BMJ  2007;334:440 (3 March), doi:10.1136/bmj.39136.502361.FA

Letters

Morphine

Double effect is a myth leading a double life

The first 150 words of the full text of this article appear below.

Kelly Taylor's request to use morphine "to make her unconscious" under the principle of double effect is a puzzling choice.1

Evidence over the past 20 years has repeatedly shown that, used correctly, morphine is well tolerated and does not shorten life or hasten death.2 Its sedative effects wear off quickly (making it useless if you want to stay unconscious), toxic doses can cause distressing agitation (which is why such doses are never used in palliative care), and it has a wide therapeutic range (making death unlikely). The Dutch know this and hardly ever use morphine for euthanasia.3

Palliative care specialists are not faced with the dilemma of controlling severe pain at the risk of killing the patient: they manage pain with drugs and doses adjusted to each patient, while at the same time helping fear, depression, and spiritual distress. Doctors who act precipitously with high, often intravenous, doses of opioids . . . [Full text of this article]

Claud Regnard, consultant in palliative care medicine

St Oswald's Hospice, Newcastle upon Tyne NE3 1EE

claudregnard@stoswaldsuk.org


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