Continuous Deep Sedation Until Death—a Swiss Death Certificate Study

Abstract

In Swiss clinical practice, continuously deeply sedated patients predominantly died outside specialized palliative care. The increasing trend over time appears to be related to changes in medical end-of-life practice rather than to patient's clinical characteristics.

Das Lebensende in der Schweiz - Individuelle und gesellschaftliche Perspektiven

“…Eine Studie, die sich gestützt auf die selben Daten vertieft mit der terminalen Sedierung auseinandergesetzt hat, kommt zum Schluss, dass Patienten mit einer terminalen Sedierung hauptsächlich in Spitälern sterben und meistens ausserhalb von spezialisierten Palliative Care-Abteilungen oder -Kliniken. Es zeigte sich ein starker Zusammenhang von terminaler Sedierung mit dem Abbruch lebensverlängernder Massnahmen und intensivierter Schmerzbehandlung, ein Zusammenhang, der dann am stärksten war, wenn diese Entscheidungen mit der Absicht getroffen wurden, den Todeseintritt zu beschleunigen oder immerhin nicht zu verzögern (Ziegler, Schmid, Bopp, Bosshard & Puhan, 2018).…”

Using sedative substances until death: A mortality follow-back study on the role of healthcare settings

“…5 In Switzerland, physicians reported that more than three out of five patients dying non-suddenly received medication to intensively alleviate pain prior to death. [6][7][8] Adequate symptom control is particularly challenging in terminally ill patients for whom all alternative treatment options have failed. 9 Where conventional symptom control is not sufficient, the administration of sedative substances can be considered.…”

“…11 European general population studies have shown considerable variation regarding the overall prevalence of continuous deep sedation until death from 2.5% to 18.3% [12][13][14] with one of the highest increase observed in the German-speaking part of Switzerland (from 4.7% in 2001 to 17.5% in 2014). 6,15 In 2014, every third patient admitted to hospital, palliative care unit or hospice died continuously deeply sedated. 6 This variability in estimates are partly due to a lack of a common sedation definition stemming from different procedural and conceptual sedation understandings that are a function of physicians' specialties, patients' population, available resources and cultural and legal backgrounds.…”

“…6,15 In 2014, every third patient admitted to hospital, palliative care unit or hospice died continuously deeply sedated. 6 This variability in estimates are partly due to a lack of a common sedation definition stemming from different procedural and conceptual sedation understandings that are a function of physicians' specialties, patients' population, available resources and cultural and legal backgrounds. 6 In specialized palliative care, the use of sedative substances intended to induce a patient's unconsciousness as an option of last resort when treating refractory symptoms is defined as 'palliative sedation'.…”

“…6 This variability in estimates are partly due to a lack of a common sedation definition stemming from different procedural and conceptual sedation understandings that are a function of physicians' specialties, patients' population, available resources and cultural and legal backgrounds. 6 In specialized palliative care, the use of sedative substances intended to induce a patient's unconsciousness as an option of last resort when treating refractory symptoms is defined as 'palliative sedation'. 10 Palliative sedation is one of the most controversial issues in end-of-life care, as international variation in prevalence suggests different sedation practices.…”