From theBMJarchives - "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."
Continuous deep sedation in patients nearing death
Re: Continuous Deep Sedation and LCP concerns 17 April 2008
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:None declared
Mary Knowles, Previously an anaesthetist but now retired