Addressing Midazolam Concerns — SCE Palliative Medicine MCQ
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Correct answer: B — Acknowledge their concern, explain that at palliative care doses midazolam provides sedation for comfort (not hastening death), describe the dose-proportionality principle, and reassure them that the goal is symptom relief
Explanation lettering: E = shown as A · A = shown as D · D = shown as E
The Scottish Palliative Care Guidelines specify that families should be given honest explanations regarding the rationale for palliative sedation—including the intent, possible risks, and the careful titration of drugs such as midazolam for comfort, not to hasten death. Option B fully meets this requirement by communicating openly, addressing the family's fear directly, and clarifying the medicine's use and proportional dosing in palliative care. Removing midazolam (A) abandons best practice and leaves the symptom unmanaged. Dismissing or avoiding (C, D) the concern undermines trust and communication and contravenes palliative care values. Agreeing that the drug is dangerous and suggesting alternatives (E) is misleading and may cause unnecessary fear. Thus, B is correct.
Reference: Scottish Palliative Care Guidelines, 'Severe uncontrolled distress'. NHS Scotland. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/last-days-of-life-care-around-dying/severe-uncontrolled-distress/