It is popularly assumed that the potential for unintended death complicates prescribing for pain relief at the end of life. However, this is not borne out in our combined experience of 36 years in the practice of specialist palliative care. Discussions with colleagues elsewhere indicate the same experience.
Modern pain control is sophisticated, involving the use of a variety of drugs and non-drug measures, and is not simply a case of an inexorable increase in the dose of morphine.
Moreover, patients taking morphine in carefully prescribed doses for pain relief are resistant to side effects of the drug and the concept that life can be ended with an increased dose appropriate to the level of pain is spurious.
It is interesting to note the inclusion in the report of evidence from the Solicitor General that no such cases have been reported to him in 27 years.
Double Effect with regard to pain relief has been overstated and provides no basis for the legalisation of assisted dying.
(Dr) Stephen MW Hutchison MD FRCP
(Dr) Jeremy Keen MD FRCP
Consultant physicians in palliative medicine