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Terminal Care — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyTerminal CareSCE Medical Oncology

A 65-year-old man with dying from metastatic pancreatic cancer develops terminal agitation and distress in his final hours. He is on a syringe driver with morphine and midazolam. His family asks about sedation for refractory symptoms. What is the appropriate palliative intervention?

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Correct answer: E — Increase midazolam dose in syringe driver for proportionate palliative sedation

Palliative sedation using proportionate doses of sedative medications (typically midazolam or levomepromazole) is an established and ethical practice for refractory symptoms in the last hours to days of life. It aims to relieve suffering proportionate to the symptom burden, not to hasten death. Clear documentation, communication with the family, and adherence to local palliative care guidelines are essential. This is distinct from euthanasia and is supported by NICE guidelines.

Reference: NICE NG Palliative care guidelines; NICE CG31 Care of dying adults; EAPC framework for palliative sedation 2009