Sedative Use in the Last Week of Life and the Implications for End-of-Life Decision Making.

• Author: Sykes, Nigel
• Position: Abstracts

Nigel Sykes & Andrew Thorns, Sedative Use in the Last Week of Life and the Implications for End-of-Life Decision Making, 163 ARCHIVES INTERNAL MED. 341 (2003).

The use of sedation at the end of life has aroused ethical controversy, attracting accusations of hastening death by gradually increasing sedative doses. The doctrine of double effect has been introduced as an ethical defense. This study sought to determine how sedative doses change at the end of life and how often the doctrine of double effect might be relevant.

Case note review was performed of 237 consecutive patients who died in a specialist palliative care unit in the United Kingdom. Sedative dose changes during the last week of life were noted and survival from admission was compared between groups of patients receiving no sedation, sedation for seven days, or a commencement of sedation in the last forty-eight hours of life. There was a detailed review of notes from patients who received a marked increase in sedative dose to explore the applicability of the doctrine of double effect.

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