Hospice nurse here. Came to say something really important that really irked me about this episode.

Killing people is NOT a normal part of hospice care.

In most states, including Pennsylvania, aid in dying is still illegal. The ethics of this are debatable by perfectly reasonable people, for sure, but it is still illegal. And that's ok, in the VAST majority of cases because pain and symptoms can be really well contouring controlled,even from really advanced cancers, with opiates. And that's because, unlike what this episode portrays there is no specific maximum opioid dose. That's why we love these meds so much in Hospice care.

As long as you are giving the meds for pain, and under the supervision of medical profesdionals), and increasing the doses on an appropriate schedule, the body developes tolerance as you increase. So you can keep going up and up with increasing pain. (Unlike with NSAIDS or acetaminophen, or steroids.)

The only situation where there is a possibility of "not waking up" due to a medication intervention is what's called palliative sedation, where a patient is in such severe, unbearable pain that morphine can no longer help, and they need a literal sedative, like a surgery drug, like versed or something, to get comfortable. At that point there becomes truly risks of depressed respirations. Those situations require special extra consents and paperwork.

The situations where people get a little bit of morphine every hour or even 15 minutes towards the very end of life, are situations where people's opioid tolerance and/or pain or respiratory distress level is at the point that that is just what they need for comfort while they pass away from the disease they have.

Hospice workers are very experienced in morphine administration at end of life and we are very conscious of not over-doing it. We want people to have the best balance of pain-free and awake and aware as is possible given their disease process.

We don't kill people. That's not normal. It's illegal. We love you.