Dear Editor: Mr. B. was an 85-year-old patient with severe ischemic heart disease and high blood pressure. He was brought to the geriatric service of our general university hospital because of falls. Right arm paresis and delirium were present at admission. Computed tomography (CT) scan showed a large hypodense left fronto-temporal mass with peripheral edema suggesting glioblastoma. Age and poor general condition precluded any specific treatment. Neither advance directives nor proxies were present. The expertise of the pain and palliative care consultation team (PPCCT) was requested because of corticosteroid-resistant headache. Morphine (15mg/d subcutaneous) was introduced with rescue doses and increase by 30% if necessary. Because of continuous deterioration of clinical condition and onset of agitation, the dose of opioids was rapidly increased without respecting the 30% ladder with no clinical improvement. The PPCCT suggested to look for a reversible etiology of delirium and to rotate opioids but the team directly in charge of the patient increased the dose of opioids to 75mg/d. The explanation was: "Mr. B. will die in any case." Five days later Mr. B. died, said to be comfortable during the last hours of life.
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