphine is a more effective form of the drug. but the twin problems of sensitivity and tolerance remain. For these reasons it is difficult to recommend morphine as a stand-alone, single-dose, oral agent for a reliable death.
Morphine does, however, have a role as a supplementary or potentiating agent, (ic. a drug taken to enhance the effectiveness of another drug). While alcohol is a common potentiating agent, for people who do not drink, liquid morphine can be a good alternative. The sedation, mild euphoria and respiratory depression can often work to improve the lethal effect of many other drugs. More detail can be found in the Chapter titled ‘Drug Pre-Medication and Potentiation.
The Doctrine of Double Effect: Pharmacological Oblivion, Terminal Sedation and Slow Euthanasia
Morphine plays a major role in the practice of Pharmacological Oblivion or ‘Slow Euthanasia’ as it is also called. In a country where assisting a suicide is illegal, this practice is often the only way that a doctor can hasten the death of a patient and escape any legal consequence.
Known commonly as the “doctor’s loophole’, slow euthanasia allows a doctor to end a patient’s life by slowly increasing the amount of a pain-killing drug like morphine. A dose of morphine is given to the sick patient to make them comfortable”. After a period of time, and upon review, it will be decided that the drug has been insufficient and that the patient is still in distress. A larger dose is then given and another period of time elapses. The patient may not be conscious or aware. They are effectively in a state of ‘pharmacological oblivion’ as the process continues. Eventually, a lethal dose will be reached and death will occur. The doctor will argue that the patient’s death was an unplanned consequence of either the patient’s disease or the necessary treatment for their pain.
It can often take a number of days for the levels of morphine to become high enough to cause death. It is important for the doctor’s legal well being that the process is slow. Indeed, it is the length of time taken that gives credibility to the argument that they tried to establish “just the right dose’ of morphine. If, for example, a single large dose of morphine were administered and death resulted, it would be almost impossible for the doctor to argue that their prime intention was the treatment of the patient’s pain. Slow euthanasia is necessarily slow. It must be. in order to safely exploit this legal loophole.
This way the doctor treating a person’s pain is not legally responsible if the person dies, provided the guidelines for administering the drug were complied with and as long as the stated primary intention was the treatment of the person’s pain.
However, the administration of the pain-relieving drug has, in reality, caused the desired double effect; it has relieved the patient’s pain, but it has also caused their death.
Slow euthanasia is a relatively common means used by doctors to bring about the death of a very sick patient. That said, few medical professionals will admit their involvement. For their own protection doctors must insist that their ‘prime intention’ was purely pain relief. While observers may be suspicious at the relentless increase in the dose of the administered morphine, unless the doctor chooses to confess that their goal was to bring about the patient’s death (rather than pain relief), they are at little legal risk.
It is a pity that this practice remains cloaked in secrecy. Clearly, it would be better if there were open and honest communication between the medical system (represented in the doctor and health care team), the patient and the patient’s family. However, in jurisdictions where the law makes it a serious crime to hasten a patient’s death, but there is no crime at all in the aggressive treatment of a patient’s pain, there is little prospect of change.
Problems with Slow Euthanasia
Slow euthanasia has a number of features that limit its appeal to a patient. Firstly, it is the doctor who is in control. While a patient might ask for this form of help, it will be the doctor who decides if and when it will be provided. Just because you – the patient – might feel that now is the right time to begin the process, there is no guarantee that the doctor will agree.
The doctor may say that you should wait: wait until you become sicker, perhaps until your hemoglobin drops a few points, or your respiratory function tests deteriorate further. The sicker you are, the safer it is for the doctor to go down this path. If the doctor disagrees with you and thinks the ‘best time” to help you is still several weeks away, there is absolutely nothing you can do about it.
Another drawback of slow euthanasia is the restriction on the range of drugs that a doctor might use to help a person die. The doctor’s defense must be that they were treating the patient’s pain (as opposed to causing death). This is why a pain-relieving drug like morphine must be used.
A doctor could not, for example, administer a large dose of a barbiturate. While a barbiturate might provide the most peaceful and quickest death, barbiturates are not pain-relieving drugs. A claim that a barbiturate was being used to treat pain makes no sense.
For a person to die of a medically-administered morphine overdose, the process must be slow to protect the doctor. Indeed, slow euthanasia can often take days or even weeks. Often the patient is given a sedative that keeps them asleep through the whole process; midazolam is the drug of choice.
Coupled with morphine, this morphine – midazolam mix (known as ‘Double M’ therapy) places the patient in an induced coma for the time needed to sufficiently raise the morphine level. Double M therapy allows the patient to sleep through their own death and gives rise to the other name for the process – ‘terminal sedation’.
In slow euthanasia, the doctor also chooses the place of death. It is unusual for slow euthanasia to take place in a patient’s home. Usually it occurs in an institution, commonly a hospital or hospice.
In an institution, a team will be involved in providing care. There may be several doctors participating in the relentless increase of the morphine. This further blurs the link between cause and effect which makes the process even safer for the medical staff involved. While slow euthanasia could take place at the patient’s home, in practice this presents logistical difficulties. The doctor would need to make many visits, perhaps several a day, to facilitate the slow increase in the drugs.
Full nursing care would also be required. An unconscious patient needs to be moved regularly and watched constantly to ensure the flow of drugs is not interrupted. This is often an extremely difficult time for those close to the patient as they find themselves participating in this deliberate, slow death watch.
For these reasons, few people opt for slow euthanasia as their preferred choice for a peaceful, dignified death. More commonly. slow euthanasia is an option of last resort, when few alternatives exist. In such dire circumstances, if a doctor does offer to help (usually through a nod, a wink and an understanding), patients will grab the chance, reasoning correctly that this is better than nothing.
Those close to the patient often see slow euthanasia as an example of a doctor helping someone to die. This leads to the commonly-expressed view that there is no need for euthanasia legislation. People say ‘I can’t see what all the fuss is about with assisted suicide – it goes on all the time – doctors are always helping people to die’.
It is as well to remember that “what goes on all the time’ is the grim process of suspending a sick person by a thread between life and death for an arbitrary time, until the thread breaks. That is slow euthanasia!
In Exit’s internal polling of over 1000 of our members, slow euthanasia was found to be one of the least-preferred methods of dying, and one that is usually avoided when other options exist. Given a choice, people prefer to have control of the dying process. This is not the case with slow euthanasia. It is relatively rare to find someone who wants to spend their last days in a drug-induced coma.
When people decide that their suffering is so great that death is preferable, they want their passing to be quick. This is why slow euthanasia is almost always an option of last resort.. It is the method accepted when nothing else is on offer, and when the only alternative is relentless and ongoing suffering.
Another unfortunate consequence of slow euthanasia is the common belief that morphine is the best drug to end life. This reputation is undeserved and comes from the almost-universal use of morphine (or other opioids) in slow euthanasia, where doctors have little choice.
While a single overdose of morphine may cause death, individual sensitivity and tolerance to these drugs make this an uncertain and unpredictable process. Morphine is best used to do the job it is designed to do, control strong pain. There are better euthanasia options available.