Last-resort options for palliative sedation.

Full Abstract

Despite receiving state-of-the-art palliative care, some patients still experience severe suffering toward the end of life. Palliative sedation is a potential way to respond to such suffering, but access is uneven and unpredictable, in part because of confusion about different kinds of sedation. Proportionate palliative sedation (PPS) uses the minimum amount of sedation necessary to relieve refractory physical symptoms at the very end of life. To relieve suffering may require progressive increases in sedation, sometimes to the point of unconsciousness, but consciousness is maintained if possible. Palliative sedation with the intended end point of unconsciousness (PSU) is a more controversial practice that may be considered for much fewer refractory cases. There is more ethical consensus about PPS than PSU. In this article, the authors explore the clinical, ethical, and legal issues associated with these practices. They recommend that palliative care and hospice programs develop clear policies about PPS and PSU, including mechanisms for training and ensuring competency for clinicians, and approaching situations where individuals or institutions may conscientiously object.

Author information

Author/s: Quill, Timothy E (TE); Lo, Bernard (B); Brock, Dan W (DW); Meisel, Alan (A);

Affiliation: Center for Ethics, Humanities and Palliative Care, University of Rochester Medical Center, Rochester, New York 14642, USA.

Grants: MH062246 (Agency:NIMH NIH HHS)

Journal and publication information

Publication Type: Case Reports; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Annals of internal medicine (Ann Intern Med), published in United States. (Language: eng)

Reference: 2009-Sep; vol 151 (issue 6) : pp 421-4

Dates: Created 2009/09/16; Completed 2009/10/05;

PMID: 19755367, status: MEDLINE (last retrieval date: 10/5/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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