title: Relieving suffering or intentionally hastening death: where do you draw the line?
abstract: OBJECTIVE
  End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process.
  
  
  METHODS
  Secondary analysis of a prospective, observational study.
  
  
  METHODS
  Thirty-seven intensive care units in 17 European countries.
  
  
  METHODS
  Consecutive patients dying or with any limitation of therapy.
  
  
  METHODS
  Evaluation of the type of end-of-life category; dates and times of intensive care unit admission, death, or discharge; and decisions to limit therapy, medication, and doses used for active shortening of the dying process and the intent of the doctors prescribing the medication.
  
  
  RESULTS
  Limitation of life-sustaining therapy occurred in 3,086 (72.6%) of 4,248 patients, and 94 (2.2%) underwent active shortening of the dying process. Medication for active shortening of the dying process included administration of opiates (morphine to 71 patients) or benzodiazepines (diazepam to 54 patients) alone or in combination. The median dosage for morphine was 25.0 mg/hr and for diazepam 20.8 mg/hr. Doses of opiates and benzodiazepines were no higher than mean doses used with withdrawal in previous studies in 20 of 66 patients and were within the ranges of doses used in all but one patient. Doctors considered that medications for active shortening of the dying process definitely led to the patient's death in 72 patients (77%), probably led to the patient's death in 11 (12%), and were unlikely to have led to death in 11 (12%) patients.
  
  
  CONCLUSIONS
  There is a gray area in end-of-life care between treatments administered to relieve pain and suffering and those intended to shorten the dying process.
authors: Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel. sprung@cc.huji.ac.il
authors: Charles L
authors: CL
authors: Sprung
authors: Didier
authors: D
authors: Ledoux
authors: Hans-Henrik
authors: HH
authors: Bulow
authors: Anne
authors: A
authors: Lippert
authors: Elisabet
authors: E
authors: Wennberg
authors: Mario
authors: M
authors: Baras
authors: Bara
authors: B
authors: Ricou
authors: Peter
authors: P
authors: Sjokvist
authors: Charles
authors: C
authors: Wallis
authors: Paulo
authors: P
authors: Maia
authors: Lambertius G
authors: LG
authors: Thijs
authors: Jose
authors: J
authors: Solsona Duran
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D001926:Brain Death; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D005060:Europe; D028601:Euthanasia, Active / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care; D011364:Professional Practice / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines