Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Sprung CL, Sjokvist P, Hovilehto S, Wennberg E. Topical Antibiotics Before Cataract Surgery—Reply. JAMA. 2003;290(22):2938-2940. doi:10.1001/jama.290.22.2938-a