Intended for healthcare professionals

Re: Why I decided to provide assisted dying: it is truly patient centred care

Agree or not with the concept of assisted dying, it’s clear that the account of Dr Sandy Buchman is heartfelt, and that the sincere intention was to lessen pain & suffering. It’s also clear that pain and anguish are not limited to the patient alone. Sometimes however, big questions can overshadow seemingly trivial details - like the choice of drugs to enable that dreamt-for but dreamless sleep.

Intravenous propofol given to induce anaesthesia not infrequently results in the patient complaining of discomfort or pain as the drug enters the vein. This can be reduced by the admixture of lidocaine. Rocuronium also sometimes results in arm withdrawal or flinching, in those already given a ‘sleep’ dose of propofol. Other equally effective muscle relaxants do not cause this pain response.

We have little doubt that the end-of-life described was as painless and peaceful as it appeared, but know that patients we anaesthetise with these drugs do sometimes ‘drift off’ experiencing short-lived pain that our drugs have caused. Of no lasting consequence for the dying perhaps, but potentially unsettling & upsetting for those doing the assisting. Forever wondering whether last thoughts were interrupted by pain from the procedure: never able to ask, explain or apologise.

Personal views on the big question clearly differ but no-one seeks to add to the suffering of those involved. Whatever our views, we need to talk.

Competing interests: No competing interests

08 February 2019
Karan Kanal
CT2 anaesthesia
Mark Davies, consultant in anaesthesia & perioperative medicine
Royal Liverpool & Broadgreen University Hospitals NHS Trust
Liverpool L7 8XP