Intended for healthcare professionals

Rapid response to:

Editorials

Continuous deep sedation in patients nearing death

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39511.514051.80 (Published 10 April 2008) Cite this as: BMJ 2008;336:781

Rapid Response:

Re: Continuous Deep Sedation and LCP concerns

Euthanasia implied intervention to hasten death. Alice Ricciardi-von
Platen (Obtituary The Times 16.4.08) noted in her book recounting the
history of the killing of the mentally ill in Germany that the doctor
collaborators convinced themselves that they had a forward looking
approach to their patients best interests. This ideology persists. Many
Dutch physicians instituting continuous deep sedation with an irreversible
condition and death expected at most one to two weeks consider they are
providing high quality end of life care. However in 2007 international
pallative care experts decided that sedation is a valid option when other
treatments do not relieve symptoms in a patient expected to die within
hours or days. This decision is to be made in consultation with a
pallative care specialist, Midazolam, a short acting benzodiazepine being
the sedative of choice. By careful titration against symptoms the paitent
can communicate intermittently and request fluids. This high quality end
of life care in the patient's best interests. A patient may want to
reconsider i.e. terms of his will or to end a bitter family feud. The
study unfortunately discovered that only 9% of Dutch general practioners
had previously sought the advice of a pallative care specialist. The
editorial comments that last year 43% non-compliance with the Dutch
prescribing guidelines for terminal sedation was reported.This fact
suggests that continuous deep sedation could be euthanasia masquerading
under a different name.

Mary Knowles
Chair
Doctors Who Respect Human Life

Competing interests:
None declared

Competing interests: No competing interests

17 April 2008
Mary Knowles
Previously an anaesthetist but now retired
Retired