Abstract：
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.
We report the case of a woman with advanced breast cancer expressing a WTHD, treated by ketamine.
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.
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.
We report the case of a woman with advanced breast cancer expressing a WTHD, treated by ketamine.
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.
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.
摘要：
目的：一些患者在生命结束时经历的痛苦可能导致加速死亡的愿望（WTHD）。它有时是一种存在的痛苦，即使进行得很好，也难以姑息治疗，这导致了这个愿望。几年来,在精神病学中，已证明单次注射氯胺酮的快速抗自杀作用。WTHD和自杀意念有相似之处。注射单剂量氯胺酮可能对加速死亡的愿望具有效力。
方法：我们报告了一例晚期乳腺癌患者表达WTHD,用氯胺酮治疗。
结果：一名78岁的妇女表达了WTHD（安乐死请求），原因是与癌症相关的自主性丧失后的生存痛苦。在蒙哥马利-奥斯贝格抑郁量表（MADRS）上，自杀项目为4。她没有相关的疼痛或抑郁。在40分钟内注射单次剂量的静脉内氯胺酮1mg/kg加1mg咪达唑仑。她没有不良影响。从注射后D1到D3，WTHD完全消失，MADRS自杀项目为0。在D5，WTHD开始重新出现，在D6，之前的演讲完全回来了。
结论：这些结果表明氯胺酮对WTHD有影响。这开辟了在生命结束时治疗生存痛苦的可能性。必须确定该治疗的最佳剂量以及维持疗效方案。
方法：我们报告了一例晚期乳腺癌患者表达WTHD,用氯胺酮治疗。
结果：一名78岁的妇女表达了WTHD（安乐死请求），原因是与癌症相关的自主性丧失后的生存痛苦。在蒙哥马利-奥斯贝格抑郁量表（MADRS）上，自杀项目为4。她没有相关的疼痛或抑郁。在40分钟内注射单次剂量的静脉内氯胺酮1mg/kg加1mg咪达唑仑。她没有不良影响。从注射后D1到D3，WTHD完全消失，MADRS自杀项目为0。在D5，WTHD开始重新出现，在D6，之前的演讲完全回来了。
结论：这些结果表明氯胺酮对WTHD有影响。这开辟了在生命结束时治疗生存痛苦的可能性。必须确定该治疗的最佳剂量以及维持疗效方案。
