The Ethical Validity and Clinical Experience of Palliative Sedation

Rousseau, Paul

doi:10.4065/75.10.1064

Cited by 68 publications

(42 citation statements)

References 20 publications

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“…The term "palliative sedation" started to appear in the literature in 2000 (87,88). Over the years, many other terms have been used to describe sedation for symptomatic relief at the end of …”

Section: Palliative Sedation: Deep and Continuous Sedation For Reliefmentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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Section: Palliative Sedation: Deep and Continuous Sedation For Reliefmentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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“…A medical paradigm known as palliative care provides a morally sound approach to end of life decisions. 3 Palliative medicine, as opposed to curative medicine, emphasises pain and symptom management and the alleviation of suffering. This approach seeks neither to hasten death nor prolong life; the main goal is to take steps to alleviate pain, discomfort, and suffering.…”

Section: End Of Life Decisions and Palliative Carementioning

confidence: 99%

The agony of agonal respiration: is the last gasp necessary?

Perkin

2002

J Med Ethics

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Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea.Gasping respiration is also referred to as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated.We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death.

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“…5,9 Use of ANH should be addressed with patients or surrogates as part of the larger informed consent discussions, and, as in all instances of practicing PS, physician intent to relieve suffering, not to shorten life, should be clearly documented. 13,33,34 Guidelines for addressing these issues have been published. 5 Ethical soundness of refusing life-sustaining therapy is based on the principles of non-maleficence and respect for patient autonomy.…”

Section: Ethical Issuesmentioning

confidence: 99%

“…32 Of note, many patients receiving PS have already stopped all forms of nutrition and hydration for physiologic reasons before PS is begun. 33 When a dying patient is still receiving ANH and develops refractory symptoms necessitating PS, ANH may be continued or discontinued according to the patient's goals and cultural beliefs. 5,9 Use of ANH should be addressed with patients or surrogates as part of the larger informed consent discussions, and, as in all instances of practicing PS, physician intent to relieve suffering, not to shorten life, should be clearly documented.…”

Section: Ethical Issuesmentioning

confidence: 99%

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

Olsen

Swetz

Mueller³

2010

Mayo Clinic Proceedings

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Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia. © 2010 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) P alliative sedation (PS) refers to the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. The practice of PS has gained attention in the literature during the past 20 years. In 1994, Cherny and Portenoy 1 first offered an algorithm for determining appropriate indications for use of PS. During the late 1990s, several important court cases in the United States brought the issue of PS to the forefront and clarified the legality of the right to palliation at end of life. 2,3 Studies have shown that PS is effective, with efficacy rates ranging from 71% to 92%, 4 usually defined as the patient, family, or physician's perceived relief of refractory physical symptoms. In many settings, PS is uncommon, although a recent review revealed considerable variability in the prevalence of PS in the United States and other countries. 4 When PS is used, it is a measure of last resort rather than general care. Although required infrequently, PS is an important palliative tool with which clinicians should be familiar. PrActIcAl ISSueSThe following sections explore issues of the application of PS. Detailed guidelines for practicing PS, although beyond the scope of this article, have been published. 5

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The Ethical Validity and Clinical Experience of Palliative Sedation

Cited by 68 publications

References 20 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

The agony of agonal respiration: is the last gasp necessary?

Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

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