The Hypocrisy When It Comes to Morphine

Like many Americans, I have conflicted feelings about state-assisted suicide. I am well aware of the nasty history of euthanasia in Germany, and I find disturbing the contemporary reports you noted on the approval of assisted suicide in Belgium for the mentally ill and minors.

Yet too often, it seems, the process of dying in America is bound up in a perverse Christian-inspired narrative that imbues extensive suffering with righteousness, purification, and courage. One does not simply die of cancer or genetic disease in the United States. Instead one “loses a long battle” or succumbs after “a brave struggle.” Even outside the context of sincere religious objection to assisted suicide, those who do not wish to spend their last days in agony or a shadow of their former selves are seen as somehow cowardly, weak, or disturbed.

End-of-life care in this country is rife with contradictions. For the terminally ill, suicide is frowned upon, and assisting them is illegal. It is perfectly acceptable, however, for the terminally ill to refuse or stop medical treatment, or to choose to enter hospice care and die at home. Instead of talking about the nasty business of dying slowly from a terminal illness, we talk about slippery slopes, hypothetical mad doctors pressuring their patients to save the state money by ending it all, or the sanctity of life, as if dying slowly of cancer was a blessing compared to these frightening alternatives.

When my grandfather was diagnosed with a rare form of leukemia in early 2009, he wanted to fight.

He underwent a number of chemotherapy treatments and tried all the medications his doctors prescribed. Ultimately, however, the treatments did not work, and he became dependent on frequent blood transfusions to stay alive—first once a month, and then every other week, and then weekly.  

These transfusions brought his color back, but he frequently said they made him feel worse, not better. He lost 50 lbs. He was always fatigued, frequently sick to his stomach, and often complained of debilitating pain deep in his bones that none of the medications could touch. He could no longer work, drive, or use the bathroom by himself.  

By the late summer of 2009, with the treatments not working, he chose to forego the transfusions and enter hospice care. If he was going to die, he wanted it to be on his terms. He was tired of the treatments, tired of his loss of independence, tired of suffering. He wanted to die at home with his family, not in a hospital room. He made it abundantly clear that this was his final wish, and we were happy to grant it.

For all intents and purposes, the moment he made the decision to stop his treatments and enter hospice care my grandfather had “chosen” to die. Because of our laws, however, he had to wait six weeks for his terminal disease to kill him.

I suppose he could have scrounged about the house for a gun or a knife or a rope to end his life while he still had some strength, but there are consequences for that sort of thing—a failed attempt would have resulted in hospitalization, a successful one in the loss of the insurance policy he was depending on to pay for his funeral expenses, settle his estate, and care for my grandmother when he was gone. He wouldn’t have wanted that.

In his final days, as his insufficient red blood cells struggled to provide enough oxygen to his brain, he became altered. He spoke to and shouted at people who were not there. Although he was very weak, he frequently struggled to get out of bed. Sometimes he cried. Sometimes he accused us of trying to kill him. Once I heard him plead with his dead mother to take him to the hospital because he felt so sick, presumably because of the toxins building up in his blood as his organs failed.  

We did our best to calm him and make sure he knew that we loved him. We gave him the medications the hospice nurse left with us to try to ease his pain. Most of the time they worked, but when he became unresponsive in the final week, it became difficult to tell.

The gross hypocrisy in all this is that one of the hospice medications the nurse brought towards the end was a high concentration of morphine. The nurse told us that in the final days, when my grandfather’s pain or discomfort became unbearable, we should administer the morphine through an eye-dropper under his tongue and then on a regular basis after that. We were to wait until he asked for it or until the other medications stopped working, because in his weakened state, it would depress his breathing. The nurse explained that when we administered that last medication, he would likely die within 36 hours. In the end, we had to guess by his facial expressions when it was time to move on from the other medications to the morphine. He died two days later.

Did we administer the morphine too soon? Too late? Did we kill him, or was it the leukemia? Did he really want to be taken to the hospital, or was he out of his mind when he shouted those things?  

I realize how melodramatic this all sounds, but I loved him very much, and I think about these things often. I do not know what my grandfather’s wishes would have been had assisted suicide been a viable option, but I would have stood by him just the same no matter what choice he made. He and anyone else with a terminal illness should have that choice, just as they currently have the choice of treatment or none, hospital or home.