Abstract
Aim:We wanted to assess Indian palliative-care nurses and physicians’ attitudes toward pain control and palliative sedation.Materials and Methods:From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programs in New Delhi, using a semi-structured questionnaire, and following grounded-theory methodology (Glaser and Strauss).Results:The interviewees did not consider administration of painkillers in large doses an ethical problem, provided the pain killers are properly titrated. Mild palliative sedation was considered acceptable. The interviewees disagreed whether palliative sedation can also be deep and continuous. Arguments mentioned against deep continuous palliative sedation were the conviction that it may cause unacceptable side effects, and impedes basic daily activities and social contacts. A few interviewees said that palliative sedation may hasten death.Conclusion:Due to fears and doubts regarding deep continuous palliative sedation, it may sometimes be too easily discarded as a treatment option for refractory symptoms.
Highlights
When a patient enters the terminal stage of a disease like cancer, intensive treatment of pain and other symptoms will often be required to preserve quality of life
Since Indian palliative-care physicians and nurses are experienced in the treatment of pain and symptoms, their attitudes toward pain control and palliative sedation can be diverse and complex
The opinions of the Indian palliative-care physicians and nurses are in line with the evidence of studies showing that painkillers even in high doses do not hasten death if administered properly and titrated according to pain.[28,29,30,31,32,33,34,35]
Summary
When a patient enters the terminal stage of a disease like cancer, intensive treatment of pain and other symptoms will often be required to preserve quality of life. Peretti-Watel et al found that 27% of French home-care nurses and 17% of general practitioners considered prescribing high-dose morphine to be euthanasia.[1,2] In many publications and discussions, euthanasia is understood in a broad sense as a deliberate medical act or omission that has a life-shortening effect that is accepted or aimed at by the physician involved.[3] the use of the term euthanasia for the prescription of high-dose morphine by one fifth of French home-care nurses and one sixth of French GPs seems to imply that these groups believe intensive pain control with morphine hastens death.
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