Center to Advance Palliative Care

Hi,

We don't have a separate policy about IV analgesia at the end of life. One of the most important points about the "morphine drip" is that it is not theoretically any different than continuous IV pain management for symptoms at any other time. That is, the morphine drip is to control symptoms, not to hasten death. This should be at the center of any policy.

Here is the fast facts on it.
http://www1.va.gov/HCBC/pagetext.cfm?pg=31#8

and one on dose escalation
http://www1.va.gov/HCBC/pagetext.cfm?pg=31#20

There is some evidence that with patients "on a morphine drip," physicians tend to increase doses without evidence that the patient is having unrelieved symptoms (?difficulty with the waiting). So, if you develop a separate policy, it would be good to include a list of indications for bolus or increase basal rate dosings, e.g. pain or shortness of breath in a conscious patient or tachypnea, grimacing, agitation, or apparent pain in a non-communicative patient. On our service, we check in frequently with the family for their assessment about whether their loved one is in pain.

best,
Michael W. Rabow, MD
UCSF Palliative Care Leadership Center