Physical pain has always been part of human experience, and throughout history it is recorded that doctors and wise men and women have sought to ease pain. The attitudes of those suffering pain, however, have varied from stoical acceptance to sullen endurance. Today, most people consciously seek to avoid pain or to have their pain eased, although they do not always expect what in fact appears to be possible. This study of 13 patients with protracted pain was carried out at (...) The London Hospital by a professional group to see how patients regarded their own pain and the efforts of doctors and nurses to relieve it. The attitudes of the doctors and nurses were also studied, and the results, despite the limitations of the survey, suggest that: [List: see text]. (shrink)

Discussion about euthanasia is often confused because of a failure to distinguish between deliberate death acceleration and letting nature take its course. There is a need to reiterate the traditional principles upon which the care of the dying should be based, including the need for the doctor to practise medicine in the knowledge that eventually all his patients will die. It follows that a doctor does not have a duty to preserve life at all costs. The care of the patient (...) with far-advanced cancer has improved considerably in many areas as a result of the establishment of hospices and domiciliary support teams. Treating the patient as a person is the key to a successful doctor-patient relationship. An analytical approach is necessary to control pain and other symptoms. Care of the relatives is also fundamental. Voluntary euthanasia and 'assisted suicide' represent an extreme solution to a situation which demands a far more comprehensive and compassionate approach. The need is not for a change in the law but for a change of emphasis in medical education. (shrink)

To answer some of the questions surrounding the medicinal use of narcotic analgesics in advanced cancer, a group of 500 patients admitted to St Christopher's Hospice was reviewed. To achieve and maintain pain relief many of the patients received diamorphine (heroin) regularly every four hours. Almost all the patients received a phenothiazine concurrently; other drugs were prescribed when indicated. It was concluded that: 1) Although most patients receive parenteral diamorphine during the last 12 to 24 hours, the majority can be (...) maintained on oral medication until this time. 2) There is no single optimal dose of diamorphine. 3) Psychological dependence does not occur. 4) Physical dependence may develop but does not prevent the downward adjustment of the dose of diamorphine when considered clinically feasible. 5) Tolerance is not a practical problem. 6) The prescription of diamorphine does not, by itself, lead to impairment of mental faculties. Also discussed are: 1) the psychobiological nature of pain; 2) the rational use of analgesics; 3) the need for further research; 4) the importance of the doctor's attitude. (shrink)