Practice Lesson of the week

Parental suicide after the expected death of a child at home

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7542.647 (Published 16 March 2006) Cite this as: BMJ 2006;332:647
  1. Dawn E Davies, assistant professor (dawn.davies@ualberta.ca)1
  1. 1 Department of Paediatrics, University of Alberta, 11402 University Avenue, Edmonton, AB, Canada T6G 2J3
  • Accepted 10 January 2006

Doctors prescribe opioids and other controlled drugs to make patients in a variety of states of disease more comfortable. Once in the community, these drugs are not monitored or audited, and patients and their families are responsible for handling them safely. Recently, end of life care has received greater international attention, and the field of palliative care is emerging strongly. This, in turn, has often changed the setting in which palliative care services are provided from hospital to home. The two cases that follow show a potential hazard in the current system.

Case reports

Case 1

A boy with congenital rhabdoid tumour of the face received palliative care at home for progressive disease. The tumour grew to involve almost half of his face, with inferomedial displacement of his palate. He presented with pain seven weeks before his death. Initially the pain was controlled with codeine and simple analgesics, but it eventually intensified. He was then treated with morphine. The dose was gradually titrated upwards to relieve his pain. He stayed normally alert and interactive as the dose was increased.

Two days before his death, he developed sudden signs of obstruction to his airway, with stridor and respiratory distress. He had been prescribed lorazepam in anticipation of such an event. This was titrated until it helped. He was sleepy but could be roused, and he no longer seemed anxious, despite visibly laboured breathing. …

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