Palliative practice blurs ethical lines, physician says

The use of neuromuscular blockers to stop the appearance of laboured breathing at the end of a patient's life raises ethical concerns and should not be permitted, says a University of Toronto researcher specializing in palliative care.

"As we die, our respiratory pattern is altered and we seem to gasp and struggle for each breath," says Dr. Laura Hawryluck, physician leader of the Ian Anderson Continuing Education Program in End of Life Care at U of T. "This gasping is seen as a clear sign of distress and suffering by families and loved ones but it's unclear whether the dying person actually perceives this gasping or breathing difficulty."

In a rebuttal to an article in the June issue of the Journal of Medical Ethics, Hawryluck argues against the suggested use of neuromuscular blockers. Neuromuscular blockers work by paralyzing the muscles in the body. Administering the agents make a patient's death look very peaceful because they cannot move; it also kills them because they are unable to breathe, she says.

Once neuromuscular blockers are administered to dying patients, there is no return, says Hawryluck, and that is where lines become blurred between a doctor's intent to palliate or euthanize a patient.

As agonizing as it is to watch a loved one in the process of dying, it is unlikely that the patient is registering any discomfort, she says. To prepare family members for what they are about to witness, Hawryluck believes physicians should explain what to expect in terms of a dying patient's breathing and bodily reactions.


Contact: Janet Wong
University of Toronto

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