Palliative pharmacological sedation for terminally ill adults

Beller, Elaine; Driel, Mieke van; McGregor, Leanne; Truong, Shani; Mitchell, Geoffrey

doi:10.1002/14651858.cd010206.pub2

Cited by 118 publications

(140 citation statements)

References 37 publications

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“…While euthanasia shortens life, palliative sedation does not shorten life 41. Maltoni et al argued that palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not have any detrimental effect on survival of patients with terminal cancer 42 43.…”

Section: Introductionmentioning

confidence: 99%

Euthanasia and palliative sedation in Belgium

Cohen‐Almagor

Ely

2018

BMJ Support Palliat Care

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The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered.

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Section: Introductionmentioning

confidence: 99%

Euthanasia and palliative sedation in Belgium

Cohen‐Almagor

Ely

2018

BMJ Support Palliat Care

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“…However, palliative sedation is a potential solution in the control of end-of-life refractory symptoms. 25 However, even though the increase in opioid and benzodiazepine doses during and after extubation does not reduce the time until death, this method should be used with caution. The fact that, when symptoms are well controlled, there is a lesser need to indicate palliative sedation.…”

Section: Discussionmentioning

confidence: 99%

Palliative extubation: case analysis in an Intensive Care Unit

Rebelatto¹,

Moritz²

2017

Mundo da Saúde

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Current technological advancements have allowed for the prolongation of the dying process, especially in Intensive Care Units (ICU). This has increased the need for decisions on the limitation of therapeutic effort (LTE), such as the use of palliative extubation that, although difficult from an emotional standpoint, has legal and ethical justifications, and has increased family acceptance. The objective was to evaluate the clinical and demographical profile of patients submitted to palliative extubation (PT) in the ICU of the University Hospital of the Universidade Federal de Santa Catarina (HU/ UFSC), Brazil. This was a historical cohort whose data were obtained from forms filled out by critical care doctors from the Hospital Death Commission at the HU/UFSC. Patients submitted to LTE that died between January 2011 and December 2014 were included in the study. The use of PT and clinical and epidemiological data were collected. LTE was indicated in 374 (53.8%) patients, with 23 (6.1%) receiving PT. Average age of patients undergoing PT was 73.8 years; 10 patients were over 60, and 9 were over 80 years of age. Ten (43.4%) patients had been previously in the ICU. The average time from checking in at the ICU and extubation was 4.4 days, and between extubation and death it was 2.5 days. Neurological disease was the main cause of death of patients subjected to PT. All family members were aware of the extubation. Family members from 2 families witnessed the extubation. Morphine was the most common analgesic prescribed. It is concluded that patients submitted to PT were older, with neurological diseases, and the average time from extubation to death was 2.5 days ResumoO desenvolvimento tecnológico do mundo atual tem permitido o prolongamento do morrer, principalmente em unidades de terapia intensiva (UTI). Torna-se crescente a necessidade de decisões de limite de esforço terapêutico (LET), do qual se destaca a extubação paliativa (EP), que embora difícil de ser aceita do ponto de vista emocional, tem respaldo ético-legal e aumenta a satisfação familiar. O estudo teve como objetivo avaliar o perfil clínico-demográfico dos pacientes extubados paliativamente (ExPl) na UTI do HU/UFSC. Trata-se de coorte histórico, cujos dados foram coletados através das fichas preenchidas por médicos intensivistas que constituem a Comissão de Óbito da instituição. Foram incluídos os pacientes que morreram na UTI/HU/UFSC, após indicação de LET, entre janeiro/2011 e dezembro/2014. Foram selecionados os pacientes que foram ExPl, sendo anotados seus dados clínicos e epidemiológicos. LET foi apontado em 374 (53,8%) pacientes, sendo 23 (6,1%) ExPl. A média da idade dos ExPl foi de 73,8 anos, 10 tinham mais de 60 e 9 mais de 80 anos. Dez (43,4%) pacientes já haviam sido internados previamente em UTI. O tempo médio entre a internação-extubação foi 4,4 dias e entre extubação-morte foi de 2,5 dias. Doença neurológica foi a principal causa da morte dos pacientes ExPl. Todos os familiares estavam cientes da EP. Familiares de 2 pacientes acompa...

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“…Many of the study reports discussed the "settling" of symptoms in an anecdotal way; however, there were no quantitative reports' [34] (p. 15). 'Terminally ill people experience a variety of symptoms in the last hours and days of life, including delirium, agitation, anxiety, terminal restlessness, dyspnoea, pain, vomiting, and psychological and physical distress.…”

Section: "My Husband Was Ill and He Found It Very Difficult That We Smentioning

confidence: 99%

“…In the terminal phase of life, these symptoms may become refractory, and unable to be controlled by supportive and palliative therapies specifically targeted to these symptoms. Palliative sedation therapy is one potential solution to providing relief from these refractory symptoms' [34] In a recent study from France, health care providers found that in many cases midazolam failed to provide relief from some refractory symptoms. Also deep sedation broke down the patient/carer relationship [35].…”

Section: "My Husband Was Ill and He Found It Very Difficult That We Smentioning

confidence: 99%

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Veterinary and Human

Re¹,

Jw²

2017

Preprint

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This is the second of a series of two papers comparing the end of life issues in human and veterinary medicine. We outline the main differences between human and animal patients such as patient communication, finance and 'conflicts of interest' between animal, owner and veterinarian. We discuss striking similarities between human and veterinary issues such as assessing quality of life and the primary role of the attending veterinarian or doctor being the welfare and care of the patient. This paper takes the form of an ethical argument in favour of allowing euthanasia in human medicine, by providing insights into end of life issues for humans from an independent veterinary perspective. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. Doctors in the UK are limited and unwilling to put forward a case for the option of euthanasia for those patients who face a slow and agonizing death. With advances in medical science being able to significantly prolong the dying process, autonomy for the patient demands a review of the law regarding patient choice in the UK.

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Palliative pharmacological sedation for terminally ill adults

Cited by 118 publications

References 37 publications

Euthanasia and palliative sedation in Belgium

Euthanasia and palliative sedation in Belgium

Palliative extubation: case analysis in an Intensive Care Unit

Treatment, Palliative Care or Euthanasia? Comparing End of Life Issues in Veterinary and Human

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