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Effect of a single dose of intravenous ketamine on the wish to hasten death in palliative care: A case report in advanced cancer

Published online by Cambridge University Press:  24 March 2023

Esther Decazes Open the ORCID record for Esther Decazes [Opens in a new window] ,
Oliver Rigal  and
Florian Clatot
Esther Decazes*
Affiliation:
Palliative Care, Department of Supportive Care, Centre Henri Becquerel, Rouen, France
Oliver Rigal
Affiliation:
Departement of Supportive Care, Centre Henri Becquerel, Rouen, France
Florian Clatot
Affiliation:
Department of Medical Oncology, Centre Henri Becquerel, University Rouen, Rouen, France
*
Author for correspondence: Esther Decazes, Palliative Care, Departement of Supportive Care, Centre Henri Becquerel, rue d’Amiens - CS 11516, Rouen Cédex 1 76038, France. Email: esther.decazes@chb.unicancer.fr
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Abstract

Objectives

The suffering experienced by some patients at the end of their lives can lead to a wish to hasten death (WTHD). It is sometimes an existential suffering, refractory to palliative care even if well conducted, which leads to this desire. Since several years, in psychiatry, the rapid anti-suicidal effects of a single injection of ketamine have been proven. WTHD and suicidal ideation have similarities. The injection of a single dose of ketamine could have an efficiency on the desire to hasten death.

Methods

We report the case of a woman with advanced breast cancer expressing a WTHD, treated by ketamine.

Results

A 78-year-old woman expressed a WTHD (request for euthanasia) because of existential suffering following a loss of autonomy related to cancer. The suicide item was 4 on the Montgomery–Åsberg Depression Rating Scale (MADRS). She had no associated pain or depression. A single dose of intravenous ketamine 1 mg/kg over 40 min plus 1 mg of midazolam was injected. She had no adverse effects. From D1 post-injection to D3, the WTHD disappeared completely with a MADRS suicide item at 0. At D5, the WTHD started to reappear, and at D6, the previous speech was completely back.

Significance of the results

These results suggest an effect of ketamine on WTHD. This opens up the possibility of treating existential suffering at the end of life. The optimal dosage of this treatment would have to be determined as well as a maintenance of efficacy scheme.

Keywords

Wish to hasten deathKetaminePalliative careSuicidal ideasAdvanced cancer
Type
Case Report
Information
Palliative & Supportive Care , Volume 21 , Issue 4 , August 2023 , pp. 765 - 767
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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