Dyspnea in Palliative Care of Children. Mike Harlos MD, CCFP Medical Director, WRHA Palliative Care and St. Boniface General Hospital Palliative Care Section Head, Palliative Care, University of Manitoba Dept. of Family Medicine. DYSPNEA: An uncomfortable awareness of breathing. DYSPNEA:
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Mike Harlos MD, CCFP
Medical Director, WRHA Palliative Care and St. Boniface General Hospital Palliative Care
Section Head, Palliative Care, University of Manitoba Dept. of Family Medicine
An uncomfortable awareness of breathing
“...the most common severe symptom in the last days of life”
Davis C.L. The therapeutics of dyspnoea Cancer Surveys 1994 Vol.21 p 85 - 98
Hongo T. et al, Pediatrics International Feb 2003 p.60
Wolfe J. et al, NEJM 2000; 342(5) p 326-333
Robinson,WM et al, Pediatrics 100(2) Aug.1997
Only 11% were noted to have titration of opioids at end of life specifically for dyspnea
Addington-Hall JM, MacDonald LD, Anderson HR, Freeling P.
Dying from cancer: the views of bereaved family and friends about the experience of terminally ill patients.Palliative Medicine 1991 5:207-214.
in Cancer Patients
IF POSSIBLE AND APPROPRIATE
* Cancer Pain Relief and Palliative Care in Children, W.H.O. 1998
¥ The Rainbows Children’s Hospice Guidelines 2002
‡ Principles and Practice of Pediatric Oncology 4th Ed.; Edited by Pizzo & Poplack
How do you know that the aggressive use of opioids doesn't actually bring about or speed up the patient's death?
Bruera et al. J Pain Symptom Manage. 1990; 5:341-344
“Agonal” / Ataxic
Wilkinson J. Oxford Textbook of Palliative Medicine 1993: p 497-8
Where an action, intended to have a good effect, can achieve this effect only at the risk of producing a harmful/bad effect, then this action is ethically permissible providing:
Mount B., Flanders E.M.; Morphine Drips, Terminal Sedation, and Slow Euthanasia: Definitions and Fact, Not AnecdotesJ Pall Care 12:4 1996; p 31-37
The principle of double effect is not confined to end-of-life circumstances
The difference in aggressive opioid use in end-of-life circumstances is that the “bad effect” = Death