The fear usually applies to opioids, which were long thought to carry an increased risk of respiratory depression. Resolving this issue requires a careful balancing of both values by finding ways to keep the patient’s pain reasonably controlled while also respecting the family’s interest in keeping their loved one alert.įear of hastening death with certain pain medications is common not only amongst family members of patients but also amongst health care professionals, and this fear has been shown to contribute to the under-treatment of pain.
Anecdotally, this is probably the number one reason why patients themselves will refuse pain medications near the end of life many patients would be willing to accept a certain amount of pain and suffering if it allows them to remain alert enough to interact with people important to them. The concern about decreased level of consciousness is a bit more complicated because the interaction between patients and family members is often of great importance not only to the patient’s quality of life but also to the family. If they remain unconvinced another option is to explore using different medications that don’t carry the same risk. Sometimes denial is a factor as their concern about addiction may stem from a belief that the patient is going to recover and will then have to deal with the addiction. When engaged in a discussion about this, most family members will come to agree that the most important thing is to keep the patient comfortable. If risk of addiction is a legitimate side effect of the medication, it can be explained to family members that the risk of addiction is the lesser of two evils (compared to dying in pain) for patients near the end of life. In some cases their concerns are unjustified with respect to the particular medication being used. Concerns about side effects can be addressed by educating family members about the different classes of medication and what the real risks are of addiction or decreased level of consciousness.
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