Doodsreutel of een stille dood?

Death rattle, noisy breathing, is a frequent symptom in terminally ill patients for which (non)pharmacological treatment can be indicated. Although it remains unclear whether patients really experience suffering, family members may interpret this as a distressing sign of discomfort. Careful family communication remains pivotal. The SILENCE-study investigated the effectiveness of prophylactic use of scopolamine butylbromide to prevent death rattle. A double blinded randomized clinical trial in hospice patients was performed. Results were that patients in the intervention group had a significant lower prevalence of death rattle compared to the control group. The study applied innovative ways for performing a complex intervention study in palliative patients. Further reflection however is needed whether such preventive medication use may increase medicalization at the end of life. In this way, the Silence study gives rise for a broader reflection about what constitutes a good death and how society can take care of this.

Conflict of interest and financial support: none declared.