The use of sedative drugs at the end of life in a UK hospice

摘要

Sedation at the end of life can be ethically contentious and is often bedevilled by lack of clarity about definitions. There has been controversy1 over the increasing use of 'continuous deep sedation' in the Netherlands and the intent of those who practise it.3 Such practice differs from that in palliative care where sedative drugs are usually titrated against symptoms in the same way as opioids are titrated for pain.A number of factors may have influenced practice in the United Kingdom over the last decade or so: the assisted dying debate and its impact on perceptions; refinements in symptom control, perhaps leading to less of a need to resort to sedation; conversely, anecdotal evidence that specialist units might be dealing with more complex cases. This study, which was conducted in a 20-bed inpatient unit, compared practice in the use of sedative drugs at the end of life over a 10-year period and specifically, sought to determine whether more patients are being sedated than before and whether the overall level of sedation (i.e. doses used) has changed.A retrospective drug chart review was conducted of all patients who died in the hospice in the years 1996 and 2006. For those patients who were on a syringe driver at the time of death, the final prescribed doses per 24 h of sedative drugs and opioids and the length of time between starting the syringe driver and death were recorded.