The use of opioids and sedatives at the end of life

Opioids and sedative drugs are commonly used to control symptoms in patients with advanced cancer. However, it is often assumed that the use of these drugs inevitably results in shortening of life. Ethically, this outcome is excused by reference to the doctrine of double effect. In this review, we a...

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Bibliographic Details
Published in:The lancet oncology 2003-05, Vol.4 (5), p.312-318
Main Authors: Sykes, Nigel, Thorns, Andrew
Format: Article
Language:English
Subjects:
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - adverse effects
Anesthesia
Delirium
Drug Administration Schedule
Drug dosages
Dyspnea
Ethics, Clinical
Humans
Hypnotics and Sedatives - administration & dosage
Hypnotics and Sedatives - adverse effects
Morphine
Narcotics
Pain
Palliative care
Palliative Care - ethics
Palliative Care - methods
Patients
Practice Guidelines as Topic
Terminal Care - ethics
Terminal Care - methods
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Summary:Opioids and sedative drugs are commonly used to control symptoms in patients with advanced cancer. However, it is often assumed that the use of these drugs inevitably results in shortening of life. Ethically, this outcome is excused by reference to the doctrine of double effect. In this review, we assess the evidence for patterns of use of opioids and sedatives in palliative care and examine whether the doctrine of double effect is needed to justify their use. We conclude that patients are more likely to receive higher doses of both opioids and sedatives as they get closer to death. However, there is no evidence that initiation of treatment, or increases in dose of opioids or sedatives, is associated with precipitation of death. Thus, we conclude that the doctrine of double effect is not essential for justification of the use of these drugs, and may act as a deterrent to the provision of good symptom control.
ISSN:1470-2045
1474-5488
DOI:10.1016/S1470-2045(03)01079-9