1. Appel, Lea BSN, RN

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As a hospice nurse I was drawn to and intrigued by "Baring Witness" (Reflections, December 2009). I sympathize with the author and can understand her frustration.


I feel compelled to correct a common misconception. The physician in this story refuses the author's request that the dying patient, who's in agonizing pain, receive more painkillers. He responds, "That much would kill her." Actually, opioid dose changes at the end of life haven't been shown to hasten death.1, 2


This misconception is a tragic one and has harsh consequences for those dying in pain.


Lea Appel, BSN, RN


Greenfield, MA




1. Portenoy RK, et al. Opioid use and survival at the end of life: a survey of a hospice population. J Pain Symptom Manage 2006;32(6):532-40. [Context Link]


2. Thorns A, Sykes N. Opioid use in last week of life and implications for end-of-life decision-making. Lancet 2000;356(9227):398-9. [Context Link]