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.
Secondly, 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 re-affirm the important distinction between palliative care prescribing and euthanasia in practice.
- Clinical Ethics
- Palliative Care