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December 10, 2003

Topical Antibiotics Before Cataract Surgery—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(22):2938-2940. doi:10.1001/jama.290.22.2938-a

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 this to be active shortening of the dying process or euthanasia, and not palliative care. As we noted, the term "active shortening of the dying process" was used rather than "active euthanasia," as most terminally ill patients could not request the action. Some of the patients in the "active shortening of the dying process" category did in fact request the action.

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