Intended for healthcare professionals

Letters Covid-19: administration of end-of-life drugs

Administration of end-of-life drugs by family caregivers during covid-19: opportunity for future home prescribing plans

BMJ 2020; 369 doi: (Published 17 June 2020) Cite this as: BMJ 2020;369:m2408
  1. Miguel Julião, professor
  1. Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, 2635-364 Rio de Mouro, Sintra, Portugal
  1. migueljuliao{at}

Bowers and colleagues’ editorial on the administration of end-of-life drugs by family caregivers during the covid-19 pandemic highlights two things.1 The first is the lack of an evidence base and the second the effect of different cultures and healthcare systems on prescribing essential drugs for home use.

The standard practice of our home based palliative care teams is to prescribe anticipatory drugs in different formulations for use as needed by family caregivers, especially when death approaches. Families are able to engage in such a delicate role partly because of the team’s technical and emotional support. 

The team is available to explain and clarify procedures, drug mechanisms, time intervals between administrations, and possible general and local side effects. They also leave families with a sheet to record when each anticipatory drug is given.

The team acknowledges the courage and possible burden of accepting this task and gives the opportunity to refuse. They check phone availability; clarify any emerging doubts and fears, including the matter of hastening death; and reinforce the courage to perform such an invasive procedure.

Before the pandemic we considered family caregivers to be potential “drug administrators.” However, during the pandemic we have had to predict pharmacy stock washouts and delays, as well as train families more often in managing severe respiratory distress or agitation.

Future research should aim at creating home prescribing plans for the administration of drugs by family caring for the terminally ill which share common universal aspects and country specific ones.


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