To the Editor The SILENCE trial1 demonstrated not only the efficacy of prophylactic subcutaneous scopolamine butylbromide for preventing death rattle but also the feasibility of randomized clinical trials during the dying phase. Establishing evidence in palliative care through randomized clinical trials is difficult in many ways, and clinical trials in palliative care have a high attrition rate2 because their target population is highly vulnerable. Although the results of this trial are valuable, we have several concerns and believe that addressing these points will make it more feasible to conduct clinical trials in the end-of-life setting.