CONCISE REVIEW FOR CLINICIANSEthical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments
Section snippets
PRACTICAL ISSUES
The 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
SUMMARY
Palliative sedation has an important place on the continuum of appropriate palliative care at the end of life. It is appropriate therapy for refractory and unacceptably severe suffering. As with any other therapy, the patient or surrogate should be informed of potential adverse effects, including loss of social interaction and potential for life-threatening aspiration or respiratory depression. Palliative medicine teams should be involved, if possible, in any case in which PS is considered.
Acknowledgments
We acknowledge W. David Mauck, MD, of the Department of Anesthesiology, Division of Pain Medicine, for his contribution to concepts in this article.
CME Questions About Palliative Sedation
- 1.
A 61-year-old woman with metastatic breast cancer is hospitalized for dyspnea. She has symptomatic pleural effusions with lung, brain, and bone metastases. The pleural effusions are drained, and morphine initiated at 6 mg per hour resolves her dyspnea and hypoxia. That night the patient clearly shows signs of imminent death and develops agitated terminal delirium, which does not respond to haloperidol and other supportive cares. Her family knows she will die soon and wants her to be
REFERENCES (36)
- et al.
Palliative sedation: a review of the research literature
J Pain Symptom Manage
(2008) - et al.
Sedation for symptom control in Japan: the importance of intermittent use and communication with family members
J Pain Symptom Manage
(1996) - et al.
Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: comparing patients dying with and without palliative sedation
J Pain Symptom Manage
(2008) - et al.
Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan
J Pain Symptom Manage
(2005) - et al.
Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan
J Pain Symptom Manage
(2005) - et al.
Palliative sedation therapy does not hasten death: results from a prospective multicenter study
Ann Oncol
(2009) Ethical decision-making in the care of the dying and its applications to clinical practice
J Pain Symptom Manage
(1991)- et al.
Forgoing artificial nutrition or hydration in patients nearing death in six European countries
J Pain Symptom Manage
(2007) Terminal nutrition: framing the debate for the withdrawal of nutritional support in terminally ill patients
Am J Med
(2000)The ethical validity and clinical experience of palliative sedation
Mayo Clin Proc
(2000)
Sedation in the management of refractory symptoms: guidelines for evaluation and treatment
J Palliat Care
European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care
Palliat Med
Doctor is charged in death of Jackson
New York Times
Medical and ethical questions raised on deaths of critically ill patients
New York Times
Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards
J Palliat Med
Titrated intravenous barbiturates in the control of symptoms in patients with terminal cancer
South Med J
Cited by (0)
On completion of this article, you should be able to (1) define the practice of palliative sedation and describe in general terms how it is administered, (2) describe the appropriate clinical scenario in which palliative sedation may be considered, and (3) differentiate the ethical and legal permissibility of withholding and withdrawing life-sustaining treatments and accepted comfort measures (such as palliative sedation) from that of physician-assisted suicide and euthanasia.
An earlier version of this article appeared Online First.
- 1
Dr Mueller is a member of the Boston Scientific Patient Safety Advisory Board and is an Associate Editor of Journal Watch General Medicine, but neither of these activities is related to the article.