Opioid use in the last days of life: what is good practice?

Concerns have been raised in the media that doctors may routinely increase the dose of strong opioids, such as morphine and diamorphine, given to terminally ill patients with the intention of hastening their death. Indeed, speculation that clinicians are escalating doses to the point where patients become sedated and consequently die has led some to suggest that the medical profession covertly carries out euthanasia. These anxieties were brought more sharply into focus as a consequence of the murders by the GP Harold Shipman. There is also a belief, by some, that a crescendo of pain in the last days of life leads to an inevitable exponential increase in the dose of analgesia.