The agony of agonal respiration: is the last gasp necessary?

Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy...

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Bibliographic Details
Published in:Journal of medical ethics 2002-06, Vol.28 (3), p.164-169
Main Authors: Perkin, R M, Resnik, D B
Format: Article
Language:English
Subjects:
Advance Directives
Anesthesia
Attitude to Death
Bioethics
Clinical Ethics
Death
Decision Making
Dosage and administration
double-effect
Dyspnea - drug therapy
Dyspnea - physiopathology
end-of-life care
Ethical aspects
Ethics, Clinical
Euthanasia
Hospice care
Humans
Killing
Medical ethics
Medicine
Muscle pain
Narcotics
Neuromuscular blocking agents
Neuromuscular Blocking Agents - administration & dosage
Pain
Pain and suffering
Palliative care
Palliative Care - standards
Palliative treatment
Parents & parenting
Physicians
Prevention
Respiration
Respiratory Sounds
Right to die
Suffering
Terminal Care - standards
terminal sedation
United States
Ventilation
Ventilators
Voluntary euthanasia
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Summary:Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea. Gasping respiration is also referred to as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated. We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death.
ISSN:0306-6800
1473-4257
DOI:10.1136/jme.28.3.164