Professionals should not feel they are shortening life with sedation
The physician at the end of life is faced with many dilemmas.
Stripped of the usual battery of blood tests and hope of cure, he or she
is left with the suffering of the individual and the distress that
engenders in those close to that person (whether professional or lay).
The need for a comfortable death has long been agreed. The place of
assisting this by ending life is regularly suggested, yet the means of
relieving distress without shortening life continue to grow alongside a
better understanding of the needs of all those involved and how we as
professionals can help to meet these needs.
Sedation towards the end of life can be an extremely effective tool.
A dose of midazolam can provide invaluable relief from distressing,
resistant symptoms without resulting in continuous deep sedation or
premature death. With explanation and consent the dose may need to be
increased to meet ongoing needs; this may then meet the criteria described
by Rietjens et al (1), whichever definition is used (2).
When and how this is done is a clinical skill based on an
understanding of the needs of that individual and the options available.
Physicians who regularly care for the dying in the community or in
hospital should have this skill. In specialist palliative care practice
this rarely, if ever, results in significant shortening of life (3) so it
certainly should not do so in non-specialist settings.
Physicians should not feel they are shortening life by the use of
sedation or other means in an attempt to control distress. If so, those
with the clinical skills more attuned to these situations should be
involved to ensure the best care for the patient and those close to them.
1. Rietjens J, van Delden J, Onwuteaka-Philipsen B, Buiting H, van
der Maas P, van der Heide A. Continuous deep sedation for patients
nearing death in the Netherlands: descriptive study. BMJ 2008;336:810-3.
2. Murray SA, Boyd K, Byock I. Continuous deep sedation in patients
nearing death. BMJ 2008;336:781-2.
3. Sykes NP, Thorns A. The use of opioids and sedatives at the end of
life in palliative care. Lancet Oncol 2003;4:312-8
Competing interests:
None declared
Competing interests:
No competing interests
14 April 2008
Andrew Thorns
Consultant and Honorary Senior Lecturer in Palliative Medicine
Rapid Response:
Professionals should not feel they are shortening life with sedation
The physician at the end of life is faced with many dilemmas.
Stripped of the usual battery of blood tests and hope of cure, he or she
is left with the suffering of the individual and the distress that
engenders in those close to that person (whether professional or lay).
The need for a comfortable death has long been agreed. The place of
assisting this by ending life is regularly suggested, yet the means of
relieving distress without shortening life continue to grow alongside a
better understanding of the needs of all those involved and how we as
professionals can help to meet these needs.
Sedation towards the end of life can be an extremely effective tool.
A dose of midazolam can provide invaluable relief from distressing,
resistant symptoms without resulting in continuous deep sedation or
premature death. With explanation and consent the dose may need to be
increased to meet ongoing needs; this may then meet the criteria described
by Rietjens et al (1), whichever definition is used (2).
When and how this is done is a clinical skill based on an
understanding of the needs of that individual and the options available.
Physicians who regularly care for the dying in the community or in
hospital should have this skill. In specialist palliative care practice
this rarely, if ever, results in significant shortening of life (3) so it
certainly should not do so in non-specialist settings.
Physicians should not feel they are shortening life by the use of
sedation or other means in an attempt to control distress. If so, those
with the clinical skills more attuned to these situations should be
involved to ensure the best care for the patient and those close to them.
1. Rietjens J, van Delden J, Onwuteaka-Philipsen B, Buiting H, van
der Maas P, van der Heide A. Continuous deep sedation for patients
nearing death in the Netherlands: descriptive study. BMJ 2008;336:810-3.
2. Murray SA, Boyd K, Byock I. Continuous deep sedation in patients
nearing death. BMJ 2008;336:781-2.
3. Sykes NP, Thorns A. The use of opioids and sedatives at the end of
life in palliative care. Lancet Oncol 2003;4:312-8
Competing interests:
None declared
Competing interests: No competing interests