Systemic Euthanasia

[Kenzo]

Our troubles with midazolam: a story of death, dying and a powerful drug

 

Although midazolam has no analgesic properties, it was repeatedly described to us as a “breakthrough drug”, implying that it was being used to suppress spikes in pain above the level the prescribed doses of painkillers could handle. We believe this terminology is highly misleading.

According to one recent article in the UK Daily Mail, whistleblowers have claimed they were told to administer the drug to stop confused patients wandering. The article also reports that: “Retired neurologist Professor Patrick Pullicino, who was instrumental in raising concerns a decade ago that the Liverpool Care Pathway was bringing forward patients’ deaths, believes the jump indicated something similar had happened. He said: ‘Midazolam depresses respiration and it hastens death. It changes end-of-life care into euthanasia.’”

About a week before my father died in a private hospital from aggressive cancer, he complained that he had been administered a “nightmare drug”.
He said nursing staff had told him they had tried something new with his medication, a “breakthrough medicine”, but it hadn’t worked. He was told he had experienced a bad reaction.
The “nightmare drug”, he said, had robbed him of any power over his body. He was quite traumatized while telling us about it

 

Dad said the worst effect of the drug was that he was unable to tell the nursing staff he was in pain. He had become used to telling them when the pain level rose above the capacity of the morphine he was on to control, and we had become familiar with the term “breakthrough drug” to refer to top-ups of painkiller. Because of the “nightmare drug” he had lain for some hours unable to move or speak, but suffering serious pain until it wore off enough for him to be able to speak again.

I spoke to the nursing staff about this. They named the drug as midazolam. I was told it was used to deal with “breakthrough pain”, but clearly it didn’t work in Dad’s case. Only later did I discover that midazolam has no analgesic properties. Not only that: it may actually increase perceptions of pain.

Now I wonder if his ability to communicate his pain was suppressed by sedatives. I wonder if he died in pain, after all, but that he was unable to tell us about the pain because he was sedated with midazolam. I wonder whether I let him down by not understanding what was happening.

 

But the more we read, the more we feared that midazolam, by rendering patients inert and uncommunicative, might even hasten death without reducing suffering. We believe it can reduce the ability of patients to communicate important facts about their pain and other aspects of their condition. We believe it is misleading to assert that the inert state which can be induced by doses of Midazolam, is a natural part of the process of dying.

Nurses and doctors directly involved in these cases and in facilities where the drug is often used were anxious to assure me that midazolam is a “breakthrough drug” used to quash pain that spikes above the opiate painkillers. When I observed that this was not a very accurate picture to paint, since it is known and accepted worldwide that the drug has zero analgesic properties, they said it was used along with painkillers to alleviate distress.

Professor David Henry is a clinical pharmacologist with a worldwide reputation. I had interviewed him often in a professional capacity and I knew him to be honest, compassionate and ethical.
After a short search I located him at Bond University in Queensland, and told him our stories. I asked him whether I was barking up the wrong tree by harbouring concerns about the use of midazolam in the palliative care setting. I honestly hoped he would convince me I was wrong to be concerned.
Asking hard questionsInstead he said he knew exactly what I was talking about and he told me that he had personally insisted that no such sedatives be used on his mother when she was dying. He encouraged me to ask the hard questions and to ask them publicly.

midazolam actually increased the acuity of perception of cold, heat and pain, “contrary to the belief of many clinicians that sedative drugs will reduce pain perception”. The paper goes on to describe the belief on the part of many practitioners that adding a sedative like midazolam is a solution when pain relief medications aren’t quite achieving the desired level of relief. It suggests this belief is mistaken. Our personal experiences would lead us to agree.

Even the Wikipedia entry for midazolam states that the drug should be used with “additional caution in the elderly as they are more sensitive to the pharmacological effects of benzodiazepines, metabolise them more slowly, and are more prone to adverse effects, including drowsiness, amnesia (especially anterograde amnesia), ataxia, hangover effects, confusion, and falls”. Also: “Additional caution is required in critically ill patients, as accumulation of midazolam and its active metabolites may occur. Kidney or liver impairments may slow down the elimination of midazolam leading to prolonged and enhanced effects.”

We asked Professor Pullicino (quoted early in this post) to comment on our accounts. This is what he wrote:
 
“Midazolam should not be being used in the situation of those who are thought to be at risk of dying, as guidelines clearly state. it should not be used in those that are debilitated or elderly. It should never be given to treat confusion as the way to treat this is to withdraw all sedatives or hypnotics. We must do all we can to make the use of this drug illegal as an end of life “care” agent which it is not. It is an anxiolytic with strong quick effects and should only be used for conscious sedation under supervision by an anaesthetist or by buccal or rectal route for seizures.”
A number of people we have spoken to informally about our experiences have described similar situations and we believe a widespread and serious issue may exist.

A drug causes conscious sedation , wont reduce pain , prevents patient communicate enough , and may simply cause death . A drug from hell . It shows what todays " care " can be.... It should be illegal in any normal use, nurse homes...