End-of-Life Practices in European Intensive Care Units—Reply
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In Reply: Dr Kompanje states that morphine and benzodiazepines do not acutely kill patients. We disagree. Although it may be difficult at times to determine whether death was caused by a patient's underlying disease or by the administration of drugs, very large doses (200 mg) of opiates or benzodiazepines given as intravenous boluses can in fact cause death in patients who have not previously been receiving large doses. The opiate would seem to be most likely the cause of death if the patient dies within 1 minute of the injection. We agree that physicians should not be afraid to use sufficient doses of medications for palliation even if it may shorten the patient's life, although in most palliative-care circumstances it does not. This is good-quality end-of-life palliative care and not euthanasia. When physicians use massive doses of opiates in excess of patient needs for palliation to hasten death, we consider . . . [Full Text of this Article]
Charles L. Sprung, MD
Department of Anesthesiology and Critical Care Medicine
Haddasah Hebrew University Medical Center
Jerusalem, Israel
Peter Sjokvist, MD
Department of Anesthesiology
Huddinge University Hospital
Stockholm, Sweden
Seppo Hovilehto, MD
Department of Anesthesiology
South Karelia Central Hospital
Lappeenranta, Finland
Elisabet Wennberg, MD
Department of Anesthesia and Critical Care
Sahlgrenska University Hospital
Gothenburg, Sweden
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