Palliative sedation for intolerable suffering

2014 ◽  
Vol 26 (4) ◽  
pp. 389-394 ◽  
Author(s):  
Marco Maltoni ◽  
Emanuela Scarpi ◽  
Oriana Nanni
Keyword(s):  
Palliative Sedation ◽  
Intolerable Suffering

scholarly journals Reflections on palliative sedation

2019 ◽  
Vol 12 ◽  
pp. 117822421882351 ◽  
Author(s):  
Robert Twycross
Keyword(s):  
Palliative Care ◽  
Deep Sedation ◽  
Palliative Sedation ◽  
Palliative Care Team ◽  
Specific Symptom ◽  
Care Services ◽  
Continuous Deep Sedation ◽  
Continuous Sedation ◽  
Palliative Care Services ◽  
Intolerable Suffering

‘Palliation sedation’ is a widely used term to describe the intentional administration of sedatives to reduce a dying person’s consciousness to relieve intolerable suffering from refractory symptoms. Research studies generally focus on either ‘continuous sedation until death’ or ‘continuous deep sedation’. It is not always clear whether instances of secondary sedation (i.e. caused by specific symptom management) have been excluded. Continuous deep sedation is controversial because it ends a person’s ‘biographical life’ (the ability to interact meaningfully with other people) and shortens ‘biological life’. Ethically, continuous deep sedation is an exceptional last resort measure. Studies suggest that continuous deep sedation has become ‘normalized’ in some countries and some palliative care services. Of concern is the dissonance between guidelines and practice. At the extreme, there are reports of continuous deep sedation which are best described as non-voluntary (unrequested) euthanasia. Other major concerns relate to its use for solely non-physical (existential) reasons, the under-diagnosis of delirium and its mistreatment, and not appreciating that unresponsiveness is not the same as unconsciousness (unawareness). Ideally, a multiprofessional palliative care team should be involved before proceeding to continuous deep sedation. Good palliative care greatly reduces the need for continuous deep sedation.

scholarly journals French Swiss physicians' attitude toward palliative sedation: Influence of prognosis and type of suffering

2013 ◽  
Vol 12 (5) ◽  
pp. 345-350 ◽  
Author(s):  
M. Beauverd ◽  
M. Bernard ◽  
T. Currat ◽  
S. Ducret ◽  
R.A. Foley ◽  
...  
Keyword(s):  
Pilot Study ◽  
Terminally Ill ◽  
General Linear Model ◽  
Palliative Sedation ◽  
Independent Variables ◽  
Clinical Vignettes ◽  
Existential Suffering ◽  
Physical Suffering ◽  
Two Independent Variables ◽  
Intolerable Suffering

AbstractObjective:Palliative sedation is a last resort medical act aimed at relieving intolerable suffering induced by intractable symptoms in patients at the end-of-life. This act is generally accepted as being medically indicated under certain circumstances. A controversy remains in the literature as to its ethical validity. There is a certain vagueness in the literature regarding the legitimacy of palliative sedation in cases of non-physical refractory symptoms, especially “existential suffering.” This pilot study aims to measure the influence of two independent variables (short/long prognosis and physical/existential suffering) on the physicians' attitudes toward palliative sedation (dependent variable).Methods:We used a 2 × 2 experimental design as described by Blondeau et al. Four clinical vignettes were developed (vignette 1: short prognosis/existential suffering; vignette 2: long prognosis/existential suffering; vignette 3: short prognosis/physical suffering; vignette 4: long prognosis/physical suffering). Each vignette presented a terminally ill patient with a summary description of his physical and psychological condition, medication, and family situation. The respondents' attitude towards sedation was assessed with a six-point Likert scale. A total of 240 vignettes were sent to selected Swiss physicians.Results:74 vignettes were completed (36%). The means scores for attitudes were 2.62 ± 2.06 (v1), 1.88 ± 1.54 (v2), 4.54 ± 1.67 (v3), and 4.75 ± 1.71 (v4). General linear model analyses indicated that only the type of suffering had a significant impact on the attitude towards sedation (F = 33.92, df = 1, p = 0.000).Significance of the results:The French Swiss physicians' attitude toward palliative sedation is more favorable in case of physical suffering than in existential suffering. These results are in line with those found in the study of Blondeau et al. with Canadian physicians and will be discussed in light of the arguments given by physicians to explain their decisions.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

Continuous palliative sedation until death: practice after introduction of the Dutch national guideline

2012 ◽  
Vol 2 (3) ◽  
pp. 256-263 ◽  
Author(s):  
Siebe J Swart ◽  
Agnes van der Heide ◽  
Tijn Brinkkemper ◽  
Lia van Zuylen ◽  
Roberto Perez ◽  
...  
Keyword(s):  
Palliative Sedation ◽  
National Guideline ◽  
Continuous Palliative Sedation

Palliative Sedation in 2 Children with Terminal Cancer – an Effective Treatment of Last Resort in a Home Care Setting

2011 ◽  
Vol 223 (06) ◽  
pp. 374-375 ◽  
Author(s):  
M. Kuhlen ◽  
K. Schneider ◽  
U. Richter ◽  
A. Borkhardt ◽  
G. Janßen
Keyword(s):  
Home Care ◽  
Effective Treatment ◽  
Care Setting ◽  
Palliative Sedation ◽  
Terminal Cancer

Sedação Paliativa, Perspetiva de Um Clínico

2018 ◽  
Vol 26 (52) ◽  
pp. 127-138
Author(s):  
Madalena Feio ◽  
Keyword(s):  
Double Effect ◽  
Palliative Sedation ◽  
Ethical Principles ◽  
First Line ◽  
Scientific Societies ◽  
Refractory Symptoms ◽  
Medical Associations ◽  
Line Drug

Palliative sedation does not have a universally accepted definition. It is used as a measure of last resort for the control of refractory symptoms in the last days of life. The ethical principles invoked in its use are those of double effect and proportionality. Its prevalence varies according to the place of care, type of study and country. The most frequent indications for its use are the control of dyspnea, delirium and pain. The recommended first line drug is midazolam. The studies performed do not diminish the survival of the patient. It is important that fami­ly support is maintained throughout the process. Several scientific societies and medical associations have defined guidelines that regulate their implementation.

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