The possible use of general anaesthesia in end-of-life treatment is being investigated further, notwithstanding its reputation as a dynamic, contentious, and underutilised field.
With no primary care system in place in Australia, experts say palliative sedation – including the application of general anaesthesia to a dying patient – necessitates an analysis of the relevant ethical, medico-legal, mental, and functional ramifications.
Patient autonomy, informed consent, death hastening, expense, religious convictions, and counseling choices are among them.
According to new findings by anaesthesia and medical ethic specialists at the Murdoch Children's Research Institute (MCRI), as well as the Universities of Melbourne and Oxford, general anaesthesia should be made more readily accessible for people nearing the end of their lives.
The studies, published in Anaesthesia, examine the present use of sedation in end-of-life treatment and whether general anaesthesia is an expansion of traditional procedures in the United Kingdom. Since 1995, general anaesthesia has been utilised and represented in end-of-life treatment in the United Kingdom, with the writers finding foreign patterns indicating an increased usage of general anaesthesia in this sense.
Professor Dimity Pond, a general practitioner with a particular interest in geriatric and palliative treatment, told newsGP While the thesis offers a fascinating approach that is well worth the discussion, there is also plenty to think about.
She admitted that there is no denying that general anaesthesia will assist dying patients in passing away in their sleep.
She has already seen a few people die and when others are in need, you want to be sure to give them some solace. Any patients would be in excruciating discomfort and not be as well handled as we would want, and this will provide a solution for them.
It may be for more than just discomfort, but even for shortness of breath, which, as we've shown with COVID, is really painful and anxiety-inducing, so anaesthesia could help with that.
On the other side, certain individuals, such as those with cognitive disability and epilepsy, are exempt from existing assisted death practices because they are unable to agree. As a result, they will almost certainly be disqualified from this [approach].
The study's authors emphasise that general anaesthesia in end-of-life treatment is not a method of assisted death or euthanasia, but rather a means of providing patients with more resources to ensure their comfort at the end of their lives.
According to Associate Professor Joel Rhee, Chair of the RACGP Specific Interests Cancer and Palliative Care, the word "general anaesthesia" needs to be described in this sense.
He said that it is not general anaesthesia that necessitates intubation [as found in surgery]. Rather, they are referring to the usage of anaesthetic induction agents such as propofol to reach a condition of sedation/anaesthesia that does not involve airway assistance.
Associate Professor Rhee warns that this method of anaesthesia is a "potent" form of palliative sedation that necessitates inpatient treatment and anaesthesia skills.
He said that it's an extremely specialised approach and can be led by specialist palliative care teams with expertise using this type of treatment.
Pain medicine is usually administered to dying people, although the writers believe that certain terminal or palliative patients may like to make sure they are oblivious and unaware when their final moments come, or at the very least have the choice.
The doctor said these common [pain medication] measures are insufficient for certain patients. According to Professor Julian Savulescu, co-author, Chair of Practical Ethics at the University of Oxford, and Visiting Professor at MCRI.
‘Other patients may show a strong desire to die totally unaware. Any terminally ill people just ought to sleep. When a patient is dead, they have the ability to remain asleep. We have the medical resources to do so, and we should.'
A separate UK study showed strong support for recourse to deep sedation in dying patients, with 88% of those polled suggesting they would like the choice of a general anaesthetic if they were dying. About two-thirds said they would like to get an anaesthetic towards the end of their lives.
Professor Pond, on the other hand, believes that a consistent structure for the Australian context is needed.
She doesn't believe that they have the medical resources to give it to everybody quite yet. ‘I believe it is a capital problem.
And determining whether we ought to do something – maybe not in situations when the current drugs and palliative care processes are adequate – to save the individual from being in great pain.
However, if basic criteria are required, then you are conducting these tests to satisfy certain standards.
It is well understood that GPs participating in palliative and end-of-life treatment play an important part in protecting these patients and facilitating their desires.
Associate Professor Rhee said that it is important to have an early talk with the patients.
Through advance care preparation, the patient's preferences for end-of-life care will be addressed, including the likelihood of inpatient admissions as appropriate to maintain safety and symptom management.
This may avert a tricky scenario in which a patient documents in their advance care directive declarations such as, do not want to go to the hospital, yet develops refractor symptoms causing pain that may be best treated in inpatient facilities many months later.
When it comes to the choice of general anaesthesia, Professor Pond says cost is another consideration.
She said can we, as a society, support it? ‘GPs will need to put in more time to prescribe the anaesthesia, which can be costly, but we need the tools in place first.
Her other concern is why this service is only available to those who can afford it. It raises a new range of questions, and it has the ability to exacerbate our society's inequalities.
Our healthcare system is now overburdened, and there are arguably greater needs to remember.
The study's authors conclude that general anaesthesia at the end of life treatment is an "impending development" that necessitates a "strong multidisciplinary context and consensus practice guidance.
They said General anaesthesia at the end of life treatment poses an important question regarding the potential function of anaesthesia in the relief of pain outside the sense of surgical/diagnostic procedures.
Professor Pond concurs.
She added that as a culture, we ought to learn more about death because it is something that happens to everybody, but we also choose not to [think or speak about it].
There is a need to reclaim the room to hold a very lively, active conversation on how we want to protect people's integrity [when they are dying].
Having further choices is certainly something to bear in mind.
