Palliative sedation: A safety net for the relief of refractory and intolerable symptoms at the end of life

Abstract

BackgroundEvidence exists for the use of palliative sedation for people approaching the last days of life with refractory and intolerable symptoms. It is a third-line intervention that deliberately lowers the conscious state to relieve intolerable and refractory symptoms. This level of intervention is not routinely used in primary care, and there is a lack of guidelines for palliative sedation in this context. ObjectiveThis article provides some key information about palliative sedation and global issues faced by all individuals involved. A tertiary centre case study is used to illustrate the key points. Given this form of therapy may be required for palliative patients in the community, another aim of this article is to provide an overview for primary care practitioners to raise their awareness of such therapy and the issues related to it.

Ethical dilemmas and care actions in nurses providing palliative sedation

“…However, there is inherent uncertainty in the prognosis of palliative sedation patients. 6 Nurses relied on personal experiences and justified palliative sedation with the view that it relieved unbearable pain and that sudden, unpredictable death was an unintended side effect, thereby emphasizing the necessity to relieve the nurses’ sense of guilt. 19 This can be understood in relation to a previous study that had documented difficulties of comfort assessment on palliative sedation patients.…”

“…3 Palliative sedation is a medical practice in which deep sedation is induced to alleviate terminal refractory symptoms in terminally ill patients close to death, and continues until demise. 4,5 Although there is a concern that palliative sedation may advance the death of terminally ill patients, palliative sedation is reported to be ethically correct, 6 because it is conducted during the dying process in the last days or hours of life, and it does not advance death nor have any detrimental effect on life. 7 According to the guidelines in South Korea, 8 only patients with terminal cancer can be admitted to palliative care units.…”

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“…Para su uso, como establecen Voeuk et al (2017) es imprescindible que el paciente esté diagnosticado de una enfermedad crónica, progresiva y avanzada. La presencia de esta genera una serie de síntomas refractarios, tanto a nivel físico como psicológico, que producen sufrimiento en el paciente y que según Patel et al (2019), es la principal indicación para la administración de la sedación. Aparte de estos síntomas, también consideran que es necesario un pronóstico de vida inferior a 2 semanas, hecho que Índice es avalado por Swart et al (2014).…”

“…Por otra parte, según Garetto et al ( 2018) la herramienta más utilizada para la monitorización del nivel de sedación del paciente es la escala Richmond Agitation Sedation Scale (rAss) debido a su facilidad de uso y rapidez para la obtención de resultados, sobre lo que están de acuerdo en varios de los trabajos (Benítez y Ascanio 2020;Imai et al 2018;Patel et al 2019;Won et al 2019).…”

Sedación paliativa en el final de la vida

“…Una sedación tiene carácter primario cuando la disminución de la conciencia se busca como finalidad u objetivo terapéutico y sería considerada como secundaria cuando el efecto sobreviene no de la acción primaria del fármaco, sino como efecto colateral del mismo (Patel, 2019). También, la sedación puede ser puntual para controlar síntomas que pueden o no ser refractarios y que no se extiendan más de 48 horas.…”