Doctors engaged in ‘slow euthanasia’ for patients with terminal illnesses

David Rose, Health Correspondent

Patients with terminal illness are being heavily sedated by doctors before their deaths in a form of “slow euthanasia”, research suggests.

A poll of nearly 3,000 doctors found that almost one in five had administered infusions of drugs to keep patients unconscious for hours or days at a time.

In appropriate doses, sedatives and strong painkillers are considered a valuable way of easing the pain and anxiety of patients who are dying with conditions such as cancer.

But 18.7 per cent of British doctors polled said they used drugs to invoke “continuous deep sedation” in a dying patient, a practice which in other countries is seen as an alternative to legalised euthanasia.

GPs and hospital doctors who are not palliative care specialists were more likely to report using high doses of sedatives or painkillers to keep patients asleep, leading to calls for all doctors to have mandatory training in the care of dying patients.

Guidelines for care at the end of life emphasise that doctors should always act in a patient’s best interests and act within the law, which prohibits euthanasia or actively helping someone to die.

The study, published in the Journal of Pain and Symptom Management, also found that of the sample of 2,786 doctors, those who strongly supported the legalisation of assisted suicide were nearly 40 per cent more likely to employ continued deep sedation than the average.

By contrast, doctors who reported strong religious beliefs or who actively opposed changing the law were less likely to report sedating patients before death.

In most cases sedation was used for between one and seven days or less than 24 hours. But in a significant minority of patients — 8 per cent — doctors reported sedating patients for more than a week before they died.

Clive Seale, a professor of medical sociology who led the study at Queen Mary, University of London, said that deliberately keeping patients unconscious until death was controversial, with some physicians viewing it as a form of “slow euthanasia”.

“Sedation in itself not directly kill a patient, but it does put them to sleep and is associated with other things such as the withdrawal of fluids and ventilation,” he added.

“In this country it can be seen as a form of treatment to relieve intractable suffering but in the Netherlands and Belgium, doctors also see it as an easier alternative to legalised euthanasia.”

Most doctors who sedated patients reported using midazolam, a drug which in high, continuous doses can cause loss of consciousness and memory loss.

But nearly a quarter of those surveyed also reported using only opiate painkillers such as morphine or medical forms of heroin to sedate patients, which experts said suggested they misunderstood the effects of the drugs.

Rob George, of the Association for Palliative Medicine, said that rather than deliberately acting to bring on a patient’s death, some doctors may be misreporting the effect of the drugs.

“Some doctors who are not specialists may be confused and incompetent in using these drugs but the study suggests they are misunderstanding what they are doing as well.

"Dying patients are more likely to be drowsy or asleep in their final days and doctors might assume wrongly that this is a result of medication.

“It does not mean that they are hastening a patient’s death. But we do have ample evidence that many doctors do not know what they are doing when it comes to palliative care, and whether or not [dying patients] get good control of their pain and symptoms is a lottery.”

The National Council for Palliative Care, which funded the study with medical charities, estimates that 300,000 people die each year without getting the specialist care and pain management they need.

Simon Chapman, director of policy at the council, said that sedation was recognised as an appropriate part of end of life care for some patients.

An official for the Patients Association said: “There is no doubt that the vast majority of patients’ families who contact us after a death do so because they are haunted forever by watching their loved one not have the necessary care, including sedation.

“It is imperative that everyone considers making a living will to make your views about end of life care clear and understood.

“At the moment you have more training in pain relief as a vet than a doctor.”