The clinical and ethical appropriateness of sedation in palliative neurological treatments

From Sedation to Continuous Sedation Until Death: How Has the Conceptual Basis of Sedation in End-of-Life Care Changed Over Time?

“…66 Our findings reveal that, although ''indications for use'' was the essential component common to all definitions, confusion and inconsistency persevere in all aspects discussed because of the lack of common language. 26 For instance, when referring to pharmacological approaches to sedation, such lack of common language was evident, with some definitions being more selective and others more explanatory with regard to the amount of details they provided (i.e., psychotropic agents, 69 in the main benzodiazepines and neuroleptics; 70 ongoing administration of barbiturates; 71 high doses of sedatives; 72 nonopioid drugs; 67 sedative medications; 21 continuous administration of sedatives or opioids; 42 by pharmacological means; 73 continuous benzodiazepines, barbiturates, or other medications; 74 monitored use of medications; 11 and the use of specific sedatives 75 ). The same applies to all aspects discussed in definitions over time.…”

What do you mean by “palliative sedation”?

“…This content of the definitional cetegory is prone to disagreement about the facts (III), since refractoriness might be assessed controversially in a clinical situation. The same holds true for the decision on whether suffering is “unbearable” [ 28 , 29 , 36 , 38 , 42 , 47 , 48 , 51 ].…”

“…as a last resort) nonopioid drugs terminally ill patients Italian Society of Palliative Care (Italy) [ 47 ], 2007* For terminal/palliative sedation so far there has been the agreement: ‘The intentional reduction of consciousness by pharmacological means until loss of consciousness for the purpose of reducing or abolishing the perception of a symptom otherwise intolerable for the patient, despite the use of adequate means to control the symptom, that thus remained refractory.’ […] In this document, the term terminal/palliative sedation is reserved to […] the final phase of life. the intentional reduction of consciousness until loss of consciousness reducing or abolishing the perception of a symptom otherwise intolerable for the patient, despite the use of adequate means to control the symptom, that thus remained refractory patients in the final phase of life Italian Society of Neurology (Italy) [ 48 ], 2007 “By ‘palliative sedation’, we mean an intentional reduction of vigilance by pharmacological means up to the point of the complete loss of consciousness with the aim of reducing or abolishing the perception of a symptom that would otherwise be intolerable for the patient despite the implementation of the most adequate means aimed at controlling the symptom itself, which is therefore to be considered refractory[. ]” intentional reduction of vigilance up to the point of the complete loss of consciousness reducing or abolishing the perception of a symptom that would otherwise be intolerable for the patient despite the implementation of the most adequate means aimed at controlling the symptom itself, which is therefore to be considered refractory Swiss Society for Palliative Medicine, Care and (Switzerland) [ 49 ], 2005* Definition of palliative sedation: Deliberate administration of sedating medications, in the smallest effective dosage, in close collaboration with a competent interdisciplinary team, to sustainably relieve (easily evaluable goals have to be formulated), one or more refractory symptoms, of a patient with an advanced illness and limited life expectancy (days, weeks), by permanently or temporarily reducing the patient’s consciousness.…”

“…Two guidelines from Italian medical societies published in 2007 (cf. [ 47 ] and [ 48 ]) lso give different definitions, though they might have been intended as verbal translations of each other. The guideline from Austria refers to the EAPC definition but does not translate it precisely (cf.…”