Abstract
Recent UK government initiatives have stressed the importance of patient choice in health care. In relation to palliative care, this involves the achievement of the best quality of life, respect for patient autonomy and choice over treatment options. Regarding selection of analgesic, the treatment options are evaluated by considering efficacy and potency, routes of delivery, titration and conversion, adverse effects and cost effectiveness. This article explores these issues in relation to the rationale for choice of strong opioids. Morphine and diamorphine are usually considered the most effective, 'first-line' analgesics but is this necessarily the case when patient choice is put into the equation? There is a case for more flexibility in selecting the opioid depending upon individual circumstances. Opioid selection should take into account quality of life issues. However the scope for opioid selection seems likely to be restricted by considerations of cost effectiveness. The challenge is to ensure that the patient voice is heard.
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