Tuesday, October 27, 2009

More Training in Pain Relief As A Vet Than A Doctor.

The British TimesOnline reports a recent study, funded by The National Council for Palliative Care and printed in the Journal of Pain and Symptom Management that looks at continuous deep sedation (CDS) and how it is used by doctors to manage pain and suffering during the last days of a patient's life.

As I've written, CDS is legal because relief of pain is the objective and death is only a secondary outcome. In the US, what is called the "double effect" prevents doctors from being prosecuted for CDS.

The study polled 3,000 doctors and found that about 1 in five administered "infusions of drugs to keep patients unconscious for hours or days at a time."

In appropriate doses, sedatives and strong painkillers are considered a valuable way of easing the pain and anxiety of patients who are dying with conditions such as cancer.

But 18.7 per cent of British doctors polled said they used drugs to invoke “continuous deep sedation” in a dying patient, a practice which in other countries is seen as an alternative to legalised euthanasia


The study also found that of those surveyed, those who supported legalization of assisted suicide were 40% more likely to use CDS. Those doctors with strong religious beliefs or who were opposed to legalizing AS were less likely to use CDS.

Yet, the report's findings may be skewed by what experts consider a lack of understanding among general practitioners of how various drugs work. In other words, some may think they are using CDS when they are not or vice versa.

“Some doctors who are not specialists may be confused and incompetent in using these drugs but the study suggests they are misunderstanding what they are doing as well.

"Dying patients are more likely to be drowsy or asleep in their final days and doctors might assume wrongly that this is a result of medication.

“It does not mean that they are hastening a patient’s death. But we do have ample evidence that many doctors do not know what they are doing when it comes to palliative care, and whether or not [dying patients] get good control of their pain and symptoms is a lottery.”

The article concludes with this haunting quote:

Simon Chapman, director of policy at the council, said that sedation was recognised as an appropriate part of end of life care for some patients.

An official for the Patients Association said: “There is no doubt that the vast majority of patients’ families who contact us after a death do so because they are haunted forever by watching their loved one not have the necessary care, including sedation.

“It is imperative that everyone considers making a living will to make your views about end of life care clear and understood.

“At the moment you have more training in pain relief as a vet than a doctor.”

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