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Study Finds Pain Control Need Not Shorten Life (JPSM, 12/06; PM, 3/07)

A new study finds that, when cancer patients are given appropriate doses of morphine to relieve severe pain, the treatment doesn't lead to the shortening of their lives. The finding is an important refutation of the argument euthanasia proponents make that pain control leads to death and isn't different from euthanasia.

Dr. Declan Walsh of The Cleveland Clinic Foundation in Ohio, one of the study's authors, found that the pain control doesn't meet the misconception that it will depress respiration and shorten patients' lives.
"It's in all the textbooks as something to be aware of, but probably the risk has been exaggerated," he told Reuters in an interview.
"It's not that there isn't a risk, but that we've been perhaps been overly concerned about it," he added.

Walsh's team monitored the breathing and vital signs of 29 patients who had been admitted to a hospital for treatment of uncontrolled cancer pain. A previous study investigated respiration in cancer patients after appropriate doses of morphine and this one looked as respiration as the dosages were adjusted.
They found no evidence that the respiration levels of lowered and the vital signs remained normal.

Walsh told Reuters that "morphine can be used safely even in patients who are very ill to relieve pain, and that physicians need not be as concerned about the use of the drug in that situation as we have been traditionally taught. This is all contingent on morphine being prescribed correctly."
Commenting on the study, noted author and attorney Wesley J. Smith, who monitors end of life issues, said the study has implications for the debate surrounding euthanasia.

"One of the most insidious and selfish arguments of assisted suicide advocates is that pain control hastens death so that it is no different than assisted suicide," he wrote in response.
"This can keep patients from accepting aggressive pain control and doctors reluctant to prescribe it," he explained.
"People deserve to have their pain treated. And while it is true that any medical treatment can have unwanted side effects, sometimes including death, worrying about 'hastening death' should not be part of the equation when treating severe pain," he said.

Drs. Rob George of University College London and Claud Regnard of St. Oswald's Hospice wrote a commentary in association with the study, published in the March issue of Palliative Medicine.

"We urge those in the medical community to understand the facts about morphine and other opioids – it's time to set the record straight," they said.
"Doctors should feel free to manage pain with doses adjusted to individual patients so that the patients can be comfortable and be able to live with dignity until they die."
[4April2007, LifeNews.com, Cleveland, OH]

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Proper end-of-life opioid use does not hasten death
A study of 725 patients in 13 U.S. hospice programs found that the proper use of opioids (narcotics, such as morphine) does not appear to hasten death in patients with advanced illnesses. "Undertreatment of pain is a far more pressing concern than is the risk of hastened death in those with advanced disease," researchers found, "and physicians should be encouraged to use opioids effectively to relieve suffering at the end of life." [R.K. Portenoy et al., "Opioids Use and Survival at the End of Life: A Survey of a Hospice Population," Journal of Pain and Symptom Management, pp. 539, 12/6/06]
 
The study undermines the often used claims by right-to-die advocates that euthanasia and assisted suicide should be legalized because those induced death practices are no different than what happens when pain is aggressively treated and death is hastened. According to the study’s lead author, Dr. Russell K. Portenoy, "Opioid drugs can be used aggressively at the end of life to relieve pain and suffering, and this use should not be constrained by inappropriate fear of serious consequences like earlier death." [Reuters Health, 1/26/07; InternationalTaskForce.org, Vol 21, No.1, 2007]