Academic journal article The Midwest Quarterly

The Moral Meaning of Morphine Drips: A Modern Shibboleth Denied

Academic journal article The Midwest Quarterly

The Moral Meaning of Morphine Drips: A Modern Shibboleth Denied

Article excerpt

WHAT ARE THE MORAL meanings we attach to morphine, and what are the social implications this and related compounds have for us? Morphine drips are mistakenly perceived by some to be a routine instrument of euthanasia, and by many to shorten life. It is this latter belief, the routine shortening of life by intravenous morphine drips, that I wish to dispel. It is this false belief that I refer to as a modern shibboleth, a myth perpetrated by some who are simply confused about morphine's side-effects, or those who are assisted-suicide and euthanasia proponents. Margaret Battin is one of those who typically assume, for argument's sake, that morphine is lethal when she states, "it is very often claimed that it is permissible for a physician to administer heavy doses of morphine to a terminally ill patient close to death, knowing that the morphine will depress respirations and make death occur earlier ..." (18).

Intravenous narcotics, like morphine, are often referred to by medical personnel as "drips" because they are administered into an arm vein mixed with slowly dripping fluids. Morphine "drips" are variably viewed by lay and professional alike to be relievers of pain, necessary medications which may lead to premature death, or simply duplicitous "winks" by the professions as they use this route of narcotic administration surreptitiously to euthanize patients.

There are four generally recognized medical and social properties of narcotics like morphine: they represent the most effective medications available for the treatment of many types of pain; they often have side-effects which can include respiratory depression (which can also be one of its benefits in certain breathless conditions like heart failure and cancer related air-hunger); many believe that their use shortens life; and unrealistically many fear their addictive potential.

I will evaluate three possible uses of morphine drips, to include the intentional use of intravenous morphine to euthanize individuals, the historical traditions of morphine, and the Principle of Double Effect (PDE), as well as the medicalized notion that morphine drips are society's "wink" at euthanasia.

I will investigate the possible meanings we attach to intravenous morphine through the exploration of these three paradigms, three different general perceptions of what it is we are doing when we use an intravenous morphine drip. These paradigms, the historical traditions and contexts under which they have evolved, will be examined in detail. I will then draw on available data, as well as personal experience, to highlight the erroneous manner in which these paradigms are used in the assisted suicide/euthanasia debate; and finally, demonstrate why the notion of premature death from intravenous morphine is nothing more than a modern shibboleth, a myth misused by those who would continue to confuse morphine's value in terminal illness.

THE PARADIGMS

1) The "Debbie" Phenomenon

In patients who are narcotic naive (not already on narcotics) it is possible to suppress respirations to the point of death with only a modest dose of a rapidly infused intravenous narcotic like morphine. Although possible to accomplish, it is much harder to do in patients already receiving narcotics for pain control. The "Debbie" phenomenon is so named in recognition of an infamous case report published in 1988, and ominously entitled, "It's Over Debbie." The facts of the case are purported to have been as follows: a gynecology resident received a late-night call from a nursing unit to evaluate a twenty-year-old with advanced ovarian cancer. The resident found her to be experiencing unrelenting vomiting secondary to an alcohol drip, supposedly being administered for purposes of sedation. What the resident is alleged to have witnessed on entering the patient's room is worth noting in detail. However, it is also worthwhile to comment on the need for terms like "purported" and "alleged," because the very authenticity of this case has been questioned. …

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