Morphine extended-release capsules and extended-release tablets should not be used if you need pain medicine for just a short time, such as when recovering from surgery. This has raised the argument that palliative sedation does not cause or hasten death and that an individuals death following palliative sedation is more. It acts on the central nervous system (CNS) to relieve pain. In end of life care, double effect is a myth leading a double life. Morphine belongs to the group of medicines called narcotic analgesics (pain medicines). Using double effect as a justification for patient assisted suicide and euthanasia is not tenable in evidence-based medicine, he says. Palliative care specialists are not faced with the dilemma of controlling severe pain at the risk of killing the patient - they manage pain with drugs and doses adjusted to each individual patient, while at the same time helping fear, depression and spiritual distress, he adds.Īnd he warns that doctors who act precipitously with high, often intravenous, doses of opioids are being misled into bad practice by the continuing promotion of double effect as a real and essential phenomenon in end of life care. The Dutch know this and hardly ever use morphine for euthanasia, he writes. 11 Opioids are a central part of pain treatment in. Its sedative effects wear off quickly (making it useless if you want to stay unconscious), toxic doses can cause distressing agitation (which is why such doses are never used in palliative care), and it has a wide therapeutic range (making death unlikely). The fear that opioids will hasten death is an inappropriate barrier to their use, assuming proper dose initiation and escalation are used. The principle of double effect allows a doctor to administer treatment that hastens death, providing the intention is to relieve pain rather than to kill.Įvidence over the past 20 years has repeatedly shown that, used correctly, morphine is well tolerated and does not shorten life or hasten death, he explains. Mrs Taylor's request to use morphine to make her unconscious under the principle of double effect is a puzzling choice, writes Claud Regnard, a consultant in palliative care medicine. It follows the case of Kelly Taylor, a terminally ill woman who went to court earlier this month for the right to be sedated into unconsciousness by morphine, even though it will hasten her death.
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