Morphine is a safe and effective pain killer and should never cause death, according to a major new study which explodes the myth that doctors use the drug to hasten the end for terminally ill patients.
The new research comes in the wake of controversy around the case of Kelly Taylor, a 30 year old woman with Eisenmenger’s syndrome, who is currently seeking legal permission to be heavily sedated with morphine and then dehydrated until she dies.
A speaker on Radio Four’s ‘Thought for Today’, the Rev Alan Billings, Director of the Centre for Ethics and Religion at Lancaster University, courted controversy last week by commenting on the case and implying that morphine frequently ends the lives of terminally ill people, and causes sedation when given in doses necessary to relieve pain.
Commenting on the new research, Andrew Thorns, Chair of the Ethics Committee of the Association for Palliative Medicine representing 800 UK palliative medicine doctors, said: ‘Morphine is a safe and effective pain killer. It should never be necessary to give such high doses of morphine for pain that the patient dies as a result.
Only in massive overdose would this be the case and this should never be the intention of any doctor. Research and clinical practice shows that good symptom control involves far more than simply prescribing medication and can be achieved without the risk of shortening life. The dose of morphine should be adjusted to meet the individual patient’s pain requirements, with the aim of allowing the person to be free of pain without the development of unwanted side-effects. ‘
The study by Estfan and Colleagues at the Taussig Cancer Clinic in Cleveland, USA, is published today in the leading medical journal, Palliative Medicine, and involved 30 patients with severe cancer pain.
It demonstrates clearly that when prescribed properly in patients with severe pain, opioids drugs like morphine do not cause respiratory depression. There were no significant changes in objective measures of respiration such as oxygen saturation and CO2 before and after the pain was controlled.
Rob George, London Consultant in Palliative Medicine, commented: ‘Doctors in palliative care are never faced with the dilemma of controlling severe pain at the risk of killing the patient. They manage pain with drugs and doses adjusted to individual patients so that they can be comfortable and able to live with dignity until they die.’
‘It is most regrettable that the truth about morphine’s safety and efficacy never appears in the general press while claims about the so-called double effect, euthanasia and doctors “killing” with morphine automatically do.’
In the same edition of the journal, George and Regnard, in a commentary on the research, highlight the erroneous linkage between morphine and the so-called ‘Double Effect’.
They point out that, unlike many other drugs, morphine and other opioids have a very wide safety margin; that evidence over the last 20 years has repeatedly shown that, used correctly, morphine is well tolerated, does not cloud the mind, does not shorten life, and its sedating effects wear off quickly. In fact, inappropriately high, toxic doses may cause agitation and distress rather than respiratory compromise.
Dr George added: ‘When correctly used to relieve pain in a patient who is terminally ill, morphine like drugs should never cause death. By contrast they may well lengthen life and certainly improve its quality.
“Our key priority must be to ensure that the public are properly informed about the safety of pain and symptom control and to make the best palliative care more widely accessible. We need to overcome the postcode lottery of palliative care that currently exists in this country.’
The new research also comes in the wake of Baroness Ilora Finlay’s Palliative Care Bill, which seeks to make good quality palliative care more widely accessible in England and Wales. This bill had an unopposed second reading in the House of Lords on Friday 23 February. It will now proceed to a Committee of the Whole House and thence to a Third Reading. If it passes a Third Reading, then it will proceed to the House of Commons, but only if it is granted time by the Government.
Dr George concluded, ‘We call on the Government to make time for this landmark bill, in order to ensure that all terminally ill patients in the UK benefit from the very best care available.’
Notes to editors
The Ethics Committee of the Association for Palliative Medicine (APM), represents an organisation of over 800 palliative medicine doctors working in hospices, hospitals and the community across England, Ireland, Scotland and Wales.
The Palliative Care Bill is available on the parliamentary website
The full debate House of Lords can be read on Hansard
The papers quoted can be read on the Palliative Medicine online journal site
Dr Rob George: Consultant in Palliative Medicine - 07880 555075
Dr John Wiles: Chairman, Association for Palliative Medicine – 07958 986852
Dr Andrew Thorns:Chairman of the Ethics Committee, APM - 01843 233920 or 07740378544
Dr Alex Nicholson: Consultant in Palliative Medicine The James Cook University Hospital Middlesbrough 01642 854938
Dr Kathy Myers: Consultant in Palliative Medicine – 07974 116565
Claud Regnard Consultant in Palliative Care Medicine St. Oswald's Hospice Newcastle upon Tyne NE3 5JB
Tel: 0191 285 0063, Fax: 0191 284 8004
Sam Ahmedzai Professor of Palliative Medicine University of Sheffield, Sheffield S10 2JF Tel: (+44) 0114 271 2950 Fax: (+44) 0114 271 3991