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.

Palliative Care—What, Who and When?

2011 ◽  
Vol 4 (11) ◽  
pp. 624-632
Author(s):  
Emma Cope ◽  
Patrick Daly
Keyword(s):  
Palliative Care ◽  
General Practice ◽  
Royal College ◽  
Palliative Care Team ◽  
Care Team ◽  
Ageing Population ◽  
Care Services ◽  
Specialist Services ◽  
Palliative Care Services

Palliative care is a speciality which has grown considerably in recent years gaining recognition as its own subspecialty of medicine by the Royal College of Physicians in 1987. GPs have always had a role in providing palliative care, and as our ageing population increases, the number of people living with incurable illnesses will continue to rise. This article aims to provide an understanding of palliative care medicine, the role of the GP in the palliative care team, guidance to help identify those patients who may benefit from palliative care services and when referral to specialist services may be needed. We have also highlighted key documents pertaining to palliative care applicable to general practice.

scholarly journals Continuous Deep Sedation Until Death Is Not an Alternative to Assisted Suicide in Palliative Care Units in the French-Speaking Part of Switzerland: A Multicentre Qualitative Study Based on Interviews With Physicians.

2021 ◽  
Author(s):  
Martyna TOMCZYK ◽  
Nathalie DIEUDONNÉ-RAHM ◽  
Ralf JOX
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Assisted Suicide ◽  
Deep Sedation ◽  
Palliative Sedation ◽  
Continuous Deep Sedation ◽  
The Family ◽  
French Speaking ◽  
Palliative Care Units ◽  
Negative Impacts

Abstract Background: According to the European Association for Palliative Care, decisions regarding palliative sedation should not be made in response to a request for death. However, several studies show that continuous deep sedation until death (CDSUD) – a particular form of sedation – has been considered as an alternative to active assisted dying in some countries. In Switzerland, where assisted suicide is decriminalized and CDSUD is not legally regulated, no studies have comprehensively investigated if they might be correlated. Our study aimed to identify and describe the experience among palliative care physicians of CDSUD as an alternative to assisted suicide in the French-speaking part of Switzerland.Methods: We performed an exploratory multicentre qualitative study based on interviews with physicians working in palliative care institutions in the French-speaking part of Switzerland and conducted linguistic and thematic analysis of all interview transcripts. The study is described in accordance with COREQ criteria.Results: We included 10 interviews conducted in four palliative care institutions. Our linguistic analysis shows four main types of sedation, which we called ‘rapid CDSUD’, ‘gradual CDSUD’, ‘temporary sedation’ and ‘intermittent sedation’. CDSUD (rapid or gradual) is not considered an alternative to assisted suicide. In contrast, ‘temporary’ or ‘intermittent sedation’, although not medically indicated, is sometimes introduced in response to a request for assisted suicide. This is due to the impossibility of carrying out an assisted suicide at home (e.g., home transfer is impossible or the patient’s wish not to traumatize the family).Conclusion: These preliminary results can guide clinical, ethical, linguistic and legal reflection in this field and be used to explore this question more deeply at the national and international levels in a comparative, interdisciplinary and multiprofessional approach. They can also be useful to update Swiss clinical guidelines on palliative sedation in order to include specific frameworks on various sedation protocols and sedation as an alternative to assisted suicide. Potential negative impacts of considering palliative sedation as an alternative to assisted suicide should be nuanced by open and honest societal debate.

scholarly journals Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Rasheed Ofosu-Poku ◽  
Michael Owusu-Ansah ◽  
John Antwi
Keyword(s):  
Palliative Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Clinical Care ◽  
Palliative Care Service ◽  
Palliative Care Team ◽  
Care Team ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Ghana’s chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants—four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients’ expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.

Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians

2013 ◽  
Vol 22 (1) ◽  
pp. 225-231 ◽  
Author(s):  
Ian Koper ◽  
Agnes van der Heide ◽  
Rien Janssens ◽  
Siebe Swart ◽  
Roberto Perez ◽  
...  
Keyword(s):  
Palliative Care ◽  
Palliative Sedation ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

scholarly journals Palliative care for all ….. Really?

2011 ◽  
pp. 126-128
Author(s):  
Anne McAuliffe
Keyword(s):  
Palliative Care ◽  
Life Expectancy ◽  
Local Community ◽  
Respiratory Illness ◽  
Palliative Care Team ◽  
Her Family ◽  
Care Services ◽  
The Family ◽  
Palliative Care Services ◽  
Difficult Road

I have a friend, who, alongside her family, struggled with her father’s illness for over two years. He travelled a slow and difficult road towards the end of his life. He was diagnosed with a chronic respiratory illness a few years ago, with a life expectancy of six months. The mainstay of their support was the family GP and infrequent visits to the Consultant. When palliative care was suggested by a friend, as a support, their response was ‘but he hasn’t got cancer’. After a little encouragement and a speedy referral, the local community palliative care team came into their home and he and his family’s journey became a more peaceful and managed one. Their journey was transformed, not because palliative care services altered his diagnosis in any way, but because they supported the patient and his family in dealing with the present and immediate future. Palliative care services assisted ...

Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation

2018 ◽  
Vol 45 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Thomas David Riisfeldt
Keyword(s):  
Palliative Care ◽  
Survival Time ◽  
Empirical Evidence ◽  
Double Effect ◽  
Palliative Sedation ◽  
Ethical Principle ◽  
Doctrine Of Double Effect ◽  
Opioid Use ◽  
Care Services ◽  
Palliative Care Services

Opioid and sedative use are common ‘active’ practices in the provision of mainstream palliative care services, and are typically distinguished from euthanasia on the basis that they do not shorten survival time. Even supposing that they did, it is often argued that they are justified and distinguished from euthanasia via appeal to Aquinas’ Doctrine of Double Effect. In this essay, I will appraise the empirical evidence regarding opioid/sedative use and survival time, and argue for a position of agnosticism. I will then argue that the Doctrine of Double Effect is a useful ethical tool but is ultimately not a sound ethical principle, and even if it were, it is unclear whether palliative opioid/sedative use satisfy its four criteria. Although this essay does not establish any definitive proofs, it aims to provide reasons to doubt—and therefore weaken—the often-claimed ethical distinction between euthanasia and palliative opioid/sedative use.

Practices and Attitudes of Japanese Oncologists and Palliative Care Physicians Concerning Terminal Sedation: A Nationwide Survey

2002 ◽  
Vol 20 (3) ◽  
pp. 758-764 ◽  
Author(s):  
Tatsuya Morita ◽  
Tatsuo Akechi ◽  
Yuriko Sugawara ◽  
Satoshi Chihara ◽  
Yosuke Uchitomi
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Psychiatric Treatment ◽  
Deep Sedation ◽  
Terminally Ill ◽  
Palliative Sedation ◽  
Professional Burnout ◽  
Palliative Sedation Therapy ◽  
Continuous Deep Sedation ◽  
Psychologic Distress

PURPOSE: To clarify the frequency of practice of sedation therapy for terminally ill cancer patients and to identify physicians’ attitudes toward sedation. METHODS: Questionnaires were mailed to 1,436 Japanese oncologists and palliative care physicians with a request to report their practice of and attitudes toward palliative sedation therapy. RESULTS: A total of 697 physicians returned questionnaires (response rate, 49.6%). Use of mild, intermittent-deep, or continuous-deep sedation for physical and psychologic distress was reported by 89% and 64%, 70% and 46%, and 66% and 38%, respectively. In vignettes in which physicians were asked whether they would use sedation for a patient with refractory dyspnea or with existential distress, 14% and 15%, respectively, chose continuous-deep sedation as a strong possibility. Those physicians less confident with psychologic care and with higher levels of professional burnout were more likely to choose continuous-deep sedation. In vignettes in which they were asked whether they use sedation for a patient with depression or delirium, 39% and 31%, respectively, considered psychiatric treatment to be a strong possibility, and 42% and 50% regarded continuous-deep sedation as a potential treatment option. Physicians less involved in caring for the terminally ill and less specialized in palliative medicine were significantly less likely to choose psychiatric treatment. CONCLUSION: Sedation is frequently used for severe physical and psychologic distress of cancer patients. Physicians’ clinical experiences with the terminally ill and their levels of professional burnout influence the decisions. Training and education for physicians in regard to end-of-life care and valid clinical guidelines for palliative sedation therapy are necessary.

Family caregiver satisfaction with early palliative care for advanced non-small cell lung cancer (NSCLC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9027-9027
Author(s):  
J. Greer ◽  
W. Pirl ◽  
T. Lynch ◽  
J. Billings ◽  
V. Jackson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Palliative Care Team ◽  
Satisfaction With Care ◽  
Early Palliative Care ◽  
Caregiver Satisfaction ◽  
Care Services ◽  
Palliative Care Services ◽  
Oncology Care

9027 Background: Historically, there has been no established role for palliative care in treating ambulatory oncology patients who are not at the end of life, but still struggling with the physical, psychosocial and spiritual aspects of cancer. Integrating palliative care services earlier in oncology care may help alleviate the suffering of patients with advanced cancer and family caregivers. This single-arm pilot study examines caregiver satisfaction with early palliative care services in patients with advanced NSCLC. Methods: Sample included patients within 8 weeks of diagnosis of stage IIIb with effusions or IV NSCLC and their family caregivers. Patients met with the palliative care team at least monthly until the time of hospice referral or death, completing assessments of quality of life (FACT-L) and mood (HADS) at baseline, 3, and 6 months. Caregivers rated their satisfaction with palliative care services using the FAMCARE. To identify predictors of caregiver satisfaction with care, patient scores from the FACT-L and HADS were entered into a linear regression model. Results: Fifty-one patients were enrolled (31 female, mean age=64.5 years), with 73% (n=37) identifying a caregiver who consented to participate. Of the 32 caregivers who completed a follow-up assessment, 84% (n=27) reported average FAMCARE scores in the “very satisfied” to “satisfied” range. Patients with worse physical (β=−.49, p=.003) but better social wellbeing (β=.55, p=.001) on the FACT-L at baseline had caregivers who were more satisfied with palliative care services at follow-up. Patient mood symptoms on the HADS were not related to caregiver satisfaction with care. Conclusions: The majority of family caregivers reported being satisfied with oncology care that included early palliative care. Patients with greater physical disability had caregivers who were more satisfied with care, which may be due to increased contact with the palliative care team. Also, patients who felt more supported by their families at baseline had caregivers who were more satisfied with care. While these data are encouraging, controlled longitudinal studies are needed to determine if these findings are actually the result of early palliative care services. [Table: see text]

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