How Are Narcotics Used at the End of Life?

As a hospice nurse, I’ve encountered many misconceptions about how we treat our patients. One of the most frequent myths that I have had to dispel is about the use of narcotics in hospice.

Many people don’t understand the rationale for using narcotics at the end of life. To some people, it seems acceptable to use narcotics if the patient has terminal cancer, but it is frowned upon if the patient has a non-malignant diagnosis such as dementia, stroke or congestive heart failure.

For those people, I want to clarify how hospice professionals decide whether or not to use narcotics. We don’t justify the use of pain medications based on the patient’s diagnosis. The simple fact is this: If the patient has pain or appears to be exhibiting pain, we are going to treat that pain. Hospice professionals feel that pain is pain and no one should suffer at the end of life. It really doesn’t matter what is listed on their hospice chart as their terminal diagnosis. What matters is making sure that we treat that pain.

Another misconception surrounding narcotics use comes from the idea that hospice professionals use these drugs to end a patient’s life. (I’ve even had other medical professionals ask me about this hot-button issue!)

To be clear, hospice professionals do NOT use narcotics to end a patient’s life. We use narcotics to end a patient’s pain.

This is no different than giving narcotics to a laboring mother or a patient who has had a tendon tear repaired surgically. The goal is simply to treat the patient’s pain.

The only difference is that—as expected—the hospice patient typically dies. It is not caused by the narcotics, because the patient was terminally ill before narcotics were administered. The narcotics are only used to ensure that they die peacefully and without pain.

As hospice professionals, we don’t want the patient to die. We just want to make a difference in their lives, no matter how long they have left.  Overmedicating a patient isn’t what hospice is about. Remember, we are trained clinical workers. We take an oath. We are protective of our patients. We get attached to our patients. We don’t want them to die, but we want to make sure that when they do, we have done everything in our power to ensure that they experience a pain-free, symptom-free, dignified death.

DeAnna L. Looper RN, CHPN, CHPCA Senior Vice President of Clinical Operations Crossroads Hospice

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