Wednesday, March 30, 2005

A Few Issues Regarding the Morphine

One individual who left numerous comments on the morphine post may wish to talk to an expert in internal medicine.

First, decubitus ulcers, known as bedsores, are caused by a buildup of pressure on the skin because a patient was left laying in a particular position for too long. There are certain factors that make pressure ulcers unavoidable, but as one who is intimately familiar with such litigation, there are very few factors (such as AIDS or pre-existing skin disorders) which make pressure sores unavoidable. The way to avoid them is to turn and position a patient every 2 hours, and to keep the patient properly fed and full of water.

Florence Nightingale thought so too, to the point that she attributed bed sores to poor nursing. The Federal government agrees. Check 42 CFR 483.25 which provides that a resident who enters a facility without pressure sores must remain that way, unless they were objectively unavoidable, and that proper care be given to relieve existing sores and prevent new ones. It is not an unreasonable standard, just a legal requirement that the standard of nursing care be observed.

Moving past that into the existential issues, pain and its endurance is an experience which rests in the conscience. We do not anesthetize plants before we reap them, as they have no self-awareness or concept of pain. The comment, incorrectly implying that I argued that she be denied analgesia and comfort measures misses the point of this struggle.

I think she should be given these measures if she is showing signs of pain, but Michael Schiavo and George Felos told us that Terri would not experience pain. They told us that this would be a peaceful repose into death because she lacks the faculties to experience and evaluate it as such. In essence, she would be much like the plant life which is harvested--possibly reacting to certain stimuli, but not out of consciousness or conscious suffering. By their reasoning, Terri would have no need for such comfort measures. There would be no psyche left to comfort.

But we are seeing reactions that are prompting staff to medicate her, despite her impending death. It raises significant questions about veracity of the predictions of the peacefulness and painlessness of this so far two week process of wasting away to death.


JWB has a point, but is a little off on the affect of morphine. Morphine and other opoids affect the way pain (among other things) is perceived by the nervous system. This is why you sometimes hear of people describing their experience on morphine as one of still experiencing the pain, but not caring. But the effect depends on the magnitude of the dose. Up the dose high enough, and you will stop voluntary functions like movement and even breathing (yes, breathing is a voluntary action, hence your ability to hold your breath, and your inability to voluntarily stop your involuntary heartbeat). A little higher, and you slow things to the point of stopping even the involuntary functions, causing death. But make no mistake, morphine affects every quarter of the nervous system. It's the reason heroin addicts like the high when they take a hit. Heroin and morphine come from the same place and have similar affects.

But nobody should miss my point. We were told that this death would evoke no painful response. It appears that it has, and that comment comes not from the Schindlers, but from George Felos. Their predictions were fairly unequivocal. The result appears to be different.


Blogger jwb said...


One of the things that has driven me crazy has been the statements that Ms. Schiavo's death will be painless or peaceful. I'm no expert on the subject, but the statement has always seemed ludicous to me.

Having said that, I have to disagree with your analysis of the use of morphine. I'm no medical expert, so if I'm wrong, please let me know. But it is my understanding that morphine doesn't really have an affect on higher brain functions. It's main affect is on the central nervous system, particularly the spinal cord, the brain stem, and the limbic system.

Children born with the congenital birth defect anencephaly respond to pain medication, even though they have no cerebrum or cerebellum. I'm not making an argument as to Ms. Schiavo's condition. I don't know what her condition is. But assuming her cerebrum and/or cerebellum are damaged or destroyed, morphine would still have an affect on her spinal cord, brain stem, and limbic system.

12:28 PM  

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