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Jamie H. Von Roenn, MD; Charles F. von Gunten, MD, PhD

Arch Intern Med. 2009;169(5):429.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Hasselaar et al¹ report that a national guideline in the Netherlands improves the pattern of drug prescribing to achieve sedation at the end of life. The guideline addresses the problem of prescribing opiates alone as a sedative, although the literature^2-3 suggests that benzodiazepines are better. It also addresses the value of including patients in the decision-making process.

In our judgment, the analogy of putting the cart before the horse comes to mind. To ensure that physicians prescribe sedation appropriately at the end of life is equivalent to ensuring that a cart has a seat that is well upholstered before being certain the cart is an adequate means of transportation. Thus is the relationship of the appropriate sedation approach to the more pressing problem of ensuring that patients near the end of life receive quality palliative care. We question why . . . [Full Text of this Article]

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Changed Patterns in Dutch Palliative Sedation Practices After the Introduction of a National Guideline
Jeroen G. J. Hasselaar, Stans C. A. H. H. V. M. Verhagen, André P. Wolff, Yvonne Engels, Ben J. P. Crul, and Kris C. P. Vissers
Arch Intern Med. 2009;169(5):430-437.
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