A quarter of all prescriptions in palliative medicine are for licensed drugs that are used for unlicensed indications or that are given by an unlicensed route. Such prescriptions may affect two thirds of inpatients in specialist palliative care units. Doctors have been recommended to record in the patient's notes the reason for prescribing outside the licence; to explain, where possible, the position to the patient (and carers, if appropriate) in sufficient detail to allow informed consent to be given; and to inform other professionals involved in the care of the patient of such prescribing, so that misunderstandings are avoided. Given the widespread use of drugs outside their licence in palliative care, strict adherence to these recommendations may be impractical. In view of the implications of these recommendations for doctors in palliative medicine and other doctors they advise, a position statement endorsed by the specialty would be helpful. We under-took a survey of current practice to inform the debate.
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