Recent surveys in the UK have shown that many doctors don`t understand what terminal sedation involves, and haven`t received the palliative care training (inexplicably not compulsory for all UK doctors) which might help them perform it appropriately and effectively. Unfortunately, it seems that too many doctors, as well as lay people, wrongly imagine that `double effect` has a place in palliative care, that hastening of death/medicalised killing happens more often than it does, and/or that it`s the aim of terminal sedation. Doctors and laypeople alike fail to realise how wide a safety margin there is when opioids and sedatives are used correctly; a much wider one, in fact, than when using paracetamol (acetaminophen). Such misapprehensions lead to bias in favour of the legalisation of medicalised killing.

Surveys showed that doctors in hospitals and old people`s homes who lacked palliative care training were actually MORE likely to use continuous deep sedation than those in hospices and palliative care wards, and were highly likely to attempt to provide sedation with opioid painkillers alone, despite in fact that they`re not effective sedatives. The palliative care specialist`s sedative drug of first resort is midazolam, a short-acting benzodiazepine. Its effects are sedative, anxiolytic, anti-convulsant, amnesic, and muscle-relaxant. Pain relief, if the patient requires it, is continued until sedation is achieved. Other drugs used might include the anti-convulsant phenobarbital and the anti-psychotic haloperidol.

I was amazed that the writers thought that a patient such as Strathairn`s character could be maintained pain-free on a dose as low as 2mg per hour, or anywhere near sedated on 4mg. I would have hoped that House would be more knowledgable about the uses and limitations of opioids than his comments suggested, but he can`t possibly have thought 4mg per hour would hasten death. For example, my boyfriend bust his ribs recently (9 ribs in 2 places each, plus pneumothorax); he was on 12mg per hour for 48hours, in order to keep him pain free so that he COULD breathe deeply (so as to reset the ribs and fully re-inflate the lung).

House shouldn`t have been able to get inside the PCA device without a key.

It`s too much of a stretch to hope that this was an attempt to highlight the ignorance of doctors other than palliative care specialists in the area of end-of-life care, given the idiotic attitude the programme and its characters have maintained towards House`s chronic and legitimate need for analgesia. He should have had a proper drug regimen arranged years ago, and been prescribed something less toxic to the liver than vicodin, especially with his fondness for alcohol. Patients with chronic pain frequently receive lower doses than the ideal, but I don`t think Cuddy`s neglect in this area is believable.

I look forward to finding out just how long the writers are going to have House controlling his pain with ibuprofen, before he starts experiencing gastrointestinal problems?

It seems Taub and Foreman dropped two or three vicodin each; they should have been sick and dizzy for several hours.

Glad to see the back of Cameron; I think she’s a self-righteous whiner. I`m loving 13 and Taub!

I know they want to make it easier for the audience to understand but seriously, how hard is it to give Laurie some keys?

I was just going through the credits for season 7 and it seems that Dr.Samantha Carr is going to be a regular guest star.This is sure to cause some tension between House and Wilson,particularly if Huddy doesn’t work out.

And then before this episode, there was the one where Cameron leaves Chase for helping kill a mass murderer. WTF was that? The show is lying in a gutter covered in its own piss and vomit. It’s really sad to see.

There was a glimmer of hope when both Taub and 13 were gone for a few episodes. But alas, it was too good to be true.

My brother-in-law is now a religous Jew and is a bit embarrased with his middle name…