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dc.contributor.authorSchofield, Guy
dc.contributor.authorBaker, Idris
dc.contributor.authorBullock, Rachel
dc.contributor.authorClare, Hannah
dc.contributor.authorClark, Paul
dc.contributor.authorWillis, Derek
dc.contributor.authorGannon, Craig
dc.contributor.authorGeorge, Rob
dc.date.accessioned2019-07-05T00:49:08Z
dc.date.available2019-07-05T00:49:08Z
dc.date.issued2019-06-20
dc.date.submitted2018-11-12
dc.identifierpubmed: 31221766
dc.identifierpii: medethics-2018-105256
dc.identifierdoi: 10.1136/medethics-2018-105256
dc.identifier.citationJournal of medical ethics
dc.identifier.urihttp://hdl.handle.net/10034/622400
dc.descriptionFrom PubMed via Jisc Publications Router
dc.descriptionHistory: received 2018-11-12, revised 2019-05-08, accepted 2019-05-12
dc.descriptionPublication status: aheadofprint
dc.description.abstractWe read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper's conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation (CDPS) is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt's headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice. [Abstract copyright: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.]
dc.languageeng
dc.sourceeissn: 1473-4257
dc.subjectclinical ethics
dc.subjectend-of-life
dc.subjecteuthanasia
dc.subjectpalliative care
dc.titlePalliative opioid use, palliative sedation and euthanasia: reaffirming the distinction.
dc.typearticle
dc.date.updated2019-07-05T00:49:08Z
dc.date.accepted2019-05-12


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