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Are We Putting the Cart Before the Horse?
Jamie H. Von Roenn, MD;
Charles F. von Gunten, MD, PhD
Arch Intern Med. 2009;169(5):429.
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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 literature2-3 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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Arch Intern Med. 2009;169(5):430-437.
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