A doctor is in trouble for hastening a patient’s death with morphine

“The state medical board is poised to yank the license of a doctor it claims hastened a dying patient’s death by giving him a massive dose of morphine.

But pain management advocates – and the dying man’s children – have rallied behind Dr. Harold Luke, who says he was simply trying to make his 76-year-old patient, identified only as ‘Morris E,’ more comfortable.

‘The state of California should focus on better things,’ said Lori McCorry, 47, one of the patient’s three children. ‘What they’re doing to Luke is wrong.’”

Giving morphine to maximize comfort in terminal patients is rightly within the standard of care. I would be curious to find out how much morphine was given in this case.

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  • Anonymous

    My father was given a large dose of morphine at the end of his valiant fight with lung cancer. It would have been selfish to keep him alive for what would have been another 24 to 48 hours. I thank the Dr. for prescribing the dose that helped to end my father’s suffering, as well as the pain my mother was going through watching him.

  • Dr D John Doyle

    This kind of news helps ensure that timid doctors will give minimal pain medication and let their patients suffer – just to be on the “safe side” of the law.

  • Anonymous

    who is trying to railroad this guy? It says the family was in support of his care.

  • Anonymous

    My grandma was slowly dying from cancer for 7 years – at the end she was bedridden, in pain and wanted to die.
    Doesn’t the state board have better things to do?

  • Anonymous

    Patients shouldn’t suffer terrible pain. Morphine is a great drug for pain.

    HOWEVER, a 50mg. dose is a lethal dose, it’s not a pain-relief dose.

    Learning to concoct pain ‘coctails’ is something that all physicians who treat patients with big-time pain should understand. If the dose was as reported, this guy should lose his license. If he misunderstands pharmacology that much, and doesn’t recognize that he needs to call in someone who does understand pain management, you have to assume that he’s making a bunch of other mistakes.

    There’s no excuse for ‘crappy’ medicine. Patients deserve great pain relief and great care. To allow this kind of thing to go on unpunished is to demean all of us who work so hard at our profession.

  • Anonymous

    The main issue here is that the physician who was caring for this actively dying patient, who was at his bedside the entire afternoon, should be allowed to exercise his clinical judgment and be allowed to use any amount of morphine he feel was needed to alleviate the discomfort of this patient even if in doing so hasten his death. His decision should not be second guessed by a third party who was not involved in the care of this patient. A minute suffer by the patient is a minute too much. In addtion, it’s known fact that there is no ceiling or maximum dose of morphine sulfate. Some patients can tolerate large amount of morphine without any adverse effect.

  • Anonymous

    Dr. Harold Luke cares for many geriatric patients and simply does everything within his power to make them comfortable and happy. He is a great physician and in my opinion this man was obviously dying-so Dr. Luke tried to make him as comfortable as possible. After a few attempts of increasing the morphine dose the patient continued to deteriorate. Thus the large increase in dose. BTW-Dr. Luke is a Seventh-day Adventist and he opposes Physician assisted suicide.

  • Anonymous

    I cannot believe the ill-informed comment that “50mgs of morphine is a lethal dose”, as if *anyone* who takes 50mgs of morphine is guaranteed to die, without regard to age, sex, weight and tolerance to opiates. If this is the case, why are there 100mg and 200mg morphine tablets available.

    Fifty milligrams may be a lethal dose for *some* individuals who have no tolerance, but some non-tolerant individuals need far greater doses to achieve analgesia than the next person. This is especially true of heavy drinkers; naturally plenty of ill-informed people would immediately think that those who drink alcohol reguarly, “don’t deserve pain relief”, a position they will abandon the moment they or their loved ones are in pain.

    As someone has already pointed out the question of whether a terminally ill cancer patient died from the cancer or from a morphine overdose is entirely irrelevant.
    Again and again caring doctors who keep their terminally ill patients pain free are subjected to this chicken-egg nonsense after their patient dies. It is worth remebering that until 1914 any adult could purchase morphine over the counter, and thus were solely responsible for their own pain-relief and death.
    We have given up the ancient right of self medication, and worst of all these cases send a clear message to doctors to “Watch Out”

    Truly there is no excuse for “crappy” medicine. Sadly the ones promoting “crappy medicine” are the State medical board. This doctor should be commended for his compassion and bravery in doing his duty by putting his patients first, in an era when more and more doctors are being scapegoated for the dismal failure of the War on [some] Drugs.

    Doctors like this need our firm support, lest when our time comes there is no doctor willing to prescribe morphine.

  • Lorelei

    My father suffered from Parkinsons disease for 30 years and spent his final 2 weeks in a hospice center. The whole time he was there, the staff were shrinking violets and WOULD NOT relieve my father’s pain. Every time I asked for more morphine for my father, they balked or gave me the runaround or made him wait for hours. They kept warning me that we didn’t want a “morphine overdose”. I wish someone like Dr. Luke had been around who understood that forcing someone to endure excessive pain while dying is pointless and sadistic.

    –Lorelei

  • Anonymous

    I just watched a loved one die from cancer and it was a terrible painfull death because certain family members refused to increase his morphine. i believe this dr. did the right thing by giving his dying patient the appropriate comfort measures in their final hours. these patients are in their dying process and are going to die whether or not they are pumped with morphine. i say pump them up with morphine and let them die peacefully

  • Anonymous

    morality : don’t get trapped by
    the medical profession (or your family) in a state where you can’t put yourself out of your own misery
    because you waited too long and
    found yourself at their mercy…

    The people need to be allowed to leave when and how they want to !

    Not just the privileged few !!!

  • Anonymous

    I am a 57-year old nonsmoking woman dying of lung cancer. All treatments I have had are horrific. It has made the quality of my life and my husband horrific. No one should deny us the ability to pass quickly. People who take any other stance should walk a mile in my shoes–or stay 5 minutes in them–they would change their mind quickly. Please do not oppose suicide if you haven’t experienced anything like this. You are condemning people and their families to hell.

  • Anonymous

    I think wat the doctor did was very brave and commendable. My sis have advanced ovarian cancer and she is only 26 years old. But she has suffered so much and the wounds on her latest operation just won’t heal. She is at home with 3 holes in her stomach. And we r living in a country which is supposed to be very medically advanced. I do not know what is the right amount of morphine to give to her so as to relieve her immense and constant pain. The doctors that are helping her with pain control did not state any max . I wish sumone like Dr luke can help her.

  • Anonymous

    my mother just died april 26, 2006
    and she was not in any pain but was constantly recieving 100 mg morphine ,i asked for comfort measures ,i didnt ask the doctors to kill her.

  • CyberGrief

    My Mom passed away June 6 2006.
    Due to a medication label dosage mistake she was overdosed on morphine. What can be done to see that these kinds of MISTAKES are not made?

  • Love my Brother

    I have brother living with me,who is dying of liver cancer.
    What a terrible,painful way to die.
    They gave me a comfort pack with lots of morphine in it.
    I keep wondering ………..?

  • Anonymous

    We have an aunt dying of cancer, but she still is not in that much pain. We managed to get her out of the hospital and home with 24 hour care. Her quality of life has been much improved – until today when a “care giver” gave her 20 mg morphine (for an 80 lb woman). This was obviously just to knock her out in order to improve the quality of life of the care giver.

    From those who need to die now to those who wish to die gracefully, there needs to be better support. How can death be so screwed up in such a civilized and advanced society?

  • Anonymous

    50Mg lethal? Please, unless you have an idea of what you’re talking about then you shouldn’t really comment and it’s obvious this person doesn’t. I take 200mg morning then another 200mg capsule at night for my chronic pain. I’m still in a lot of pain and housebound but it just goes to show how clueless people are. The family have my deepest sympathy but for those reading these comments please keep in mind that there are a lot of irresponsible idiots out there. The suggestion this person makes that they are themselves a medical professional is so transparently laughable.

    Making such a mistake discredits your frankly rediculous comments.

  • Anonymous

    Since 2,000 ng/ml is the normal cut-off when screening an urinalysis for opiates, does anyone know how many mgs.of an opiate a person would have to take to reach that level? In other words, is there a “generalized formula” based on weight? For example, since I’m female and weigh less than 140 lbs, I know I can’t risk drinking a couple of quick beers then jump behind the wheel of my car. If I got pulled over by the police, I’d fail their little breathalyser test.

  • Anonymous

    Since 2,000 ng/ml is the normal cut-off when an employer is screening an applicant’s urinalysis for opiates, does anyone know how many mgs.of an opiate a person would have to take to reach that level? In other words, is there a “generalized formula” based on weight to reach 2,000 ng/ml? For example, since I’m female and weigh less than 140 lbs, I know I can’t risk drinking more than a couple of quick beers then jump behind the wheel of my car. If I got pulled over by the police, I’d fail their little breathalyser test.

  • Anonymous

    So, how many mgs of morphine sulphate will put a person in a final sleep? What about oxycodone?

  • Anonymous

    By steadily increasing the dosage of morphine, Hospice allowed my mother to die peacefully and with dignity and for that I am eternally grateful. For those who oppose, put yourself in the shoes of the patient. Most have already accepted the death sentance and pray for the end to be pain free. Keeping needed medication unused on the shelf to prolong terminal patients from suffering is the criminal act. Wake up.

  • Anonymous

    finding a lethal dosage of Morphine Sulfate has proven very difficult. I endure extreme chronic pain, and am counting on MS as my eventual escape valve, so I’ve been a motivated researcher. Here is the best
    I have gleaned…

    1) The presence of pain or tolerance tends to diminish the toxic effects of morphine (hydrochloride). Published data suggest that in a morphine naive, pain-free individual, the lethal dose would be in excess of 120mg. Patients on chronic oral morphine therapy have been known to take in excess of 3000mg/day with no apparent toxicity.

    2. Tabor’s Cyclopedic Medical Dictionary estimates the RANGE as 5-50 milligrams per kilogram of bodyweight. big range.

    3) Antihistamines appear to lessen the lethal dose, as does dehydration. If you need to know this info, study the effects of morphine sulfate and look for commonly available drugs that work om the same systems –notably breathing and blood pressure. Anything that lowers bloodpressure should lower the LD50 (though I want an LD100:) I figure a mixture of benadryl, valium and morphine sulphate will be my own final solution when the time comes.

  • Harry

    I am a long term chronic pain sufferer (back)and have been using morphine for pain management for over ten years now. My dosage is 800mg (oral time release) in the morning and another 800mg 12 hrs later. And I don’t even feel any particular effect besides pain relief. So yeah, the range is HUGE. I also hold a professional position. One’s resistance just keeps building through the years. Inevitably one also becomes “addicted” to the substance, but in the care of a good chronic pain specialist, I feel completely safe. He also has a way of weaning patients such that withdrawal symptoms are minimal. Oh yeah, it’s also prety expensive….like over $100.00/day

  • Anonymous

    this greatly bothered me for years! My dad also had lung cancer and was in his death bed. We had a deep bond and totally understood each other. He was such a strong-willed person, will not give in to anything, including death itself! He totally indured pain and always smile and try to make us fell better.I witnessed how he fighted like a warrior and how his refusal of letting go supported his body for months without eating anything or properly breathing. I know even when he was unconscious his will to survive was still strong. (one example could be, everytime he comes back to consciousness he would do a desperate attempt of a regular exercise — what he used to do when we were encouraging him to fight with the illness — by raising his skeletal arm for 1s)

    On the night before his death nurse had a long conversation with mum, about useing a ‘large dose of morphine’ on dad. Mum is medically trained so I guess she understood what it meant, and she agreed. while I can understand how it ended dad’s suffering, and eased my mum’s pain for watching, I can’t help but feeling this is against dad’s will : — I know he wanted to live, even for one more day! Because I know him all too well.

    Living another day in that way, does it still matter? But again,all of us are dying slowly. We eat, and sleep, living another day.

    If it is not Dad’s will to die that day, shall we leave him to live for another week, or another day? But again, nobody can really prove what his will really was at that moment.

    Dad died peacefully the next day. We had to tell him to let go repeatedly over his ears. And finally he did.

  • Anonymous

    I would have to disagree with the lethal dose here. When I had cancer back in 2000, and had been suffering for many months (9 to be exact) I was given weeks to live. One to spend with my son. I won’t go into all the bloody details as they were so very painful. But I do remember the maximum dose of MS I was given, because I thought… “Oh God I hope this let’s me go in peace”. It was 50 mg per ml MS 3 mls in the syringe. If you do the math that was 150 mg at once. I got 3 that day.

    I guess it wasn’t lethal. :) I’m still here. And thank God it took away my agony. God bless my doctor. He is a saint.

  • Anonymous

    some ppl had been commenting abt lethal doses and 100mg or 200mg dosages. but obviously, giving it IV and orally has a diff absorption rate into systemic system.. so it isnt right to compare it that way…

  • Jenny

    The Monday before my dad died, he was given 425 cc of morphine. The next morning, at 7:30, he was given 800 cc and died at 10:45. How do cc’s compare to mg’s? Is 800cc a big dose or normal?

  • Anonymous

    cc stands for cubic centermetre, hence cc=ml. It seems like quite a large dose, however as was pointed out earlier you have to take into account age, sex, weight, and tolerance (which differs greatly between individuals). Remember people that giving someone a dose of morphine to alleviate pain, with the possibility that the patients death is hastened is different from euthansia. Its all about intent. This doctor did not intend to cause the death of his patient he tried to alleviate the pain. The debate over whether euthanasia (which literally means “good death”) should be legalised is a different issue.

  • Anonymous

    Just to clear some stuff up.

    You guys really need to stop making comments like “50 mgs is a lethal dose” or “50mgs could not be a lethal dose because they make 100 and 200mg tablets” your both wrong, stop playing doctor.

    First off, the stated legal dose (accurate or not) is between 120-150mg in a NON-OPIATE tolerant patient.

    Furthermore, the reason they make 100-200mg tablets is only for OPIATE-TOLERANT patients. The bottle actually says “For Opioid-Tolerant Use Only”. For example one starts at a lower dose and it becomes ineffective so they keep ramping it up.

    Believe it or not, some take 500mg everyday or more of morphine and still go to work and lead productive lives… It all depends.

  • Anonymous

    I am 49 years old, living with chronic pain from spinal degeneration (since 1998) plus, now, fibromyalgia and chronic fatigue syndrome (since 2000). I have been on a dose of morphine sulfate ER totaling 360 mg/day for the past four years. I’m also prescribed propoxyphene 400 mg/day PRN, gabapentin 1800 mg/day, lorazepam 2 mg/day PRN, and lately take naprosyn 1000 mg/day PRN.

    I live on $860 (USD) per month (Social Security and SSI, combined) and am currently facing homelessness, since I have lost my housing and rents, everywhere within hundreds of miles, exceed $450–and I’m not eligible for any other assistance. I’m alone in the world; no family left and my illness has so isolated me that I have no friends left, either. California is cutting benefits left and right. I’ve also just been through an experience where I found a tiny attached studio (no kitchen) to rent for $380 (still too expensive for my income). I managed to get half my things slowly and painfully moved there, and on the second or third day of struggling with moving, got summarily evicted for: vacuuming (middle of the day), crying audibly (I broke down and sobbed, a couple of times, in pain and frustration), having too much stuff (in my own room…books and some art supplies), and for not having an automobile (I had my first auto accident in my life–due to exhaustion, the second day of living there, traveling to get another load of belongings, and my car was temporarily in the shop…). Obviously, my new landlady was mentally ill: she maintained that none of her other tenants had ever needed to vacuum the floor, and I was causing her IBS to flare up–and she had requested a quiet tenant. She also kept showing up every couple of hours, telling me I should pay the coming month’s rent early, by giving her any money I got before the first of the month.

    Now I am faced with re-packing and re-moving what belongings are at the studio, finishing packing what’s left at my prior address, dragging it all to a third, storage, location, and continuing my futile search for affordable housing. All while in increased pain and exhaustion, dejection and heartbreak (concurrently ending a relationship, not by choice), a chaotic disarray of my belongings, no support system, a partly-repaired automobile (no turn signals or front bumper, and it handles poorly now), and with no business driving, in this state of body and mind.

    In spite of sertraline for depression and Provigil for alertness, things look impossibly bleak–and, realistically, they are. Yesterday afternoon, I decided to try to take a large enough dose of morphine and solve all these problems. I swallowed twenty-five of my 60 mg morphine sulfate ER, emptied my pockets, and walked as far as I could to a vacant park, where I sat down and waited. Six hours later, I dragged myself back to the basement where some of my things are, took eight more morphine tablets, and waited again. I woke up this morning face down on the table in front of my little coffeemaker, where I had made a mess, apparently trying to make my routine morning pot of coffee. Now it’s nineteen hours since my decision to sensibly solve my problems, and I’m groggy but obviously alive and mostly coherent. So, clearly, the lethal dose of morphine is all over the map, and very difficult (for the layperson) to predict. I wish I knew what it will be, for me. Something’s gotta give, and I’m too sick and too tired to keep trying.