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Sedation until death: indications 1
Published in Govert den Hartogh, What Kind of Death, 2023
The existing guidelines on ‘palliative sedation’ all take the following positions: the patient's consciousness should not be lowered more than is necessary for preventing her from suffering; it must be impossible to alleviate the suffering in any alternative way; and the patient's mere preference for dying peacefully cannot justify the procedure. In addition, some guidelines stipulate that existential suffering cannot do so either. Most of these restrictions are merely asserted, or at best argued for in terms of principles of proportionality and subsidiarity which are mentioned but not articulated. My aim in this chapter is to evaluate the few arguments I have found in the guidelines themselves and in the literature, and in particular the argument that it is either a vital interest, or even a duty of the patient to preserve consciousness as long as possible at all times. In Chapter 6 I have argued that we should be cautious with forms of palliative care that disable patients to consider their circumstances as they are and to adjust their decisions to these circumstances. It may seem to follow that we should be most reluctant to compromise their consciousness.
Conclusion
Published in Catherine Proot, Michael Yorke, Challenges and Choices for Patient, Carer and Professional at the End of Life, 2021
Catherine Proot, Michael Yorke
Some people who oppose euthanasia also oppose palliative sedation, which they consider to be a disguised form of euthanasia. In palliative sedation, sedative medications which may diminish the patient’s consciousness are administered to imminently dying patients in order to relieve intolerable suffering when symptoms become unbearable and refractory. We are adamant that everything should be done to control the patient’s pain and symptoms at the end of life as, indeed, all through their illness. Their comfort is a must, and the fact that lack of resources in people and time or lack of appropriate training in pain and symptom management prevent this from happening is deeply offensive. Euthanasia is not a problem which arises at the time of the lethal injection. It starts months before that when patients are left in discomfort, hopeless and helpless and start thinking there is no future left for them in this world. Sedation can sometimes be an effective antidote as long as it is not prolonged.
Sedation in Palliative Care and Its Impact on Nutrition and Fluid Intake
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Carel M. M. Veldhoven, Kris C. P. Vissers, Jeroen H. Hasselaar, Constans A. V. H. H. M. Verhagen
Palliative sedation is mainly an intervention aimed at controlling symptoms of the dying patient. In this stage of life, considerations of maintaining organ functioning are no longer applicable. In earlier stages of palliative care (or curative care), the decisions will be made based on the patient's general condition, the life expectancy, and the patient's own will.
Continuous deep sedation at the end of life in children with cancer: experience at a single center in Japan
Published in Pediatric Hematology and Oncology, 2020
Sayaka Maeda, Itaru Kato, Katsutsugu Umeda, Hidefumi Hiramatsu, Junko Takita, Souichi Adachi, Satoru Tsuneto
Palliative sedation is a medical procedure used to relieve suffering at the end of life.1 One form of palliative sedation is continuous deep sedation (CDS), which is a recognized last resort to alleviate unbearable and otherwise refractory symptoms.1,2 CDS poses clinical and ethical challenges, and the clinical indication, standard procedure, and decision-making process for CDS have been the subjects of expert debate.3 Over recent decades, evidence-based guidelines have been published to help practitioners deal with these challenges.1,4–7 However, few of these guidelines target pediatric patients. A small number of reports on CDS in children have been published,8–11 suggesting that CDS is frequently used. In these reports, the frequency of CDS for children with cancer ranged from 44% to 68%, although cross-study differences in the definition of CDS and study subjects are apparent.8,9
Mental Integrity and Intentional Side Effects
Published in AJOB Neuroscience, 2018
Gavin G. Enck, Anne L. Saunders
According to our account, the permissibility is determined by whether the intention or reason for using mandatory neurointerventions on this offender is for rehabilitation. On the constitutive framework, we suggest that while the side effects are foreseen, the intention is in fact neutral or indifferent toward them. To illustrate, consider the example of physicians’ narrow intention for implementing palliative sedation in end-of-life patient care (Jansen 2010). Palliative sedation is the use of deep sedation for end-of-life patient care to control refractory symptoms. The aim, plan, and objective of physicians implementing palliative sedation comprise a patient-centered and compassionate intervention attempting to relieve suffering caused by refractory symptoms. This intention is the salient consideration for palliative sedation to be permissible. While the patient could potentially die as a side effect of the palliative sedation, the physician’s intention is so narrowly focused on patient-centered care and relief of suffering caused by refractory symptoms that it is neutral to the side effect of death. Similarly, on our account the narrow intention of rehabilitation is the salient consideration for permissibility of mandatory neurointernventions and the intention so narrowly focuses on rehabilitation that it is neutral or indifferent to the potential side effects. Thus, rather than attempting to claim the side effects were foreseen and unintended, this account holds these effects as foreseen but neutral or indifferent in intending them.
Suboptimal palliative sedation in primary care: an exploration
Published in Acta Clinica Belgica, 2018
Peter Pype, Inge Teuwen, Fien Mertens, Marij Sercu, An De Sutter
Palliative sedation (PS) as a therapeutic option in terminal palliative patients is the administration of sedatives in doses and combinations that diminish the patient’s consciousness in order to control one or more refractory symptoms [1]. Refractory symptoms are physical (e.g. uncontrollable pain) or psychological (therapy-resistant anxiety) symptoms that cannot be controlled sufficiently with regular medical care or without diminishing the patient’s consciousness. Palliative sedation can be continuous or intermittent, deep or superficial. According to the intended degree of symptom control and the patient’s preferences, the level of PS can evolve throughout the treatment trajectory. One can start with a superficial intermittent sedation and evolve towards a deep continuous sedation until death. Or one can start with a continuous deep sedation from the start [1]. The tailoring of the sedation level according to the intended level of symptom control is called proportionality. According to many guidelines, PS should only be performed close to death for unbearable and refractory symptoms without the intention to hasten death [1,2]. The idea of a possible life-shortening effect of PS is a major concern for family members and doctors [2–9]. Literature shows, however, that PS is not life-shortening, when initiated at the end of life and when medication dose is only being adjusted in case of insufficient symptom control.