Tuesday, March 29, 2005

More Wisdom on Morphine

Ramesh Ponnuru over at The Corner sent me a link in an e-mail to this Merck comment on ventilators. The very end of the article reads in pertinent part:

A person undergoing mechanical ventilation may experience agitation, which can
be controlled with sedating drugs such as lorazepam and midazolam or opioids
such as morphine or fentanyl.

Now the rub here is that morphine and related drugs are given for what is a conscious response to unpleasant stimuli. Granted, Terri is not going on a ventilator, but her response to the pain of starvation requires pain relief. George Felos makes the point that Terri received two injections, not a constant drip. But in this case, it is a distinction without a difference. The line that they have been feeding us is that she will experience NO pain. She has no facilities with which to perceive it or the extended suffering of it.

Make no mistake, Terri is receiving palliative care in response to pain. That's what morphine is for.


Blogger John Tabin said...

It would be proper to administer morphine even if the doctors think she's neurologically incapable of feeling pain, because it's a diagnosis they can't be sure about (there's no test to positively distinguish a persistant vegetative state from a minimally conscious state). That she's received only small doses is extremely disturbing; it suggests that she may be one of the many victims of undertreatment of pain, which is exactly what I worried about in my AmSpec column last week.

5:54 PM  
Blogger JAMES said...

I am not surprised that she has been uncomfortable, or in pain. I don't think anyone could have seriously believed "the line they were feeding us."

Once again, we are faced with the capability of sensation, which is not the same thing as capability of cognition, or to put it bluntly, personhood. I think, sadly, that she has the former, not the latter. To say that has not had adequate medical examination is not credible. To perform MRI, PET scans, etc. will change nothing. She has had 15 years of observation, many physical therapies, many evaluations.

She should be medicated to relieve discomfort, even if its experience is only reflexive. Most likely it is being given intermittently in response to the appearance of agitation. To give it as a continuous drip might open the caregivers to later accusations of attempting to hasten her death.

7:29 AM  

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