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[Pain control in the terminal stage of life]
1Academisch Ziekenhuis, afd. Anesthesiologie, Nijmegen.
A 67-year-old woman suffered from terminal cancer as a consequence of local recurrence of endometrial carcinoma which had been treated by hysterectomy. She had excruciating pains and was requesting euthanasia. Advanced techniques for pain relief e.g. intrathecal administration and nerve blocks resulted in adequate relief and postponed the request. Besides knowledge and skill, the application of these techniques requires a logistic network in the home situation. An alternative therapeutic approach for this patient would have been continuous intravenous administration of morphine, which would have implied accepting an earlier death. The Dutch National Inquiry on euthanasia and life ending interventions revealed that in 19.1 per cent of the overall mortality in the Netherlands, pain treatment had contributed to death. In 1.4 per cent (1900 cases per year) death was even the main goal of pain treatment. A wider application of advanced pain relieving techniques can diminish requests for euthanasia in the Netherlands and also can curtail mismanagement of pain. An advice from 1991 of the National Health Council for better hospital support for terminal patients in the home situation is still awaiting implementation.
A 67-year-old woman suffered from terminal cancer as a consequence of local recurrence of endometrial carcinoma which had been treated by hysterectomy. She had excruciating pains and was requesting euthanasia. Advanced techniques for pain relief e.g. intrathecal administration and nerve blocks resulted in adequate relief and postponed the request. Besides knowledge and skill, the application of these techniques requires a logistic network in the home situation. An alternative therapeutic approach for this patient would have been continuous intravenous administration of morphine, which would have implied accepting an earlier death. The Dutch National Inquiry on euthanasia and life ending interventions revealed that in 19.1 per cent of the overall mortality in the Netherlands, pain treatment had contributed to death. In 1.4 per cent (1900 cases per year) death was even the main goal of pain treatment. A wider application of advanced pain relieving techniques can diminish requests for euthanasia in the Netherlands and also can curtail mismanagement of pain. An advice from 1991 of the National Health Council for better hospital support for terminal patients in the home situation is still awaiting implementation.