"A medical dispute caused by morphine" has caused extensive discussion in the domestic medical community and society. Ms. Zhan, who is in her 60s, was diagnosed with advanced stomach cancer, and the cancer cells had already metastasized in multiple organs, so she underwent surgery at the Army General Hospital. However, the postoperative effect is not good. The patient's condition still deteriorated sharply, and the oncology department gave the patient palliative care such as anti-inflammatory and asthma nutrition support.
The World Health Organization proposes the following definition for palliative care for patients with advanced cancer: "Active and comprehensive medical care for patients whose disease has been ineffective." Control of pain, other symptoms, and psychological, social, and spiritual problems is paramount. The purpose of palliative care is to enable patients to live a more quality of life, a more dignified life.
At that time, Ms. Zhan was critically ill, and the doctor explained the truth to the patient's family, and there may be respiratory and circulatory failure and death at any time, and Ms. Zhan's family members expressed understanding. Ready to take Ms. Zhan home for recuperation. Just as she was preparing to be discharged from the hospital the next day, Ms. Zhan had an abnormal condition, her heart rate suddenly increased to 200 beats per minute, and she had difficulty breathing. Conventional treatment with conventional sildiracin, furosemide, isosorbide nitrate, and sustained low-flow oxygen inhalation after multidisciplinary consultation has been unable to suppress the patient's dyspnea. Ms. Zhan was in pain, half sitting and gasping for breath, her face was suffocated purple. At this time, the attending physician decided to alleviate the patient's pain, the doctor communicated with the patient's family, and after the patient's family agreed, Ms. Zhan was injected with morphine hydrochloride injection, and the pot of morphine 10mg was injected intravenously, and the breathing difficulties improved significantly after use, and she could lie down and fall asleep. In the early morning of the next day, the patient had difficulty breathing again, and injected morphine 10 mg subcutaneously, and the breathing difficulties improved again. In the afternoon, the patient's breathing difficulties worsened, the subcutaneous injection of morphine injection 10 mg was ineffective, and the patient died due to respiratory and circulatory failure. The medical staff expressed regret that they had tried their best. Family members take care of the aftermath.
Unexpectedly, half a year later, Ms. Zhan's son, Mr. Liu, sued the Army General Hospital and the attending physician in court with a complaint, on the grounds that the doctor's excessive use of morphine before her mother's death had caused her mother's death. The hospital was required to compensate 100,000 yuan (later added to 240,000 yuan).
After investigation and evidence collection, the judicial organs identified, "Why is it the fault of medication?" Because there are no indications for the treatment of respiratory failure in the instructions for morphine hydrochloride injection.
Morphine is a poisonous anesthetic drug, the production enterprises are designated by the state, and the amount of production per year is also stipulated by the state. At present, the domestic manufacturer of morphine injection is Northeast Pharmaceutical Group Shenyang First Pharmaceutical Co., Ltd. The company is also responsible for the production of other narcotic drugs and class II psychotropic drugs.
Drug instructions are an important statutory document for providing drug information, and are also the preferred basis for physicians, pharmacists, nurses, and patients when treating medications. The instructions must have a generic name, ingredients, specifications, production enterprises, approval number, product batch number, production date, expiration date, indications or functional indications, dosage, contraindications, adverse reactions and precautions.
The indications for morphine hydrochloride injection produced by Northeast Pharmaceutical are powerful analgesics for this product, which are used for other treatments ineffective acute acute pain, advanced cancer pain, can be used for cardiogenic asthma to temporarily alleviate the symptoms of pulmonary edema, anesthesia and preoperative administration can keep patients quiet into sleepiness. There are only three indications. However, the National Cancer Comprehensive Network (NCCN), an international authority on cancer diagnosis and treatment, clearly states that only a few days to a few weeks of terminally ill patients with nausea tumor cancer have dyspnea, the focus of treatment is to improve patient comfort, can use opioids such as morphine for treatment, and for acutely progressive dyspnea, it is also necessary to consider increasing the dose of morphine and the rate of titration. Morphine is listed as an essential medicine for pain and difficulty breathing in the Essential Medicines For Palliative Care of the World Health Organization and the International Society for Hospice care and Palliative Care. However, there are no domestic guidelines and consensus that morphine can be used in this way. The only legally substantiated specification does not have this indication, which means that morphine for patients with breathing difficulties will lose legal protection in the event of a medical dispute.
Therefore, this requires a lot of medical arguments, and this matter has set off a big discussion and a big argument in the medical and judicial circles, which lasted for a year. Many doctors have called law firms and judicial authorities to give a large number of opinions and evidence. If the hospital is sentenced to lose money, then the palliative care of all cancer patients will be difficult to carry out in the future, and the patients will not have quality in life. But it is not right that the doctor did not use the drug as directed. Fortunately,
这个事件告诉我们，医生在诊疗过程要遵守诊疗规程，严格按照说明书上的适应症来
进行诊疗活动。 说明书是药品唯一具有法律效力的文书。 患者及家属也要及时了解药品的适应症和说明书，以方便进行维权。 如果医生有违反诊疗过程的行为，都要及时掌握证据，维护自己的合法权益。