As part of the decision to allow resuscitative measures, the Living Will includes a provision to allow maximum pain relief – even if it may hasten death. For some clients, there’s no question at all – maximum pain relief it is! For these folks, I usually jokingly ask them if the prefer a rum or whiskey drip as well! The fact is most people do not want to be in pain, especially in their final moments in life. But, some people have questions about what exactly “maximum pain relief, even if it may hasten death” means.
For those who hesitate at this question, the main concern is the idea of authorizing their agents and/or doctors to kill them faster. So, I always explain to my clients the election to allow maximum pain relief, as a preliminary matter, does not mean their agents and/or the doctors are required to give them maximum pain relief. Rather, the directive to allow maximum pain relief is permissive in that they are allowing their agents and/or doctors to provide pain relief up to the legal maximum, which is 25 milligrams of morphine per hour, in they are in such pain that it is necessary to be comfortable. The latter part, “even if it may hasten death”, is a recognition that a person who receives the legal maximum amount of morphine every hour on the hour for a sustained period of time (usually 4 to 48 hours) will eventually relax them so much that their body stops breathing, which results in death.
But, one piece that is missing, it seems, in most people’s analysis of this question is whether “maximum pain relief”, ultimately, is for them or for their family. In my opinion, it’s for both, but mostly for the family. The reality is that we do have people coming out of a “Persistent Vegetative State” and/or “Terminal Condition”, though, rarely. But, of those people, we do not have a lot of people coming out who say, “Gee, I wish you would have pumped me with more morphine.” So, in reality, we do not really know how much pain a person in one of those two conditions is actually feeling and/or remembering. We do know, however, their families will be with them for whatever period of time they choose to remain on life support, and the only thing their families will be able to do for them during that time is watch and provide pain relief, if they feel it is necessary. Thus, the reality is the administration of pain relief, minimal or maximal, is as much for the person on life support as it is for their family.
When it comes to pain and pain relief, everyone is different. The decision for whether to allow the administration of maximum pain relief is very personal, and as usual, you should always consider your family and how they will handle you being in pain, not just how you handle pain.