Good care at the end of life, not hastening death

doi:10.1136/bmj.39577.425544.3A

BMJ 2008;336:1085 (17 May), doi:10.1136/bmj.39577.425544.3A

Letters

Continuous deep sedation

Good care at the end of life, not hastening death

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

Treloar misunderstands the fundamental premise of the Liverpoolcare pathway (LCP).¹ A patient is put on the pathway only onceit is recognised they are dying imminently, within hours toa few days.² The evidence does not support that artificial hydrationor nutrition has a role to ease symptoms and suffering and may,in fact, add to it.³

Deep sedation is not recommended as part of the Liverpool carepathway and is not usual practice in UK palliative care teaching.Sedation can be a feature of symptom management but is not theprime aim. Morphine will be used to treat pain or breathlessness,glycopyrronium to treat bubbly secretions, haloperidol to treatnausea or agitation and delirium, midazolam to treat distress,etc. Most patients do not need large doses of these medicationsto achieve the necessary symptom control. In a study from StChristopher’s Hospice, dose increases in sedative medicationat . . . [Full text of this article]